Iranian Journal of Medical Education

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Introduction: Assessment tools of academic achievement in the field of surgery have always been received considerable attention. The issue that has received less attention is that which one of these methods has higher efficiency to cover appropriately educational objectives in surgical groups. This survey aimed to evaluate the results of three examinations (including OSCE, in-group educational assessment, final improvement examination) of neurosurgical assistants of Isfahan University of Medical Sciences in 2009-2010. Methods:In this retrospective cross-sectional study, results of examinations (OSCE, the annual improvement examination and in-group educational assessment) of neurosurgical assistants of Isfahan University of Medical Sciences were investigated. Scores from all three tests were extracted and analyzed. The 1-4 academic -years' scores of 15 individuals from 18 residents were analyzed. Results: The results of these exams showed that there is a significant difference between the scores in OSCE, the annual improvement examination and in-group educational assessment. This difference for the results of in-group exam was significant in comparison with the two other exams (p=0.000), but the results did not show significant difference (p=0.21) for annual improvement examination in comparison with OSCE. In addition, high grade residents’ score in OSCE and in-group was somehow similar and their mean rank was close together. But their scores in in-group exams showed considerable difference. Conclusion: Although annual improvement examination will be held as MCQ, and measures scientific and cognitive assistants’ ability and OSCE essentially assess psychomotor capabilities, but accurate planning and applying the MCQ is effective on its result. Holding annual improvement examination as focused, its proper conducting by Medical Education Development Center, participating all professors in designing questions, proper questions distributing of all references, applying two axes table tables for designing questions, its quality, adherence to the principles of designing question, using more than 70 percent questions in the taxonomy of two or three are factors which are effective for closing this test to the standard tests and making an accepted tests for assessing academic progress and differentiating assistants.

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Introduction: Pursuing the purpose of promoting students’ potentials for learning practical skills, medical universities have tried to create a suitable environment in clinical skills centers for the practice of medicine in a simulated environment to prevent possible mistakes in real-life situations. This study aims to determine the effect of basic gynecological clinical skills on students’ performance in Guilan University of Medical Sciences. Methods: This quasi-experimental study with a single before-and-after-training group conducted in April 2009 in the Clinical Skills Center of Guilan University of Medical Sciences. Through census sampling 25 clerckship students taking the basic gynecological clinical skills course were studied. Data collection was done through 8 researcher-built checklists. Their validity and reliability were confirmed .Descriptive (mean and standard deviation) and inferential (paired t-test) statistics were applied for data analysis using SPSS. Results: There was a significant difference between the students’ performance on basic gynecological clinical skills before and after training the mean of the students’ total scores on all eight skills showed a significant increase after the training course. The highest mean scores before the training belonged to pop smear sampling skill(7.12w±2.42) and IUD insertion skill (5.8±2.41),while the lowest belonged to the management of third stage of labor skill(1.33±0.57) and bimanual examination skill (1.8±0.18). Skills which showed the highest mean scores after the training were IUD Insertion skill (13.52 ± 1.29) and Pap smear sampling skill(12± 1.08). Conclusion:Before the skills training, the students’ mean scores on most procedures were not satisfactory, but after the training course, they increased significantly. Therefore, it is suggested that clinical skills centers and objective assessment methods be used both to meet students’ needs and preserve patients’ rights.

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Introduction: Critical thinking is an essential part of nursing care, and developing critical thinking skills in nursing education is a priority. So, this research is to assess the effect of clinical evaluation with portfolio method on critical thinking skills of nursing students. Methods: Fifth semester nursing students of Nursing and Midwifery school in Tehran University of Medical Sciences participated in this quasi experimental research. These students were randomly divided into two groups of clinical evaluation through portfolio and routine methods. Both groups filled the Watson-Glaser Critical Thinking Appraisal Questionnaire at the beginning and end of clinical course. Data were analyzed by Fisher, Mann Whitney U, Wilcoxon, and Spearman tests. Results: Results showed that all aspects of critical thinking skills had been improved in both groups. Statistically, comparing before- and after- course scores, skills advancement just in total score (p=0.005), and diagnosing propositions (p=0.002) and evaluation of reasons ( p=0.015) in routine group were significant. Wilcoxon test results showed that total scores of critical thinking before and after intervention for each student in routine group were significantly different (p=0.005 ). But, the total score of critical thinking test in portfolio group showed no significant difference before and after intervention(p=0.303). Although, total test scores were more in portfolio group compared to routine group after intervention, Mann Whitney U test showed no significant difference (p=0.628). Conclusion: According to the findings, it can be concluded that although critical thinking scores increased in both groups after intervention, promotion of critical thinking was less in portfolio group compared to the routine group. Since previous researches have shown portfolios to improve critical thinking, more researches are recommended to be conducted to evaluate their clinical function in nursing education.

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Introduction: Acquiring clinical skills is an important issue in nursing education. This study aimed to determine senior nursing students’ opinion toward their achievement level of clinical skills in Ahvaz Jundishapur University of Medical Sciences in 2008-2009 academic years.

Methods: In this descriptive cross-sectional study, sixty students who were selected by census from those who were passing the last semester of the Nursing BSc program. Data collecting tool was a questionnaire on ordinal scale. It included 190 items on clinical skills regarding medical-surgical nursing in areas of caring patients with common medical–surgical diseases, nursing (care) procedures, performing and interpreting diagnostic tests, care before, during, and after diagnostic procedures, recording, medication administration, working with therapeutics equipments, and students' demographic information. Data was analyzed by SPSS software using descriptive statistical analysis.

Results: Most students believed that clinical skills of medical surgical nursing were 18.3%, 63.3%, 18.3% respectively as excellent, good, and average. Total mean score of clinical skills was 365.51±79.08 out of 570 and was reported as good. The best clinical competence reported to be in medication administration and nursing procedures, and the lowest competence reported to be in care before, during and after diagnostic procedures.

Conclusion: Most students reported their own clinical skills of medical surgical nursing as excellent and good. Since in some areas clinical skills reported as moderate to poor, or in some cases as not performed, it seems that an accurate evaluation of students’ clinical performance prior to graduation is highly needed. Clinical training programs also should be revised along with putting emphasis on its strength points.

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Introduction: Medical students face with extreme amount of curriculum materials which can't be simply memorized, so different ways of learning have always been emphasized. The goal of this study was to investigate learning styles and related factors among medical students of Birjand University of Medical Sciences using VARK questionnaire. Methods: This was a descriptive cross-sectional study. In 2009-2010 academic year, 148 medical students from different stages of medical school were selected by stratified random sampling..The learning styles of Data gathering tool was VARK questionnaire in which learning styles were classified into four subclasses of visual, audio, reading, and kinetic (skill). Data was analyzed using descriptive and inferential statistics. Results: Among 148 people participating in this study 77% were female and most of them (66.2%) were passing the basic sciences stage. The learning style mostly used by these students was auditory (48.6). There was no significant relationship between the preferred learning styles and gender (P= 0.18). Conclusion: Considering the fact that students are educated through lecture and oral methods from elementary to university, it would be expected that students prefer auditory learning style to others. Despite the practical outbreak of medical students in clinical settings, increasing students’ ability in kinetic methods seems to be necessary.

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Introduction: 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. Methods: 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. Results: 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). Conclusion: 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.

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Introduction: Although the majority of student assessments in medical sciences relates to their clinical competencies, adopting an assessment method which fulfills students’ satisfaction has always been a great challenge. In recent years logbooks have been used in the clinical evaluation of midwifery students in Mashhad University of Medical Sciences. So, the present study determines students' satisfaction with this approach. Methods: This descriptive, cross-sectional study was conducted on all 34 eligible midwifery students in school of nursing and midwifery of Mashhad University of Medical Sciences. Data gathering tool was a researcher–constructed questionnaire with confirmed validity and reliability. The questionnaire included 23 items covering nine domains and used Likert scale. Data were analyzed through descriptive statistical indices as well as T test, correlation and multiple regression analysis. Results: The mean score for students' satisfaction with logbook was 62.7 ±15.5 (of 100). The lowest satisfaction score was related to the domain of "interest in logbook method" (57.8 ±24.5) and the highest one was "conformity to educational goals" (71.1 ±14.9) (of 100). Most of the students agreed that logbook is fair (55.9%), objective (64.7%) and in conformity with educational goals (61.8%). However, only 44.1% of them were interested in using this method. Overall, 38.3% of the students were satisfied with logbook and 26.5% were dissatisfied and the rest were in between. Conclusion: Most of the students were satisfied with logbook, but less than half of them were interested in utilizing it. This could be due to insufficient ability of logbook in assessment and promoting of clinical skills from the students' view point. Thus, we may improve the students' satisfaction level by revising logbook and combining it with some other methods of clinical evaluation in order to cover its weak aspects according to students' views.

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Introduction: A variety of standard setting methods are used worldwide for medical examination acceptance scores while standards of most exams in our country are pre-determined fixed scores which are set without any scientific methodolgy. The aim of this study is to determine minimum pass level for a pre-internship objective structured clinical examination using Angoff method in Tehran University of Medical Sciences. Methods: After designing the questions for examination, a panel of eleven faculty members was formed. These judges were asked to individually estimate the probability that a borderline student would pass each station. The mean of all stations estimated by judges was considered as the standard for the whole exam. This procedure was repeated twice more after sessions of discussion between judges and checking students’ real scores. Results: The individual standard for the whole test was 49.15 while it turned to 49.90 after discussion and finally 51.52 after checking the real scores of students. The change of standard of the whole test after checking real scores was significant compared to individual standard (p=0.02). It showed no significant difference compared to the second standard. The rates of passing students according to the three standards were respectively 67.6%, 64.8% and 58.1% which showed a significant reduction in the third compared to the first one. Conclusion: Angoff method was used in this study to set standard for an OSCE. According to the findings of the study, it seems to be a credible and reliable procedure, especially when group discussion and reality check are used.

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Introduction: Studying patients’ (as consumers) and nurses’ (as care providers) expectations is very important. This study aimed to determine the differences between patients and nurses’ expectations of nursing service and medical cares in Alzahra teaching hospitals in Isfahan. Methods: This descriptive cross-sectional study was conducted in Isfahan in the second half of 2011. 120 nurses and 114 patients were selected randomly. Data were collected through self-rating questionnaire and data analysis was done through descriptive and inferential (t-test) statistical methods. Results: Results showed significant differences between patients and nurses’ expectations of nursing care. In all dimensions, the mean scores of patients’ expectations were consistently higher than nurses’ mean score. In both group (nurses and patients) the highest rating was related to tangibility. Conclusion: In nurses’ view, the most important item was “Having a clean and tidy appearance” and in patients’ view, it was “Considering the cleanliness and hygiene of the patients'’ room”. Therefore, it is necessary to consider these items to improve the service quality and satisfaction.

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Introduction: Self-Assessment is one of the final evaluation methods, which is complete formative evaluation. This study aimed to assess clinical competencies of graduated students in Isfahan dental school. Methods: In this descriptive-analytical study, thirty-three graduated students were completed a 93-items questionnaire which was based on ability to carry out independently dental services. Data analysis was done using cronbach’s Alpha, ANOVA, Tukey HSD, Spearman and Chi-Square. Results: The Cronbach’s Alpha of the questionnaire was estimated 0.979. The average ability to carry out independently dental services was 2.92-3.74. Conclusion: Dental students’ competencies were moderate-to-good. There was no significant difference between the skills taught in different parts. In addition, there was no significant difference between male and female graduates.

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Introduction: Recently, peer assessment is especially noticed as a progress evaluation method. Although it is a known method, it is a novel method in many countries that they use traditional methods. Then the topic of current review article is peer assessment in medical education. Methods: The documents related to peer assessment, advantages, disadvantages, applications and how use it extracted of articles, books and report of researches in reliable sources. Results: Peer assessment is a comprehensive evaluation of peer student performance and activities. The main aim of using this method was to produce more correspondence to own learning and peer learning. Of advantages for this method might be mentioned like increasing in student perception of his/her learning, encourage students to accept accountability for their learning, give and get feedback, encourage students to deep learning. The peer assessment is used in evaluation for communication skills, professionalism and effective domain. In peer assessment we should notice to some points: determine assessment criteria, discussion between students after peer assessment, confidence of sufficient time and educating it to students. Also we should notice to some limitations like the correlation between characteristics and results of assessment. Conclusion: Peer assessment is an evaluation method, that if it was used correct and proper, it could be an effective method in formative evaluation for some domains of medical education like affective domain. It is necessary, according to the gap in evaluation of these domains of medical education, we use better of this cheap and accessible tool.

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Introduction: Evaluation of educational objectives achievement is one of the most important jobs by medical universities. Therefore the aim of this study is to evaluate educational goal achievements of operative dentistry department from the viewpoints of general dentists graduated from dental school of Hamadan University of Medical Sciences during 2004-2009 years. Also their viewpoints about preclinical and clinical courses were surveyed. Methods: In this descriptive cross-sectional study, a questionnaire was sent to all dentists graduated during the years 2004 to 2009 from dental school of Hamadan University of Medical Sciences. This researcher made questionnaire encompassed multiple choice questions to evaluate theoretical knowledge of graduates and opinion poll about preclinical and clinical courses. Data was analyzed using Fisher's exact test. Results: Achievement of general goals was desirable in 16.3%, almost desirable in 83%, and poor in 0.7% of dentists. The impact of preclinical courses on operative skills of dentists was considered desirable by 16.72%, and almost desirable by 83.2 percent. The effect of clinical courses on operative skills of dentistry was considered desirable by 21.94% of graduates, almost desirable by 61.87%, and poor in 16.18% of them. Achievement of educational objectives of operative dentistry showed a significant correlation with sex, age, admission allotment, marital status, interest, and graduation year (p<.05). Conclusion: This study showed that the educational objective achievement of operative dentistry department of dental school of Hamedan University of Medical Sciences enjoys a good status.

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Introduction: Clinical assessment in nursing education is essential because of variety of objectives and complexity of clinical performance. Programmatic approach is an opportunity for comprehensive and multidimensional assessment. Opinions of stakeholders have an effect on application and effectiveness of a program. Thus, the aim of this study was evaluation of nursing students’ and faculties’ viewpoints about using programmatic approach in assessment. Methods: In this descriptive-analytic study, a census sample of 38 internship nursing students and 8 faculties in critical care rotation have participated. Clinical assessment of students was designed based on a programmatic approach and applied for one educational semester. Then, the viewpoints of faculties and students about this assessment method and its strengths and weaknesses were collected by a questionnaire. A visual analog scale in 0-10 measure was used to evaluate satisfaction of subjects. The data were analyzed using descriptive indices and t (paired and independent) tests. Results: The mean score of faculties and students’ satisfaction with programmatic assessment was 8.70±1.82 and 7.66±1.50, respectively. Totally, 87.5% of faculties and 97.3% of students were agreed with this method for students’ clinical performance assessment. According to attitudes of both groups, the strengths of this method were objectivity, impartiality, feedback provision, accurate coverage of educational objectives and specificity. 87.5% of faculties and 89.47% of students believed programmatic approach in assessment has a positive educational impact. Conclusion: The findings showed the majority of nursing students and faculties are satisfied with clinical assessment using programmatic approach and that is acceptable because of its objectivity, feedback provision, specificity, complete coverage of educational objectives and positive educational impact. Therefore, extensive application of this method in other clinical settings can be considered.

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Introduction: The necessity of valid and reliable assessment tools is one of the most emphasized issues in literature related to nursing students` clinical assessment. But it is believed that the present tools are mostly not valid and reliable, and can not measure students` performances properly. The aim of this study was to design a valid and reliable assessment tool for evaluation of nursing students` general performance in clinical education. Methods: This is a methodological research done in 2011 at Universities of Medical Sciences in Tehran. First, nursing students` general clinical performance was defined. Domains and items of the tool were determined through expert interviews and literature review. Then psychometric properties of the tool were determined. Validity was determined using face validity (through expert viewpoints and item impact method) and content validity (through expert viewpoints, content validity ratio and content validity index). Reliability was calculated through Cronbach`s alpha and interclass correlation (ICC). Data was analyzed using SPSS. Results: Regarding general clinical performance definition (performances which can be applied in a range of nursing students` roles and clinical sites), domains and items of the tool were determined and the primary tool was designed. Experts` viewpoints were used during designing and psychometry. Item impact score was ≥1.5, content validity ratio was ≥ 0.54 and content validity index was ≥ 0.8 for each item and the total index for the tool was 0.94. Cronbach`s alpha for the whole instrument was 0.992 which also was determined for each domain separately. ICC with r =0.89 was sufficient. Conclusion: The designed tool with good validity and reliability was considered proper and can be used for evaluating nursing students` general performance.

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Introduction: In spite of the critical value of possessing a high level of knowledge and skills in cardiopulmonary resuscitation (CPR) by health care team, knowledge and skills of nurse interns (final year nursing students) has not been studied. This study aimed to longitudinally investigate knowledge and skills of CPR in nurse interns of Kashan University of Medical Sciences. Methods: A longitudinal study was conducted on 96 nurse interns of Kashan University of Medical Sciences (final year) in three consecutive semesters during 2010-2011 academic years. Data was collected using a demographic questionnaire, a knowledge questionnaire, and four checklists for assessing skills. Tests were conducted in three phases at four month intervals. Data was analyzed by descriptive statistics, independent t-test and ANOVA. Results: In total, students gained 59.05% of knowledge and 70.12% of skill scores. The mean of knowledge and skill scores showed fluctuations through the three phases as knowledge scores decreased from 24.91±4.08 in first phase to 22.80±4.88 in the second and finally showed an insignificant increase to 23.05±4.85 in third phase (p=0.057). Also the total mean score of resuscitation skill decreased from 41.20±3.90 in first phase to 30.37±5.58 in the second and finally showed an improvement to 37.15±4.62 in third (p=0.001). No significant relationship was detected between background variables like students’ grand point averages and their experience (observation and attending times) in resuscitation, with knowledge and skill scores. Conclusion: The research showed that trainees' knowledge and skills had a variable trend over time. Given the importance of resuscitation skills, it is recommended to retrain the students in this filed at the beginning and the end of the internship courses.

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Introduction: Direct Observation of Procedural Skills (DOPS) is a valuable method in evaluation of clinical procedures. The aim of this study was to evaluate the advantages and disadvantages of this evaluation method from the restorative dentistry students' point of view in Mashhad University of Medical Sciences Methods: This cross-sectional study was conducted on the students of restorative dentistry in Mashhad University of Medical Sciences, where 110 students were enrolled. "Direct Observation of Procedural Skills" was designed in accordance with the objectives of restorative department and executed. An unstructured interview with 12 students was done to develop a valid questionnaire for the evaluation method used. All of the 4th and 5th grade students were asked to fill the questionnaire. The data were reported with descriptive statistics. Results: Seventy one percent (71%) of the students recommended this method be continued because of its positive effect on their independency and learning. Seventy six percent (76%) mentioned that this method failed to improve inter-rater reliability between the teachers. Eighty five percent (85%) believed that students should not fail the course upon failure to meet requirements for a standard treatment. It was also mentioned that it is preferred for formative rather than summative assessments. Conclusion: Within the limitations of this study it can be concluded that DOPS is a suitable formative assessment method for restorative dentistry in Mashhad University of Medical Sciences.

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Introduction: Student assessment is of the most important responsibilities of a clinical teacher. Application of new methods of assessment is necessary due to significant improvement in clinical teaching methods. In the meantime, new assessment approaches that simultaneously enforce learning have been greeted more than other methods. Therefore, this study was conducted to compare the new methods (Mini-CEX and DOPS) with traditional method of assessment on the clinical skills of nursing internships students in Army University of Medical Science. Methods: This study is a randomized trial which was carried out on nursing students of Army University of Medical Science. All eligible students and instructors willing to take part were randomly divided into two groups of experiment and control. After training the instructors and assessing the reliability of evaluators, three rounds of assessments were performed using DOPS and Mini-CEX for experiment group while control group was evaluated using the routine method. Evaluation of procedures (Vein puncturing, dressing up, report writing, and patient education) in each group was based on valid and reliable check-lists made by the researcher. Results were analyzed using descriptive and inferential statistics (Chi-square and independent T tests). Results: There was no significant difference between groups regarding demographic variables such as age, gender, and average (p<0.05). The mean scores of final assessments in the experiment group(by Mini-CEX and DOPS methods) were significantly(p=0.000) higher than the control one(traditional method). In other Conclusion: It seems that applying Mini-CEX and DOPS methods resulted in improvement of clinical skills among students. Accordingly, it is recommended that nursing education centers apply these two methods to assess students’ clinical skills in conjunction with other methods, to help promote their learning.