Iranian Journal of Medical Education

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Background. The factors affecting learning have been always under special consideration by educational experts. It seems necessary to learn about students’ study habits, styles and resources to realize their weaknesses and strengths, and make suggestions regarding educational revisions based on this information. This study was performed to determine medical students, interns and residents study styles in obstetrics and gynecology department in Shahid Beheshti Hospital of Isfahan. Methods. In a descriptive study, 260 medical students, interns and residents were studied through a simple random sampling. The data gathering tool was a questionnaire whose validity was confirmed by content validity and its reliability by test/re-test. The data was analyzed by SPSS software using relative and absolute frequency. Results. 45% of the students and 50% of interns studied books during the semester and used their notes for the exam as a study resource. The residents always used books. Most students, interns and residents studied translated books. Forty two point five percent of them had a special hour for the study and most of them studied during the night. Being married, having children and residents’ responsibilities at the hospital were the most important barriers for studying in this group. Conclusion. The study method, duration and resources used by students, interns and residents were inadequate and require some changes. It is also recommended to provide them with education and facilities in this regard.

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Introduction. One of the important economical and social problems of our society is employment situation of higher education graduates which is necessary to consider for the development of future plans. This study aims to determine the employment situation of midwifery graduates in Babol University of Medical Sciences. Methods. In this cross-sectional survey, a questionnaire was sent to all midwifery graduates who had entered the university between 1992-1997 (n=120). A total number of 82 filled questionnaires were returned. The data analysis was done with SPSS-10 software using frequency distribution and Chi2 test. Results. Based on the results, 51.3% of subjects were employed which nearly half of them were spending their mandatory services. Statistical data revealed a significant relationship between the year of graduation and being employed. Twenty two point five percent of employed graduates worked in jobs other than midwifery. Eighty two point nine percent of them were employed at government section, 17.1% at private section and 75.9% of them did not have any office. There was a significant relationship between quota of acceptance to the university and the desire to work in deprived areas. Most midwives did not have any desire to work in the deprived areas, and in the case of having the opportunity to choose again, they would not choose midwifery as their future career. Conclusion. The unemployment rate between midwifery graduates of Babol medical university is high. So, it is recommended to provide them with appropriate job opportunities, and employ young graduates in counseling clinics for maternity care

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Introduction. The inappropriate increase in the number of general physicians in Iran is one of the critical and problematic issues of our society which leads to a big concern for medical students regarding their field of study and future career. This research aims to determine the attitude of medical students towards their own future career and field of study in Isfahan University of Medical Sciences in the year 2003 in order to inform educational planners about this issue. Methods. In a cross sectional survey, medical students in four levels of study including basic sciences, physiopathology, clerkship and internship were studied in the year 2002 – 2003. 321 students were selected by simple random sampling. The data gathering tool was a valid and reliable questionnaire including 42 attitude questions based on Likert scale. The data were analyzed by SPSS software using frequency distribution, mean and standard deviation, t-test and Pearson Correlation Coefficient. Results. The mean score of the medical students’ attitude towards their future career was 65.2 ± 6.1. Also, 80.9 percent of the students recommended studying medicine to others, 74.2 percent of them did not intend to quit their study, 78.8 percent chose medicine as their first selection in the national entrance examination for the universities, and 71 percent of the students would choose medicine as their first selection if they took the entrance examination again. Conclusion. The results showed the negative attitude of medical students towards their own future career, while the attitude of the majority of them towards their field of study was at an optimal level. Adjusting the number of students accepted for medicine, proper distribution of human resources, informing students about university disciplines before they take the entrance examination, providing financial support for young physicians, and establishing counseling and supporting centers for students is recommended to improve their attitudes.

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Introduction. One of the most important duties of the heads of departments is effective leadership. In theory and practice, the effectiveness of educational leaders could cause the improvement of education and provide a proper ground for personal development of faculty members. This study was conducted to determine the leadership style of the heads of the departments in Hamadan Medical University. Methods. In a descriptive cross-sectional study all the heads of departments (42 persons) were selected through census sampling method and investigated using a valid and reliable questionnaire. The questionnaire composed of 2 parts, the first part asked about demographic characteristics, and the second part measured the leadership style of the heads. The data was analyzed by SPSS software using frequency distribution of the data and Pearson correlation coefficient. Results. In total, most of the heads (37.4%) used directive leadership style. A significant relationship was found between effective leadership style and the age of the departments’ heads (r=.34). Conclusion. It is necessary that appropriate changes take place in the organizational structure and communication, so that the heads of the departments use supportive effective leadership style more and have a dynamic management system.

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Introduction. Community-Oriented Medical Education (COME), compared to traditional education in hospitals is considered a new educational approach in the school of medicine. This study was designed to determine the quality of education during the Clerkship and internship in community medicine course in Shahrekord Medical University. Methods. In a descriptive cross-sectional study, 41 clerckship students and 14 interns selected by convenience sampling method were studied. The data was collected by a valid and reliable questionnaire and analyzed by descriptive statistics using SPSS software. Results. Eighty percent of Clerkship students and less than 50% of interns were satisfied with the course plan, the content of the workshop, the presence of faculty members and answering Students’ questions. In addition, more than 80% of Clerkship students and less than 42% of interns revealed their satisfaction from teaching health management such as collecting data, data analysis, prioritizing the problems, and planning and evaluation. Teaching specific programs such as vaccination, family planning and so on was supported by more than 85% of clerkship students, and almost 97.5% of them were satisfied with teaching situational analysis of health care system. Conclusion. Considering community oriented education approach in medical schools of the world and spending one month community medicine as an obligatory course in all medical schools of Iran, the revision of community medicine course seems necessary.

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Abstract Introduction: The problem of educational failure in paramedical students is an important concern in medical education which can lead to a low efficacy in paramedical staff in the future. This study was performed to determine the reasons of paramedical students’ educational failure in paramedical school of Kashan University of Medical Sciences. Methods: This cross-sectional descriptive study was carried out on 242 paramedical students admitted to Kashan University of Medical Sciences in 2003-2004. The students’ demographic characteristics and study information were collected by a valid and reliable questionnaire. The students with the average score of 14 and more, without any failure were classified in the successful group, the students with the average score lower than 14, or more than16 with at least one term failure were classified in the unsuccessful group. The data analysis was performed with Chi-square, Fischer exact test and Odds Ratio. Results: The overall rate of failure was 1.6% (4 out of 166). From 242 students in this study, 94 (38.8 %) were classified in the successful group, and 148 (61.2%) in the unsuccessful group. The Odds Ratio of educational failure was 3.34 in “entering the university in more than one year after high school graduation”, 2.6 in “average score of diploma less than 16”, 3 in “low concentration in class”, 3.66 in “studying without preplanning”, 1.93 in “study duration less than 2 hours per day”, and 2.31 in “not being native”, which all were significant. The rest of factors had no difference in successful and unsuccessful students. Conclusion: The educational failure was mostly concerned with learning and study methods. The low average score of high school diploma, the duration before entering the university and not being native were recognized as the most important factors for educational failure in this faculty. Changing the method of acceptance according to the average score of diploma, improving the quality of teaching and welfare facilities, using educational counseling, and participation in educational workshops focused on learning methods and study skills are recommended.

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Introduction: Different evaluation methods have been introduced for evaluating clinical skills. Using checklist and logbook are common methods in clinical units. The purpose of this study was to compare logbook and checklist as the means for evaluating midwifery students in labor and delivery training. Methods: This pre-experimental study was performed in Hazrat Zaynab Nursing and Midwifery School affiliated to Gilan University of Medical Sciences in the first semester of 2005. The study sample included all midwifery senior students (n=21). In order to record students’ daily scores, the students and their instructors were provided with a logbook including all the skills they were supposed to acquire. The instructors checked all students’ activities using a checklist at the end of semester, while at the same time, the instructors and students had to evaluate and mark any daily activity, using the logbook. The data was analyzed by SPSS software using frequency distribution, mean, standard deviation and t-test. Results: The mean and standard deviation of the scores recorded using the logbook and checklist were 16.33±.77 and 17.88±.41, respectively, which had a significant difference. At the beginning, all students were completely satisfied with the new method of evaluation, but after receiving the results, their satisfaction rate decreased to 85.71%. The students had significantly more satisfaction with logbook. Conclusion: Using logbook provided a more objective evaluation and led to more students’ satisfaction. However, using logbook requires more studies and revisions in other university centers.

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Introduction: The continuous examination of the current situation, and recognizing the strengths and improving the weaknesses are necessary for promoting the quality of clinical education. This study was designed to determine the problems of clinical education from the viewpoints of nursing and midwifery students of Shahrekord University of Medical Sciences. Methods: In this descriptive study performed in 2004-2005, all bachelor nursing and midwifery students who were in their last semester (n=133) were asked to complete a 36 item questionnaire as self-administered. The data was analyzed by SPSS software using frequency distribution. Results: The most important strength of clinical education were proper encounter with trainees, on time presence of trainees and trainers, respecting the pre-requisite courses, respecting the stages of clinical education, full support of trainees, and complete supervision over clinical education. The weaknesses included not using audiovisual aids, lack of welfare facilities, not evaluating trainers by the students, and lack of coordination between theory and practice. Conclusion: Most subjects concerning educational objectives and trainers were confirmed while the situation of educational environment, supervising and evaluation were not optimal. There were also some problems in encountering with students. It is recommended to improve the facilities and equipments of clinical education and revise the evaluation tools and process.

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Introduction: Identifying effective factors in learning is one of the important issues considered by researchers. The aim of this study was to determine nursing and midwifery students’ learning styles in Tabriz University of Medical Sciences. Methods: In a descriptive study performed in 2005, 250 nursing and midwifery students were selected by census sampling method. The research tool was David A. Kolb's Learning Style Inventory including 12 questions which was distributed and collected as group administered. The analysis of data based on LSI guide was done by SPSS. Results: The majority of nursing and midwifery students were converger (54.2%). Also, 32.1, 7.5 and 6.2 percent of them were assimilator, accommodator, and diverger, respectively. Conclusion: Considering the use of converger and assimilator learning styles among students, it is recommended that faculty members use visual methods, diagrams, teacher’s handouts, lecture and self-learning methods.

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Introduction: Acquainting the viewpoints of Continuing Medical Education (CME) programs’ participants concerning different aspects of these programs is of special importance. The aim of this study was to determine the status of CME programs' implementation from general physicians’ viewpoints and their motivation for participating in these programs. Methods: In this descriptive cross-sectional study, 150 general physicians were randomly selected among CME programs' participants in Mazandaran University of Medical Sciences from October 2004 to March 2005. The data gathering tool was a self-administered questionnaire including a list of items regarding CME programs' features, their optimum status and the participants' motivations. The analysis and comparisons were made using chi2 by SPSS software. Results: The main motivation for participating in CME programs was achieving points in 60% of respondents and in 28% of them, was restoring the previous knowledge and acquiring new information. Fifty six and a half percent believed that it was better to hold the programs in successive days, and the mean of the number of favorable days was 2.3±0.93 days. Sixty four percent identified the last three days of the week as the most suitable days for holding these programs. Eighty nine percent of them, described general physicians' needs assessment as a suitable means for selecting the topics, and 58% stated a combination of correspondence and attendance methods as an appropriate educational method. The programs' levels were evaluated poor by 14%, average by 66%, and satisfactory by 20%. Internal medicine was identified as the most important need by 60% and 56.5% requested Cardio-pulmonary Resuscitation workshop. Conclusion: Most general physicians participated in CME programs with non-scientific motivations and the programs' level in some cases was not according to their expectations. Planning CME programs based on general physicians’ needs and situations may lead to enhancing their motivations and promoting these programs.

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Introduction: Since the year 2004, structured Continuing Medical Education (CME) programs with 25 credit points were each divided into five programs of 5 credit points which were shorter in duration. The aim of this study was to conduct a comparative study on the two programs, in terms of program success, relevance to professional needs, and participants’ satisfaction. Methods: This descriptive study was carried out on four programs with 25 credit points during the year 2003 and four programs with 5 credit points during the year 2004 in Golestan province. The tool used for this research was a questionnaire designed by the ministry of health for the evaluation of CME programs which were completed by the participants at the end of each session. The questions were arranged in three sections: the success of the programs in strengthening the previous information and presenting new scientific topics, the relevance of programs content with participant’s professional needs, and their satisfaction with the programs. The sample size for the three-day programs (25 credits) was 121 persons and for one-day programs (5 credits) was 64. Data analysis (descriptive analysis and Mann-Whitney test) was done using SPSS software. Results: One-day programs were considered as successful according to 76.9% of the participants, while 59.6% of participants rated the three-day programs as successful. Seventy five and nine percent of participants of one-day and 57.4% of three-day programs considered the contents relevant to their profes-sional needs. Seventy nine and seven percent of participants, in one-day and 66.2% in three-day programs were satisfied with the programs. There was a statistically significant difference between the success, relevance, and the satisfaction between one-day and three-day programs. Conclusion: The results of this research indicate that as a whole the success rate of 5-point CME programs was better than 25-point ones. This could be attributed to their better focus on subjects, shorter duration, and more diversity in topics. Therefore it is suggested that CME organizers, focus their efforts to increase the diversity and quantity of one-day CME programs for general physicians by using new scientific resources.

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Introduction: Recognizing students' conceptions and feelings towards class culture and revealing class members' relationship are important for planning and making positive changes. This study was done to determine students’ views toward the class culture in Semnan University of Medical Sciences. Methods: In this descriptive study, 269 university senior students were investigated. The questionnaire of class culture (Stephen Robins) was used to gather the data. It included demographic information questions and also 8 questions about different aspects of class culture using 5 point Likert scale. Data was analyzed by SPSS software. For data analysis, frequency distribution, mean and standard deviation were used. Chi-square test was applied for determining the relationship between the variables. Results: Most of the students (63.6%) gave a score between 20 to 29 to the current class culture. Fifty one percent of medical students recognized class culture open with the score of 30 and higher. Most associate and bachelor students gave a score of 20-29 (border line) to the current class culture. The students believed that their classmates and teachers were not friendly and supportive. They mentioned that the teachers did not state their expectations clearly and did not foster a challenging learning atmosphere to encourage students for making questions. No significant relationship was observed between class culture, school and level of study. Conclusion: Most MS and medical students believed university class culture was open, warm and supportive. Concerning other majors, a border line culture was identified. More interactions between faculty members and students and using student-centered methods are recommended which can lead to more relationship between faculty members and students as well as between students themselves, and also can establish a friendly open culture in the class.

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Introduction: In order to improve the educational process, it is highly important to recognize effective factors in establishing communication between students and faculty member. This study was performed to determine students' points of view concerning such factors. Methods: In this descriptive-cross sectional study, 162 students from Arak Medical University were selected through stratified sampling method in 2004-2005. A questionnaire consisting of two parts demographic data and 23 questions related to the assessment of effective factors in establishing communication between students and faculty was used. The scale of the questionnaire was a four point scale ranging from "very effective" to "having no effect". Data was analyzed by SPSS software using frequency distribution, mean and standard deviation. The groups' comparison was made by chi2. Results: The most effective factors in establishing communication, according to students’ views, respectively were faculty member's rhetoric and teaching skills (%84), his knowledge (%81.5), his experience (%76.5), and his moral behavior (%68.5), while more than %50 of students indicated that faculty member’s age and sex, had no effect in this communication. Conclusion: Some educational features of faculty member which reflect his teaching skills and proficiency, and some of his personal and behavioral characteristics revealing his social communication, are effective in establishing communication. It is highly recommended to conduct workshops for improving this communica-tion.

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Introduction: Storytelling is one of the educational methods which can be employed without considering the learners' age, educational subject or learning level. The purpose of this study was to compare the effect of storytelling and lecture methods in transferring the complicated concepts of medicine. Methods: A quasi-experimental study was carried out as two-groups, post-test only in Isfahan University of Medical Sciences in 2005. Two groups, each including 46 medical students in clinical clerkship of dermato-logy ward were selected and three similar concepts in medicine were taught to both through storytelling or lecture methods. Then the two groups took post-test and the achieved results were compared using t-test by SPSS software. Results: The mean of the total scores achieved by the lecture group was 8.94±4.36 and by storytelling group was 14.84±3.47 out of the total score 20. The difference between the two groups was statistically significant. Conclusion: The impact of storytelling method in enhancing medical students' knowledge was significantly more than simple lecturing method. Therefore it is highly recommended to use this method for teaching rare and genetic diseases.

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Introduction: Identifying factors which lead to academic achievement and impede academic failure, is of special importance. Some studies suggest that there is a direct relationship between self-esteem and educa-tional achievement however some experts doubt this direct relationship. This study was done to determine the correlation between academic achievement and self-esteem in rehabilitation students in Tehran Univer-sity of Social Welfare & Rehabilitation. Methods: This research was a correlational study in which all bachelor rehabilitation students studying in the fields of occupational therapy, physiotherapy, or speech therapy in Tehran University of Social Welfare & Rehabilitation (n=88) were included. Students’ self-esteem was measured using Cooper Smith inventory containing 58 items and its relationship with students’ final scores was assessed. Results: Pearson correlation coefficient revealed a significant relationship between rehabilitation students’ self-esteem and their educational status (r= 0.36), but academic achievement had no relationship with the educational field, semester, gender, marital status, and living place. Conclusion: Students with higher self-esteem had a better educational status compared with those who had lower self-esteem. Thus, it may be possible to promote educational status by improving self-esteem through appropriate methods.

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Introduction: Investigating the problems and barriers in learning clinical skills has been regarded in so many studies but the factors facilitating this process have not been taken into consideration. This study was performed with the aim to determine the facilitating and preventing factors in learning clinical skills from the viewpoints of third year students of Fatemeh School of Nursing and Midwifery in Shiraz. Methods: In this descriptive cross-sectional study, 54 nursing students in their sixth semester were selected through convenience sampling method. A researcher made questionnaire including questions about demogra-phic characteristics and 67 questions about facilitating and preventing factors in learning clinical skills was distributed among the samples. The questions included the areas of the relationships between the student, staff, instructor and the patient student’s satisfaction with the teaching methods of instructors and staff teaching methods of theoretical and practical lessons the facilities provided by the hospital and university and instructors’ characteristics. The data was analyzed by SPSS software through descriptive statistics. Results: The most facilitating factors in learning clinical skills belonged to Instructors’ educational and scientific experiences in developing educational affairs (77.8%), the educational environment provided by the instructors for experiencing clinical skills by students (77.8%), paying attention to the patient’s rights and needs (76%), and instructors' responsibility toward education (76%). The most preventing factors in learning clinical skills were the stress felt in the ward (83.3%), lack of students' support by staff (66.6%), and staff's bad temperedness (64.8%). Conclusion: Students were satisfied with the items in different areas but they were unsatisfied with the relationship between staff and students, and also the way that instructors presented the practical and theoreti-cal lessons. They mentioned these factors as the ones prevented their clinical learning. It is recommended to revise clinical education and take some appropriate action in order to provide a proper clinical education environment.

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Introduction: One of the reasons causing academic failure among students is disregarding factors affecting learning. The aim of this study was to determine the relationship between academic achievement of nursing and midwifery students and their learning characteristics including study style, control locus, and self-organized learning factors which are modifiable issues in learning. Methods: In this correlational study, all nursing and midwifery students with average grade of 17 and above (high academic achievement) or average grade of 14 and lower (low academic achievement) in Tabriz School of Nursing and Midwifery were investigated through census sampling method in the year 2005-2006. Data was gathered using questionnaires of "Kolb's Learning Styles Inventory," "Karami Study Methods," "Julian Rotter Locus of Control," and "Motivational Strategies for Learning" and then, was analyzed through descriptive statistics and logistic regression test by SPSS software. Results: Logistic regression analysis showed that control locus (P=0.008) and motivational strategies for learning (P= 0.032) had a significant relationship with academic achievement of students. Conclusion: Control locus and motivational strategies for learning, were recognized as determining factors in academic achievement. Taking the results of this study into consideration, running workshops or seminars on the issue of "Locus of control related to learning" and "motivational strategies for learning" are recommended for learning improvement in first year students.

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Introduction: Accurate medication calculation is a critical skill that nurses must demonstrate in order to administer medications safely. However, the ability of nursing students to calculate the correct dasage of medications has been mentioned as a concern in numerous studies. The aim of this study was to investigate the ability of nursing students in medication calculation. Methods: In this cross-sectional descriptive study, 76 nursing students were selected. The data gathering tool was a questionnaire consisted of three parts including demographic information, students' views toward their interest and ability in medication calculation, and 20 questions about medication calculation. After gathering the questionnaires, they were analyzed by SPSS software using statistical t-test, ANOVA, and correlation coefficient. Results: According to most students, calculating medication dosage was simple (65.78 percents), they were interested in it (55.26 percents), and they had enough proficiency in performing this activity (63.15 percents). Six students (7.89 percents) had provided correct answers to all of 20 questions and 33 ones (43.42) had responded to 75 percents of the questions correctly. The mean and standard deviation of students' scores were 14.9±6.2. There was a significant relationship between the semester and interest in medication calculation, and the test results. Conclusion: Although medication calculation is one of the essential skills for nurses few participants had provided correct answers to all of the questions. This reveals the importance of this skill and a need to emphasize on medication calculation in nursing students' education.

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Introduction: The prevalence of musculoskeletal and orthopedic diseases is high in outpatient visits and emergency ward. Meanwhile, evidences show that there is no appropriate and sufficient education in this regard, in the educational programs of medical students and especially orthopedic interns. The aim of this study was to determine the accomplishment of minimum learning essentials by interns in orthopedic ward of Isfahan University of Medical Sciences. Methods: This descriptive study was conducted in educational hospitals of Isfahan Medical School in April and June 2006. A 14 item questionnaire including determined minimum learning essentials in 4 fields of surgery room, emergency, ward, and clinic was developed. Forty orthopedic interns, who at least had passed 3 months of their internship course, completed the questionnaire as self-administered. The data was analyzed by SPSS software using frequency distribution. Results: All participants in this study performed the assessment of the "signs of the compartment syndrome" and "sutures" by themselves. Not all of the interns had received the needed education for casting and splint, doing different kinds of bandages, suturing open wounds and doing intra-articular injections. Conclusion: Interns could not achieve minimum learning essentials in orthopedic ward which was in accordance with previous studies. Therefore, it is necessary to implement a complete revision in educational programs of orthopedic interns such as extending the course duration, determining the task descriptions, and providing externship course.

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Introduction: Currently, the best way for preventing Aids occurrence among medical personnel, is increasing their information and perception concerning risk factors of this disease. This study was performed to determine the effect of education on knowledge and attitude of medical students about AIDS. Methods: This quasi-experimental study was done on 133 medical students of Isfahan University of Medical Sciences passing their clinical course. The data collection tool was a questionnaire consisting of three parts of demographic features, knowledge, and attitude. After performing pre-test, the educational program was held during an academic semester and then the post-test was held. Data was analyzed by SPSS software. Scores achieved by samples before and after the educational program were compared using t-test and paired t-test. Results: Forty six point six percent of the participants were female and 53.4% were male. Knowledge score of the students about risk factors of the disease before and after intervention were 15.06±2.07 and 17.12±1.44, respectively. The mean and standard deviation of attitude score of the students also increased from 92.77±10.7 to 97.78±10.33 after the education. Therefore, the results of the study demonstrated the effect of education in enhancing knowledge and attitude of students about AIDS disease. Conclusion: In regard to the increase in knowledge and attitude of clinical students in this study, considering continuing and up to date education in medical students' curriculum is recommended.