Iranian Journal of Medical Education

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Abstract Introduction. Hepatitis B is the most common cause of end stage liver disease in Iran. As a high-cost disease with a relatively high incidence, and the relative lack of community knowledge, it warrants initiation of a public health intervention in Iran. Methods. This was a Before-After educational intervention that analyzed the data obtained from questionnaires filled out by 80 patients infected by Hepatitis B and their family members. The patients were registered and invited by “Hamedan Society for Support of Hepatic Patients” for the educational program. The questionnaire was designed in order to evaluate the degree of knowledge according to patients’ needs and experts’ ideas i.e. means of transmission, preventive measures and their use and some basic practical knowledge of hepatitis B management. Nedelsky method and T-paired test were used to analyze the results. Results. The participants were aged between 11 and 59 (The age of the participants was from 11 to 59) and about half of them were females. The comparison between pre-test and post-test indicated a significant increase in the learners' level of knowledge concerning transmission of and prevention from hepatitis B and its management. 45% of the participants got an acceptable score in pre-test while in post-test it increased to 69% of them. 90% of the participants believed that the performed education had been effective in increasing their knowledge about hepatitis. 81% found the question-answer session effective in solving their problems. Moreover, 92.5% described the instructor's teaching method good or very good. Finally, 36% believed that they still had some questions about hepatitis B. Interestingly, both before and after education, about 90% thought they needed more education regarding hepatitis B. Conclusion. Group education is a useful tool for improving patients’ and their families’ knowledge of and attitude towards hepatitis B in an example of Iranian community situation.

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Introduction: Clinical Education is the essential part of nursing education. Because the nursing teachers' clinical role is not clearly defined, this study was designed to understand the clinical role and its process in nursing teachers. Methods: This was a qualitative research (Grounded Theory) in which 15 nursing teachers of five nursing schools participated based on theoretical sampling. The data were collected using a semi-structured interview. The data constant comparison was used for analysis. Results: Categories including role clarity, professional identity, professional autonomy and fitting in were proposed as the means of describing how the respondents approached their clinical role. Conclusion: Due to perceived role ambiguity and professional dependence, the nursing teachers have problems in achieving their role of mastery. They try to avoid these problems by making a new professional identity and fitting in strategies. Unfortunately, these strategies banish them from educational real goals. Key words: Nursing Teachers, Clinical Role, Role Clarity, Nursing Education Address: Zamanzadeh V, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran Source: Iranian Journal of Medical Education 2002 6: 27-32.

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Introduction. Learning clinical skills at the bedside is one of the best educational methods which mainly depends on clinical instructors’ characteristics. It seems that teaching by qualified and competent instructors can enable students to reach their maximum capability. This research was designed to study the effect of teaching on knowledge, attitude and practice of nursing and midwifery instructors concerning effective behaviors at clinical teaching. Methods. This was a quasi-experimental research which studied all nursing and midwifery instructors (N=25) at Tabriz University. The research was designed as one group and two stages which assessed knowledge, attitude and practice of instructors before and two months after running the educational program (two days workshop). The data collecting tool was a questionnaire including four sections. The scientific validity of the questionnaire was confirmed by content validity and its reliability was evaluation by split-half method. In addition to instructors, the forth section of the questionnaire concerning performance, was also completed by the students who were under the supervision of trained instructors before and two months after the workshop. The results were analyzed by SPSS 9 software and using paired t-test, relative frequency, mean and standard deviation. Results. According to the results, participation of instructors in educational workshops had a positive effect on increasing knowledge and improving their attitude toward clinical teaching behaviors. Moreover, according to the viewpoints of instructors and students, their performance scores increased after education. But, no significant difference between the mean of performance score of instructors before and after workshop was observed. Based on students' viewpoints, instructors' performance in assessing students showed a significant difference. Conclusion. Considering the positive effects of education on knowledge and attitude of the instructors, providing education and an appropriate background in clinical environment for employing effective behaviors seems necessary. The results of this research can be used in designing a valid evaluation tool for assessing the effectiveness of clinical education and the educational performance of clinical instructors

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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: Clinical rounds as one of the clinical teaching methods, may cause adverse effects on patients and the medical team is able to report such problems. The purpose of this study was to determine the effects of clinical rounds on patients from medical teams' points of view. Methods: This descriptive cross-sectional study was conducted on 150 members of clinical care team including clerkship and internship students and nurses who were selected through convenient sampling method in educational hospitals affiliated to Isfahan Medical University. A questionnaire containing demo-graphic features, items asking the medical team's viewpoint about the method of running medical rounds, the list of events experienced by the patient, and medical team opinions regarding the patients' feelings toward the manner of clinical round was distributed as self-administered. The data was analyzed by SPSS software using frequency distribution, mean and standard deviation, and the comparisons were made by ANOVA. Results: The medical team believed that patients had the most satisfaction from performing procedures by interns and residents, precision and follow up in therapeutic affairs, general outcome of hospitalization, and the duration of visits. Their least satisfaction was about the number of examiners, the duration of patient's encounter with the main physician, explanation about the disease and taking the patient’s opinion into account in decision making. Conclusion: Based on the medical team's opinion, the current method of clinical rounds may cause dissatis-faction in patients and result in undesirable consequences. Revision and reforming the current situation of rounds can lead to the improvement of this process.

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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: Several studies have recommended revisions in educational programs based on learners' feedbacks and needs. This study was performed with the aim of exploring and describing the meaning of challenges and feelings experienced by nursing students during their study. Methods: This qualitative study was performed as phenomenology on 20 senior nursing students selected by purposeful sampling method. In-depth and semi-structured interviews were used for data gathering. Data was analyzed by the team of researchers using hermeneutic analysis method. Results: Findings were categorized into three major themes including challenge of "integrating knowledge and practice" with minor themes of employing theory in practice, using nursing procedure, and following scientific principles in clinic, the challenge of "management of learning environment" with the minor themes of environmental factors' effect on students' learning, causes of hopelessness and disappointment with nurses, preference in evaluation, deficiencies of educational programming, and lack of respecting patients' rights and privileges, and the challenge of "lack of community's respect to the value of nursing" with the minor themes including recognizing stَAuts of nursing discipline, and the necessity for its revision, attitude of individuals and society toward nursing and limited independence of nursing. Conclusion: Interviewing students provided an insight into the challenges of educational environment which students had faced, during their study. Using the results of this study, nursing educators could build a positive and stimulating environment for students' learning and motivate them to maintain their interest in education and learning.

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Introduction: Advising and counseling students, a part of faculty members' duties, is a way for overcoming preventable problems and educational failure due to those problems. The aim of this study was to determine the attitude of faculty members of Kerman University of Medical Sciences toward advising and counseling students and their views about the duties of counselor faculty members. Methods: In this descriptive cross-sectional study, 164 faculty members were investigated using a question-naire. The attitude questions of this questionnaire had the validity and reliability of 0.8 and 0.67, respectively. The reliability of 0.8 was calculated for questions of counselor duties. The gathered data was analyzed by SPSS software, using t-tests and one way ANOVA. Results: Seventy seven percent of faculty members had the experience of student counseling, 82.6% were aware of counseling duties, and 86.7% were completely agree or agree with counselor's duties. In total, 74.3% of the faculty members achieved the total score of attitude. A significant difference was observ-ed between the mean scores of the attitude based on the variables of academic rank and being aware of counselor's duties. Conclusion: With regard to almost positive attitude of faculty members towards counseling and advising, and their agreement with the duties approved by ministry, there is no doubt that having enough and appropriate knowledge and competency in performing counseling tasks in order to help the students is essential. Therefore, informing and educating faculty members regarding student advising and counseling are recommended.

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Introduction: Despite global acceptance of outcome-based education, few investigations are available about its effects on clinical competencies (cognitive and behavioral skills) of nursing students. The aim of this study was to investigate the effect of outcome-based education on clinical competencies of nursing students compared to traditional education. Methods: In this quasi-experimental study using two groups design with pre and post-tests, 26 nursing students were selected through census and divided randomly into two control and experiment groups. Each group included 6 to 7 persons. After completing the pre-test of cognitive skills, the control group received clinical education through traditional method and the experiment group through outcome-based education, for 9 days. Then, students' cognitive skills were measured by post-test and their behavioral skills were observed via checklist. Data was analyzed by SPSS software using Wilcoxon, Mann Whitney, and Fisher exact tests. Results: Outcome-based education was effective in promoting students' cognitive and behavioral skills. The mean of cognitive and behavioral skills of the experiment group in post-test were significantly higher than that of the control group in all cases and in total. Also, students' clinical competency in the experiment group was significantly higher than control group. Conclusion: Outcome-based education leads to developing nursing students' competencies more than traditional method. It is recommended to employ this method more in clinical education.

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Introduction: With regard to attributes of taking herbal medications considering multiplicity of efficacious chemicals existing in herbal drugs and needed cautions to be exerted, and also considering medicinal safety, the associated points must be precisely observed by consumers. Holding the undeniable role of pharmacists in this field, the current study was performed with the aim of evaluating knowledge, attitude performance of pharmacists of Isfahan concerning herbal drugs consumption. Methods: In this descriptive cross-sectional study, using clustering method, 100 were selected out of total number of 350 community pharmacist occupied in pharmacies of Isfahan (year 2008). A questionnaire made by researcher (which its reliability and validity were separately completed through focus group method) was used for evaluating knowledge and attitude and also scientific scenarios (WWHAM-type question) were used for performance evaluation. After data gathering, the collected facts were analyzed by SPSS software Version 11.5 and using descriptive statistics, chi², and correlation tests (concerning significance level of p≤0.05). Results: There was a significance relation between pharmacists' knowledge on herbal drugs features and number of their graduation years (r= 0.38 and p. value= 0.0001). Meanwhile, female and male pharmacists' knowledge showed no significant difference. The range of pharmacists' attitude scores was 51 to 107 and its mean was 88.85±13.44 and considering the mean of 75 for the mentioned questionnaire, 91% of pharmacists had positive attitude to herbal drugs. The relationship between pharmacists' attitude and their knowledge on herbal drugs was not significant. A correlation (r= 0.09) was observed between pharmacists' performance and knowledge but no significant relationship was detected. No considerable relationship was observed between pharmacists' attitude and their performance as well. Conclusion: Paying attention to the objectives and classic educational curricula of pharmaceutics and making some revisions on them seems to be necessary in presenting herbal drug services. It is highly recommended to pay special attention to this topic in educational programs of continuing education of pharmacists in an applicable manner and change the traditional methods.

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Introduction: During the recent two decades, practical medical skills’ training has experienced dramatic changes, which has led to establishment of CSLCs (Clinical Skills Learning Centers). Thus, it is necessary to evaluate the effects of these centers on students' learning of the relevant procedures. The main objective in this study was comparing the output of skills training processes in two groups of medical interns trained in conventional settings (training only on bedside) and conventional settings plus the use of CSLCs. Methods: This is a quasi experimental study conducted on two groups of medical interns introduced to Bahrami Hospital (affiliated with Tehran University of Medical Sciences) for their pediatric course. Twenty five students were taught by the conventional method (control), and 19 students received training in Pediatrics CSLC (experiment). The sampling method was simple & non-randomized. The study used OSCE (Objective Structured Clinical Examination) for assessments of student’ learning, and SPSS15 software, Kolmogrov-Smirnov, paired and independent T – tests for analytical purposes. Results: There was a significant difference between the mean scores of the two groups of interns before and after training (P<0.001).Mean and SD of the scores in the experiment group after training were 120.69±14.84, while for the control group they were 102.87±11.20. Mean and SD of score changes (difference between before and after pediatrics ward rotation) for experiment and control groups were 29.6±12.32, and 16.45±7.97, respectively, which were significantly different(p<.001) Conclusion: Clinical skills training in Bahrami's CSLC was effective in promoting medical interns' pediatric practices. We suggest that training in CSLCs be included in traditional pediatric training courses.

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Introduction: Using the appropriate teaching methods, nursing educators are trying to improve students` both effective learning and knowledge retention. The survey reveals the impact of lecturing and problem-based learning in academic achievement and knowledge retention in the pediatrics course. Methods: A quasi-experimental design was used to compare the effects of the two teaching methods. 56 nursing students who had taken the pediatric course were selected through census in two semesters in school of nursing and midwifery of Tabriz University of Medical Sciences. Pediatrics was taught in lecturing and problem based learning methods. Then, the academic achievement and knowledge retention were evaluated by tests. Data analysis was carried out in descriptive statistical and paired T test. Results: Findings revealed that the average of the scores in pre and post tests as well as knowledge retention tests were increased in both teaching methods. The mean difference of scores in the two methods was not a significant difference between the pre test and post test. But, in the post test - Knowledge retention test, the lecturing method scored significantly higher than the other one. Conclusion: It can be concluded that the lecturing method keeps its standing point and value in educational system. ProblemBased Learning method can be of great help along with the lecturing to improve students' achievement and knowledge retention.. Also, PBL is feasible enough in teaching pediatric nursing to ensure the achievement of educational objectives.

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Introduction: Our country needs expert nurses who are professional in family nursing. As a result, it is required to determine their professional duties as a basis for future planning for new disciplines and new majors such as family nursing. This study is an endeavor to determine a portion of professional tasks of family nurses via the viewpoints of physicians (family physicians and specialists), families, nurses, managers of health care centers, and administrators of private and public hospitals. Methods: In this descriptive cross-sectional study in the year 2010 in Isfahan, study population included multiple groups of families who were covered by Isfahan health centers, nurses employed in public hospitals of Isfahan, family physicians, specialists, and managers of private and public health care centers. Families and nurses were selected through multi-stage cluster sampling, family physicians and specialist were chosen via simple random sampling, and managers were selected randomly among managers volunteered for participation in the study. Data gathering method was interview and focus groups were employed for completing and modifying the tasks. After determining the viewpoints, the tasks were categorized based on interview items and research objectives. Overlapping items and the number of repetitions were determined and were written beside each item. Results: Based on the viewpoints of study groups, 59 items were determined from families' viewpoints, 30 items from nurses', 25 items from family physicians', 15 items from family physicians', and 31 items from managers. After integration, elimination of the repeated items, and finalization in focus group, 32 items were remained. Conclusion: With regard to the need for future planning to train family nurses, there is a need for defining their professional tasks. Findings of the study could be used in curriculum development of this discipline.

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Introduction: Evaluation of student's viewpoints in order to improve and maintain continuous promotion of clinical education quality can lead to recognition and reinforcement of strong points and elimination of weak points of an educational system. The current study was carried out to evaluate the viewpoints of nursing and midwifery students about clinical education in Ilam University of Medical Sciences. Methods:Tthrough a descriptive cross-sectional study using simple random sampling,90 nursing and midwifery students were studied they had all at least passed one clerckship course in educational hospitals. Data was collected using a standard questionnaire. Data analysis was carried out through student’s t-test applying SPSS Ver.16 . Results: From the viewpoints of the students, the affecting factors on clinical education are educator's characteristics (85.2%), educator's conduct (63.3%), supervision and evaluating components (61.5% , educational objectives and courses (52.2%, and clinical environment (42%) were the most important factors, respectively. T-test showed a significant difference between viewpoints of nursing and midwifery students on supervision and evaluating components(P<0.004). Conclusion: Findings indicate that current nursing clinical educational status trends need to move toward providing more facilities and revising clinical evaluation methods. Also promoting clinical educatos' teaching abilities can lead to improvement of clinical educational status.

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Introduction: Determining factors affecting teacher's evaluation from the students' point of view (learners) could greatly influence the quality of education. This study aims at identifying those characteristics which qulify a university teacher cabale in students' opinions. Methods: In this descriptive, cross – sectional study, in 2009-2010, 800 students of Ilam University of medical sciences were selected. Multi – stage stratified random sampling was used for sample selection. A standard questionnaire was used for data collection, and data were analyzed afterwards. Results: 68% of the students were female and 52.7% were undergraduates/PhD candidates. The mean for teaching style, interpersonal relationships, the teacher's personal characteristics and the knowledge seeking attitude of the teacher were 83.8±11.3, 83.7±13.9, 81.9±11.2 and 71.6±11.3, respectively. There was a significant relation between students' viewpoints and sex, their field of study, educational level and faculty (p<0.05). Conclusion: Teaching style, interpersonal relationships, personal characteristics and the knowledge – seeking attitude were respective the most import characteristics of a capable University teacher. Students' needs, interests and viewpoints at different educational levels are not necessarily identical therefore, it is suggested that these discrepancies be considered in educational planning.

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Introduction: There is a growing pace in using portfolio in clinical education of nursing students. Although qualitative researches have shown that this method may enhance clinical learning of students, up to now, this effect has not been proved with quantitative methods. Therefore, the purpose of the present study was to assess the effect of clinical education and assessment through portfolio on cognitive learning of nursing students in clinical settings. Methods: This quasi-experimental study was conducted in Tabriz nursing and midwifery faculty. The population studied consisted of all final year nursing students divided into two groups of control (15 students) and experiment (20 students) through non-random method. Education and clinical assessment with regard to cognitive goals in coronary care unit were done by portfolio in study group, and by a blend of traditional methods in control group. A researcher made cognitive test was designed to measure learning. The data were analyzed by dependent and independent t- test through SPSS. Results: Both blended and portfolio methods significantly enhanced the cognitive learning of nursing students. Portfolio significantly enhanced cognitive learning of nursing students more than the blended method. Conclusion: Portfolio is a suitable method to enhance cognitive learning of nursing students in clinical settings, but this finding needs further investigation.

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Introduction: The present research compares curricula for undergraduate medical education(UME) in Iran and in selected medical schools in terms of general structure, program length, mission and objectives, content, number and type of study stages, and finally, the extent of implementing quality improvement strategies. Methods: This is a descriptive-comparative study on the important components of UME curricula in Iran and some renowned or innovative medical schools, selected purposefully from all continents. The study had two stages: first, finding medical schools offering high standard education from all continents second, identifying and studying the different aspects of curricula in those schools as well as Iranian medical schools’ curriculum, based on Ludvigsson’s indicators. Results: The results show that considering available standards in an effective educational curriculum (Ludvigsson’s indicators), medical schools of Australia, North America, Europe, Asia and Africa rank from the highest to lowest. The study reflects that UME curriculum in Iran does not fulfill the necessary standards. Conclusion: There is a great gap between the quality of UME curriculum of Iran and that of other universities in terms of implementing effective educational standards, which suggests that UME program in Iran needs to be revisited and revised.

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Introduction: Alteration and adjustment of nursing care system in 21st century depends on its success in designing the nursing pedagogical models. This study was conducted in order to identify and explain the challenges in postgraduate (MSc) levels in nursing and to represent appropriate solutions. Methods: This qualitative study was conducted in Tabriz University of Medical Sciences in two phases. The existing challaenges were identified through "Focus Group Discussion" method in phase one and for the second, "Delphi Technique" was utilized to prove the challenges and represent the solutions. Sixteen MSc students participated in phase one and thirty panel members including nursing managers of teaching hospitals, faculty members and executive staff of nursing school, and eight MSc students and PhD candidates attended in phase two. FGD data analysis was done through content analysis by conventional approach. For phase two through Delphi Technique, consensus has been gained on final options after three rounds. Results: This study identified post graduate (MSc level) challenges including 1)Cultural and professional identity, 2)Work atmosphere and 3)Imbalance between theory, research and clinical practice. The most important solutions to these challenges were respectively as follows: “to adopt strategies to improve the nursing image”, “to specify determined positions for postgraduates of MSc and to define their duties”, and “to specialize nursing education in MSc degree and upper levels as well as representing new disciplines such as intensive nursing and cardiovascular nursing”. Conclusion: Challenges identified through FGD, were proved via Delphi Technique. The offered solutions were also supported by review of literature. The information derived from this study could be used as a base for further investigations in the application of these solutions.

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Introduction: One of the most effective factors on quality of learning is using appropriate communication skills by faculty. Appropriate communicational foundation cause to pass information to students as well. The present study aimed to evaluation interpersonal communication skill levels in lecturers of Ilam University of Medical Sciences. Methods: In this descriptive-analytic study, 60 lecturers of Ilam University of Medical Sciences with randomly sampling were selected in 2009. Data collection was performed using a questionnaire of Interpersonal Communication skills test. The questionnaire has 34 questions and based on 170 scores. Data was analyzed using SPSS software ver.16 and t test and Pearson correlation. Results: Mean age ± standard deviation of participants was 36.03±7.86 years and 80% were male. Overall, 30% of participants were assistant professor and 45% had more than 5 years educational experiences. Mean score of communication skills of lecturers was 106.53 ± 8.59 that it was significantly associated with their gender (p<0.04). While, this relationship not found for age of lecturers, teaching experiences and their scientific ranking. Conclusion: Based on results, Interpersonal communication skill levels of lecturers study were evaluated average. Conducting of educational workshop on interpersonal communication for lecturers is one of the methods to improve their effective communications which can cause to increasing learning and promoting communicational skills of students.

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Introduction: Achieving the organization goals depend on management and effective leadership styles. This is true in all organizations including academic centers. This study aimed to investigate leadership effectiveness and styles among the middle level managers of Isfahan University of Medical Science. Methods: This descriptive study was conducted on all middle level managers (head or deputy of faculties) of Isfahan University of Medical Sciences. Data collection was done using a questionnaire consisting of three parts: demographic characteristics, Metzcus & Burden’s leadership style questionnaire, and Ramazani’s effective leadership questionnaire. Leadership styles was classified into three categories: liberal (democratic), arrogant (authoritarian or dictator) and consolidated. The principles of effective leadership, based on obtained scores, were described as strong leadership, good leadership, leadership that requires more effort, and poor leadership. Data analysis was done using descriptive statistical methods. Results: Based on results, mean age was 44.9 years, 76% were men, mean work experience was 17.5, management experience was 7 years and mean training duration was less than one month. 87% of managers had postdoctoral degree. 60% of managers were dictator, 26% were consolidated and 13 percent of managers had a democratic leadership style. 84% of managers believed that their leadership is strong, 16 percent believed they are good leaders and none of them believed that their leadership requires more effort or is poor. Conclusion: It seems that current managers were selected based on their degree not they major. For most of them leadership was equal to duty performance. They believed that utility is in higher productivity and they paid less attention to its human aspects. University administrators need to pass formal and informal management courses in order to have an effective leadership and they should not be selected merely based on their academic degree.