Iranian Journal of Medical Education

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Introduction: The relationship between students' learning styles and their preferred teaching methods has been considered in recent years. This relationship was explored in the present study. Methods: This is a descriptive-analytic study. A stratified sample of nursing students out of all grades participated in it. Students' learning styles were explored with the Kolb's questionnaire for learning style. Their preferred teaching methods were determined using another questionnaire. Results: A correlation between learning styles and some preferred teaching methods was observed for theoretical courses. There was not such correlation in for practical courses. Conclusions: Considering students' learning styles may help university teachers to choose more appropriate teaching methods.

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Abstract Introduction. This survey was performed to assess the competency level of last year medical students (Interns) in performing 20 selected basic clinical procedures as well as the effect of learning opportunities on their competency level. Methods. 200 randomly selected interns were asked to fill a questionnaire in order to self-assess their competency in performing 20 procedures and to record the ones they used in practice. These procedures were selected from current educational programs, according to expert opinion. They were also asked about the related learning opportunities they faced in clinical wards. The 20 selected procedures were divided into three groups by employing factor analysis with Varimax rotation (KMO=0.87). Results. The mean level of skills for the first group (general techniques) was 51.4%. Students assessed their level of skills "poor" for lumbar puncturing, airway intubation, splinting, chest tube insertion, and removal of superficial foreign bodies from the ear and the eye. They learnt most of the techniques through observation. Most of the students performed the procedures without direct supervision of teachers or residents. The majority of the students did not have the opportunity to use manikins for learning. Conclusion. The results suggested that competence of the students in performing most of the procedures was insufficient and most of them did the procedures without the needed training. It is recommended that using some educational facilities including skill labs and student assessment methods including OSCE (Objective Structured Clinical Evaluation) can play an important role in improving students’ level of skills in performing clinical procedures, especially before working as interns at clinical wards and in order to respect patients’ rights.

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Introduction. The significance of fostering critical thinking in students has been explicated by the increasing rate of knowledge and information. To assimilate knowledge and to assess the considerable amount of information, students need to develop their thinking skills. Considering reflection as a teaching strategy and one of the most effective ways for fostering thinking, this study was designed to determine the effect of reflection on thinking skills of nursing students at Tabriz faculty of nursing and midwifery. Methods. 40 senior nursing students participated in this study voluntarily. After receiving the necessary information regarding their participation they took California Critical Thinking Skill Test. Then they were divided into 2 equal case and control groups. Both groups had their routine clinical programs, but the interventional program was offered only to the case group. This interventional program consisted of 3 main parts: A 4 day workshop on reflection and 10 weeks reflection on their clinical experiences, concluding dialog journals and writing up logs. At the end of their clinical program, both groups took the same test as pretest. Data were analyzed by paired T-test and T-test. Results: Results of the study revealed that reflection has been effective on improving inductive reasoning and total scores of critical thinking skills of students. Conclusion: Improving general critical thinking skills due to a disciplinary specific strategy was a valuable outcome. Regarding this results, reflection is recommended to be infused in our educational program.

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ِIntroduction. Since the major part of professional nursing education takes place in clinics, clinical teaching is considered one of the most important parts of nursing education process. Accordingly, clinical teaching effectiveness and the characteristics of an effective teaching have overshadowed a good number of nursing and midwifery research studies. This study was performed to determine and compare the teachers' and students' perspectives regarding the characteristics of effective clinical teachers in Isfahan University of Medical Sciences in the year 2002. Methods. In a triangulation study using both qualitative and quantitative methods, 93 teachers and 475 students in the school of nursing and midwifery were investigated. During the first stage, the Delphi method was used and the teachers and students were interviewed regarding the characteristics of effective clinical teacher. Then a 56- item questionnaire was designed with the five domain of "professional", ''personal", ''communicative", ''teaching methods" and "evaluation" using 1 to 7 Likert scale. In the second stage, through survey method and using the designed questionnaire, the students and teachers' perspectives were determined. The data were analyzed by SPSS software using mean, standard deviation and t-test. Results. The mean of Students' and teachers' scores for effective clinical teachers characteristics were 6.15±0.98 and 6.19 ± 0.48, respectively which showed a statistically significant difference between them. Based on the viewpoints of students and teachers, the most important characteristic of effective clinical teachers was responsibility for one's own action and the lowest score belonged to educating clinical ward's staff. Conclusion. All the characteristics mentioned in the questionnaire were approved by the teachers and students. Moreover, the mean of the scores given by teachers was higher than the one given by the students. It is recommended that teacher evaluation be performed using these characteristics and teachers pay more attention to them.

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Introduction. Clinical skills training program provides an opportunity for medical students to improve their clinical skills in a simulated setting which is designed and equipped for learning a number of key skills by practicing on manikins and related equipments. The aim of this study was to determine the effect of clinical skills training program on clinical competencies of medical students in the management of vaginal delivery in Tabriz Medical University. Methods. In this quasi-experimental research with one group, pre- and post-test design, 50 medical students were selected randomly and assessed using a valid and reliable questionnaire asking about their clinical competencies in the management of different stages of vaginal delivery and also about their suturing skill. Likert scale was used for determining the level of competency based on self-assessment approach. Data analysis was done by SPSS software using descriptive analysis, paired t-test, ANOVA and Pearson correlation coefficient. Results. A significant increase was observed in the mean score of skills related to pre-delivery stage (from 14±13.65 to 89±10.72), skills needed during performing the delivery (from 18.17±13.3 to 88.95±9.26), and skills needed during the post-delivery stage such as suturing and dressing (from 31.07±16.57 to 85.17±12.78). There was a significant difference between the mean score related to the skills needed before, during and after delivery, before and after education. Conclusion. Practicing in Clinical Skills Center considerably increased perceived self-efficacy of medical students for doing the skills needed for the management of a safe vaginal delivery which in turn could lead to increasing their skills in confronting patients.

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Introduction. Medical education leaders in different countries try to pay attention to the appropriateness of medical education programs and their role in the development of medical graduates' competencies. This study was performed to determine the role of basic science courses in promoting the medical graduate’s competencies in medical schools of Iran. Methods. In a descriptive study 165 basic science faculty members from 11 medical schools of Iran were randomly selected through multi-stage method. Data-gathering tool was a questionnaire which assessed the nine main competencies in medical graduates using 5 point ranking scale ranging from very much to never. The results were analyzed by SPSS software using frequency distribution and mean of the frequencies. Results. Based on faculty members' view points, role of basic science courses was assessed less than %20 in promoting the competencies such as: “effective communication’’, “basic clinical skills”, “using the science in guiding diagnosis, management, therapy and prevention”, “life long learning”, “self-awareness, self-care and personal development”, “social context and community health care”, “moral judgment and clinical reasoning”, “problem solving” and “professionalism and role cognitions” in medical graduates. Conclusion. The role of basic science courses for developing the nine competencies in medical graduates was assessed “low”. It is recommended that the use of specific strategies in teaching basic science courses and also, integration of basic sciences and clinical courses in medical curriculum be considered.

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Introduction: Lack of an evaluation tool with objective criteria is one of the problems in evaluation process specially in nursing management practicum. Considering the role of evaluation in assuring nursing students’ management skills, this study was designed to develop a specific tool for measuring their management skills and determine the validity and reliability of this tool. Methods: At first, through literature review and expert panel sessions, the objectives of nursing management practicum were determined. Then, using Delphi technique, 56 important criteria were developed and the domains and criteria of evaluation were designed by Bars technique. A panel of experts was used to confirm content and face validity. Reliability was determined by a descriptive study in which 30 nursing students from one of Tehran’s nursing schools were evaluated by this tool and the reliability was estimated by split half and inter-rater reliability. The data was analyzed by SPSS software, using Pearson Correlation Coefficient and reliability analysis. Result: A dual evaluation tool was provided for nursing instructors and head nurses. The face and content validity were confirmed by experts. The internal consistency and inter-rater reliability were confirmed by r>./8 as well. Conclusion: The designed tool with acceptable validity and reliability is appropriate to apply in clinical environment for evaluating the management skills of nursing students. Applying this instrument can improve the effectiveness of clinical education activities of nursing management instructors and students

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Introduction: Controversial reports are available about the relationship between students’ self-esteem, and their academic achievement and general health. Since these reports are mainly based on studies in high school students, this study was performed to determine the relationship between self-esteem, general health and academic achievement in students of Shiraz University of Medical Sciences. Methods: In a cross-sectional study, a sample of 512 students (168 male and 344 female) from 8 schools were randomly selected through multistage random sampling during autumn 2005. Data was gathered by demographic and achievement questionnaire, Copper-Smith inventory (for assessing self-esteem) and Goldberg Health Questionnaire (to assess general health). The results were analyzed by SPSS-13 using descriptive statistics, Pearson correlation, t-test, ANOVA and multiple regressions. Results: The mean score and standard deviation for self-esteem were 17.6±4.6 (out of 25), for general health were 20.9±4.13(out of 84) and average grade point was 15.6±1.6 (out of 20). There were no significant correlations between self-esteem, and achievement. A significantly negative correlation between self-esteem and general health was seen (r=-0.59). However, the difference between probationary and non-probationary students in terms of self-esteem and general health was significant. Predictive factors for grade point average were sex, residence, and being in probation. Conclusion: There was not a strong correlation between students’ academic achievement and their general health and self-esteem, but, self-esteem and general health were correlated. It seems that students’ academic achievement is influenced by other factors.

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Introduction: Assessing patients' health is the base of nursing process. Also finding patients' problems is necessary for designing care plan by nurses and nursing students. This study was performed to determine the proficiency level of senior nursing students in assessing patients' health in Zanjan University of Medical Sciences in the year 2005. Methods: In this descriptive cross-sectional study, all senior nursing students of Zanjan University of Medical Sciences (44 students) were studied. The data gathering tools included a questionnaire consisted of demographic data, which was filled by the samples and an observational checklist which was completed by researchers while observing students' performance in assessing patients' health status. Data was analyzed using descriptive statistics methods, independent t-test, and one-way ANOVA by SPSS software. Results: Twenty point four percent of students had a poor performance in assessing patients' health, 68.2% of them achieved moderate score, and only 11.4% were proficient in assessing patients' health. Conclusion: Most senior nursing students were not skillful enough in assessing health status. The collabora-tion of administrators of nursing in ministry of health and medical education, hospitals, nursing schools and instructors in order to make appropriate planning for this problem seems necessary.

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Introduction: Considering students' learning styles may change teaching methods in accordance with their learning styles and consequently improve the educational outcome. The aim of this study was to investigate learning styles of medical students in Isfahan University of Medical Sciences. Methods: This descriptive study was performed during the academic year of 2008-2009 in Isfahan Univer-sity of Medical Sciences. Ninety medical students were selected through random sampling method as study samples. VARK learning style inventory was used as the research tool. Data was analyzed by SPSS software using descriptive and inferential statistics. Results: Medical students use different learning styles. The most preferable one among them was visual learning style with the score of 39.26±6.87. The learning style of Male and female students were different. Conclusion: Improving educational quality requires for paying attention to learning style in teaching and educational technology. Teachers and educational technologists are recommended to make use of media and various technologies.

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Introduction:The first short term special course was held named as “diabetes educator nurse”. This article brifely reavealed the process of designing, performing and executive challenges of the course. Methods: Due to lack of previous history of courses for training diabetes nurse educator in Iran, wide literature review was done on credible sources. Mission, goals, course content, and training methods was determined based on obtained information from literature review, several meetings with endocrinology and metabolism specialists and faculty members of school of nursing and midwifery and considering the job description specified for the diabetes nurse in the Ministry of Health and Medical Education. Course was designed as a six-month course (280 hours including 100 hours theoretical issues, 180 hours practical issues). Accepting 30 volunteers were estimated in each course. A registration criterion was at least holding BSc in nursing. Passing criteria was gaining at least 16 score in theoretical and practical exam. Prepared core curriculum was send to department of continuing education in the Ministry of Health and Medical Education. Results: Department of continuing education assessed prepared core curriculum, and then experts’ recommendations was done. Finally, curriculum was approved and allowed to be implemented. Considering challenges that First specialized course would be faced, course was hold by eight participants. The best teachers of endocrinology and metabolism specialists and best teachers of school of nursing and midwifery (Isfahan University of Medical Sciences) were used in teaching theoretical and practical topics. All learners could successfully finish the course. Conclusion: The successful holding of specialized training course in diabetes nurse educator increased motivation to hold this course again. However, holding this course again requires more support of health authorities in the province and country. In addition, there is need to revise executive principle of course in order to facilitate and attract more learner.

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Introduction: Critical Thinking is one of the most important skills for people of 21th century, especially for medical students. Emotional intelligence is another outstanding factor for success in all aspects of life, profession and education. It seems that both critical thinking and emotional intelligence altogether can play an important role in training professional doctors. The aim of this study was to evaluate the critical thinking skills of medical students and their relationship with emotional intelligence score of them in the first semester of 2010-2011 school year. Methods: The target group was all the students of the term 6 of medicine (n=69) in the Isfahan Medical University.California Critical Thinking Skills Test-(CCTST) with 5 subscales and Bar-On Emotional Quotient Inventory- EQ-i with 5 scales and 15 subscales were used for data collection. Data were analyzed by SPSS11.5, using descriptive statistics, Pearson's correlation coeffitient, paired-samples T-test and independent-samples T-test. Results: Based on the findings, mean age of the target group was 22 years, and 72% of them were women. Mean score and standard deviation of Critical thinking test respectively were 11.96 out of 34 and 3.69. The mean score of deductive reasoning (6.12 out of 16) was significantly higher than inductive reasoning (4.92 out of 14). The total scores and standard deviation of Bar-On test were 330.7 (out of 450) and 34.29 respectively.There was no significant relationship between total score of Critical Thinking and Emotional Intelligence, except for the field of social responsibility of emotional intelligence that was directly related to Critical Thinking score (r=0.45, p=0.001). Conclusion: Although, mean score of critical thinking in medical students was not appropriate enough compared to the similar international studies, it was consistent with national ones. This can reflect the lack of critical thinking training in iranian educational curriculum. Lack of relationship between critical thinking and emotional intelligence scores might have been due to the difference in the type of questionnaires and students’ overestimation about their emotional abilities.

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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: Originality and dynamism of university activities calls for a democratic atmosphere and considered as a supporting principles for faculties. Giving autonomy to universities is a fundamental policy to enhance their responsibility, accountability, and dynamism. Hence, this study is an endeavor to investigate the autonomy and academic freedom situation in university from the viewpoints of faculty members. Methods: Study population included 550 faculty members in Shiraz University of Medical Sciences. According to Morgan tables, a sample size of 230 faculties was selected from different schools. Academic freedom, the effect of international policies, and university independence were measured through a researcher-designed questionnaire including 15 close questions in 4 points Likert scale. The score for each item was calculated out of 100. The questionnaire’s validity was verified by experts and the reliability was approved by Cronbach's Alpha (91%). Results: The mean scores for main domains were: university’s autonomy (81.3±21.3), the effect of international policies (76.9±20.5), and academic freedom (73.3±21.6). Among the items, lack of university’s financial independence and its reliance to governmental budget (85.6), the effect of international politics on international academic associations (79.1), the effect of political attitude of university managers on academic atmosphere (76.9), continuous changes of programs after management changes (76.5) were factors which showed the highest mean scores respectively. Conclusion: Regarding the importance of academic freedom and autonomy in accountability and the growth of creativity and innovation in university, this subject should be considered more than ever. Besides, according to strategic management and planning and establishment of monitoring system and systematic accountability could prevent the redundancy resulted from political changes.

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Action research is a means for creating meaning and promoting understanding of complex social situations, and improving the quality of human interactions and performance in those situations. Action research is one of the words that can be heard now frequently in the educational cycle, but there are several definitions for it. Literature review shows that several writers have referred to this concept and have mentioned several categories of action research. They identify its models, types, approaches, typologies, and taxonomy or action research views. In general, action research is an umbrella that encompasses a range of research traditions and several established methodology. This paper deals with describing them.

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Action research is a research methodology with a dual purpose (action and research). Action research as other research approach is led through a paradigm or a philosophical perspective. This article briefly describes paradigm, research paradigm and discuss about “which paradigm (positivism, interpretive, or praxis) does cover action research?”.

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Introduction: Distinguished work force is a major factor for growth and development of all countries and training programs should be designed based on their needs. Interviews with students provide an insight into the challenges of learning environment. This study investigated the educational problems from the viewpoint of talented students of Shahid Sadoughi University of Medical Sciences. Methods: In this qualitative study, 55 talented university students expressed their educational problems during three focus group sessions. At the end of each session, the data were classified and organized and findings were sorted, categorized and tabulated, based on the frequency of statements in group discussions. Results: Most problems were related to the areas of educational objectives, planning, and management. The main reported problems were inclusion of a number of unnecessary content materials in the syllabi, low emphasis on research, unrealistic teacher evaluations, and inharmonious educational departments. Conclusion: Except for a few problems such as changing some parts of curricula that must be resolved at country level, there are many less important problems that influence the effectiveness of the educational outcomes. These problems do not need much effort to eradicate, as more cooperation of teachers, students, and managers can remove them.

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Introduction: Diabetes Prevention and Control has become among the nation's health system priorities in recent decade. Meanwhile, educational programs for executives have been designed and implemented. Tha aim of this study was to describe the situation of training of general practitioners who care diabetiv patients under National Diabetes Prevention and Control Program. Methods: This study is a qualitative content analysis (the conventional type). Data gathering was done through unstructured interviews with eight of diabetes management planners in the Ministry of Health and Medical Education as well as officials of the health system in Isfahan, and six general practitioners working in diabetes centers in Isfahan province. Observations and several field notes as well as existing records, documents, and technical notes were other sources of data collection. After manuscript analysis, meaning units, codes, categories, and key themes were achieved. The strategies for results validation included triangulation of data collection sources and methods, continuous observations in the field, and supervision and review of the analysis process by research team. Results: Three major themes and six sub-themes were emerged through qualitative data analysis. Major themes were (1) unstructured education including sub-themes of lack of continuous primary training among freshmen and lack of retraining for physicians (2) inadequate physician's competence including sub-themes of inadequate knowledge, and lack of success in earning patients and colleagues' trust (3) barriers to effective education including sub-themes of planning-related challenges, inadequate supervision on physician training process. Conclusion: Despite the importance of physician roles in diabetes management in health care centers, findings showed their education is faced with significant shortcomings.

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Introduction: The lack of communication skills among employees could result in less organizational citizenship behavior. Hence improving communication skills is of high necessity. The aim of this research is to determine the effect of communication skills training on the organizational citizenship behavior of nurses. Methods: In this quasi-experimental research, the statistical population included all the nurses employed by Isfahan’s Kashani hospital in 2009 (158 male and female nurses in 12 wards). By applying the random stratified sampling, 20 participants were assigned to the experimental group and another 20 to the control group. The experimental group received an 8-session training course on communication skills. To measure and evaluate the organizational citizenship behavior of each group before and after training, Organizational Citizenship Behavior Questionnaire was used (Cronbach’s Alpha=0.74). Analysis of the data was done using descriptive statistics (average and standard deviation) and inferential statistics (correlation coefficient and co-variance analysis). Results: After adjusting the effect of pre-test scores, the mean score for organizational citizenship behavior in the experimental group a month after the intervention (66.45±3.57) showed a statistically significant difference (p<0.01) compared to its previous value (62.85±4.34). According to ANCOVA, main effect of organizational citizenship behavior of nurses, before training was 0.364 whereas a month after the intervention, this increased to 0.607, (p<0.01). Conclusion: Communication skills training increased the nurses’ organizational citizenship behavior in the experiment group and the effect sustained a month after the intervention. Running standard communication skills training programs, with the help of specialized lecturers, is recommended in various nursing feilds such as education, research, management, and clinical nursing.