Iranian Journal of Medical Education

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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: 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: 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: 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: 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: 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: Medical education in general, and physiopathology teaching program in particular, have undergone a number of changes in recent years. Outcomes of recent reforms performed in undergraduate medical curriculum should be determined. The present study investigated the possible effects of a simple horizontal integration in curriculum of physiopathology phase on the attitude scores of the stakeholders including students and curriculum directors, and academic achievement of students. Methods: In this descriptive cross – sectional study each physiopathology course marks and the mean of grand point averages of 287 students of physiopathology from 2001 till 2008 was gathered from the school office for education. These observed indices were compared between students who had passed discipline-based program and who had passed the integrated program. Also a researcher–made questionnaire was used for the survey of the physiopathology educators’ and students’ attitude. The data were analyzed using independent t-test and correlation to compare student marks and attitude scores. Results: Total mean of students’ grand point averages in physiopathology phase was 14.3±.71 in traditional group and 14.49±.93 in the integrated group. The difference was statistically significant (p=0.047, t=-1.994). The score of educators' attitude was 3.22(±0.63) out of 5. Most of educators had positive attitude to course system and the score of students’ attitude was 3.21 (±0.35) out of 5. Conclusion: Changing the curriculum in physiopathology phase to the integrated system improved students' academic performance. Also most educators and an average of students were satisfied with these changes. Thus, this change could affect teaching and learning process positively.

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Introduction: The anesthesiology BSc program was first started in 2008 in Iran and has been continued so far. The purpose of this study was to provide a critical appraisal of the anesthesiology BSc program according to the Eisner’s Connoisseurship and Criticism Model.

Methods: This qualitative study employed Eisner’s Connoisseurship and Criticism Model to evaluate the anesthesiology BSc program. Consistent with this model, the curriculum and educational environment of the program were assessed in three main dimensions: description, interpretation and evaluation. Data were gathered by means of observation, interview and review of the literature. Results were then discussed and criticized by professors and PhD students of Tabriz School of Nursing and Midwifery.

Results: While other countries offer anesthesiology as nursing MSc program, it is offered as anesthesiology BSc program in Iran. Preliminary codes extracted from interviews were summarized in four themes: inattention to context, uncertainty, lack of differentiation between educational levels, and educational irregularities. Findings also indicate shortages in educational space and facilities for students and faculty members. Hourly-paid instructors who teach students during their work shifts are employed for clinical training.

Conclusion: It seems that due to the novelty of the program and the importance of caring for anesthetized patients, a comprehensive evaluation of the program and making the necessary changes are essential. It also should be determined whether the program has been successful to achieve its ultimate goal that is improving the quality and quantity of care for patients; final decision then should be made about the continuation or termination of the program.

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Introduction: Conducting comparative studies is one of the research methods for revising and modernizing educational programs. The aim of this study was to compare the emergency nursing MSc curriculum in Iran and the USA.
Methods: This descriptive-comparative study was conducted in 2018 at Tabriz University of Medical Sciences. Vanderbilt University was selected through internet searches due to the relative similarity between the fields of study offered by the given universities and then two curricula were compared using Bereday’s four-stage model: description, interpretation, juxtaposition and comparison.
Results: The program offered by both universities had certain mission, vision and goals. The goal of Vanderbilt University was to train professional clinical nurses while the goal of Iran's program was to provide the graduates with the proficiency in the clinical, educational, research and managerial fields. The admission requirements in both universities included holding a bachelor`s degree in nursing and having at least two years of clinical nursing experience. In Iran, the graduate students in Emergency Medicine can also take the examination. Some of the requirements for the admission to Vanderbilt University were a confirmation letter of clinical competence, a confirmation letter of at least three faculty members and a good GPA and students can study at a university whether full-time or part-time.
Conclusion: The Emergency Nursing MSc curriculum in Iran was designed as a general program, whereas Vanderbilt University curriculum was more specialized and operational with an emphasis on clinical practice. Differences in course credits offered by Emergency Medicine and Nursing bachelor's programs and their different fields of service make it necessary to revise the relevant curricula or develop separate educational paths for these two fields.
 

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Introduction: Regarding the importance of ethics and specifically justice, the most basic concept in the realm of ethics, in designing curriculums and considering the importance of curricula in the development of the country, this study aimed to design novel scales to evaluate curricula in terms of ethics and justice.
Methods: This developmental and psychometric study was performed in the School of Nursing and Midwifery of Tabriz in the year 2018. To develop the initial scales, initially, the related literature was reviewed to define ethics, justice and curriculum, and then the Scale items were presented. To confirm the face and content validity of the scales, qualitative methods as well as descriptive statistics were used. Moreover, the reliability of the scales was computed via Inter-rater reliability coefficient (Kappa) and internal consistency method (Cronbach's alpha coefficient).
Results: Initially, the scales for the evaluation of ethics and justice were developed, each containing 25 and 39 items respectively. After quantitative and qualitative measurement of the face and content validity of the scales, the total number of the items in the scale of ethics increased to 28 items and that of justice declined to 32 items. The content validity of the whole scales based on S-CVI/Ave was 96.34 and 89.07 respectively. Moreover, the kappa coefficient of each scale was 0.87 and 0.81 and Cronbach's alpha coefficient was 0.76 and 0/92 respectively.
Conclusion: In this study, the scales for the evaluation of the curriculum in terms of ethics and justice were developed, which can examine curriculum in terms of applying the required principles of healthcare ethics. It is recommended to use pilot scales in other educational environments.