Iranian Journal of Medical Education

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Increasing access to the softwares and hardwares for electronic learning (e-learning), especially World Wide Web (WWW), has opened a new horizon to educational institutions. It seems that using these facilities helps to attain several goals as educational quality indicators, including student-centeredness, life-long learning, active and interactive learning, and using multimedia in learning. Although some educational institutions have provided all their courses electronically, only little evidence has been published indicating the evaluation results of such programs. Considering the general advantages of e-learning and its specific potentials in medical education, its integration into current university curricula seems to be inevitable, in a way that current curricula contain a blend of traditional and electronic learning situations. This is more demanding for continuing medical education programs, which face a huge number of learners with a vast diversity in learning needs, expertise, and interests. The importance of change in university programs, as well as high expenses for preparing e-learning infrastructures, especially soft wares, necessitates a long term programmed approach to the integration of e-learning in traditional curricula. To do this, using the experiences of other universities, organizing resources and activities, and using the existing capabilities in the public and private sectors is essential. This approach requires a scientific insight about different aspects of e-learning as well as a change plan according to the present situation and justified goals in medical education. If it is complemented with a serious intention on the policymakers' side, it will be expected to accomplish valuable steps towards quality improvement and efficiency of medical education in the near future.

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Introduction: In order to enhance e-learning, the first online educational course for teaching Medline, was established in Isfahan University of Medical Sciences. This study was designed to compare the effectiveness of online, face to face and combined educational methods presented for medical students. Methods: In an experimental study, Medline was taught to 40 medical students by three methods of online, face to face and combined educational methods and then, their knowledge, skills and satisfaction rate were measured and compared. The data collection tools included a questionnaire consisted of 10 multiple choice questions for measuring knowledge, a checklist for assessing participants’ skills in searching strategies, the appropriateness of the found articles for the subject and the time length for searching, and a ten item questionnaire with five point Likert scale for measuring their satisfaction. The data was analyzed by chi2, t-test, ANOVA and Kruskal–Wallis through SPSS software. Results: The mean and standard deviation of students’ knowledge in face to face, online and combined educational methods were 75 16, 70  21 and 82.213 out of 100, respectively. The mean and standard deviation of their skills in face to face, online and combined educational methods were 76.925, 7024 and 90.711 out of 100, respectively. There was no significant difference between the scores of knowledge and skills of the three groups. Also, students' satisfaction showed no significant difference in the three groups. Conclusion: It seems that, for expanding E-learning, a combination of online and face to face guidance can possibly have an acceptable effectiveness. Meanwhile, for achieving such combined method, the appropriate ground, containing related hardware and software must be provided in universities.

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Introduction: Traditional teaching methods used in medical education are not able to respond to the rapid changes and growth of information as well as continuous change in educational needs of societies. This study was performed to compare the effect of two teaching approaches, lecture and e-learning on learning outcomes of mother and child health course in nursing students of Tehran Medical University. Methods: This quasi-experimental study was performed on all third semester nursing students who had passed mother and child health course in 2006 (N=32).It was a one group two-shot study. During the first four weeks, the students received traditional education and during the second four weeks they studied the rest of the subject matter using an on-line learning method. At the end of the course, the students' opinion toward the educational methods was asked using a questionnaire. An exam that covered the content of the 4-week block was also administered. Analysis of data was done by SPSS software using mean, standard deviation, and t-test. Results: The learning outcomes in both groups were similar. Based on the students' opinion about two teaching methods, e-learning was more effective on "their capability to use the method" and "independence in using the method", and lecture was better than e-learning in "the effect on learning" and "motivation". Conclustion: E-learning can be used for teaching some nursing courses. It is recommended to use e-learning method with considering appropriate interactive and more attractive virtual environments to motivate students.

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Introduction: Employing exclusively electronic learning is not possible for practical and clinical courses. But, using a combination of different educational approaches seems to be sensible. The aim of this study was to compare the effectiveness of mixed method of electronic and small group education with that of small group only method. Methods: Seventy two students of Introductory Clinical Medicine (ICM) course in School of Medicine attended this quasi-experimental study in Isfahan University of Medical Sciences in the year 2008. They were randomly divided into two groups. The experiment group received a CD of Schwartz physical examination a week before running the sessions and they were asked to practice chest physical examination before attending small group training sessions. Chest physical examination skills were taught to both groups using small group training approach, one week later. Students’ learning was measured through an Objective Structured Clinical Examination (OSCE) and the scores achieved by each group were compared. Students' viewpoints regarding the mixed method, was asked through a questionnaire. The results were analyzed by SPSS software using inferential statistics such as T-test. Results: The mean score of the test in the experiment group was significantly higher than that of the control group. Also, the mean score for following detailed technical points in examination was higher in the experiment group compared to the control group. Conclusion: Making use of e-learning in the mixed approach facilitates active and deep learning. Despite the difference in the scientific source of the CD and the one used in small groups, a significant effect on learning was observed in the mixed method. Therefore, before providing the needed electronic sources relevant to the curriculum, using the existing sources would be useful.

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Introduction: Nowadays, E-learning is one of the most advanced educational techniques. Considering the commencement of adopting such modern teaching techniques across the world as well as in the Iranian universities, one needs to apprehend the knowledge and attitude of students as one of the most important components in the education system. Thus, this study was designed to investigate the knowledge and attitude of students towards E- learning at MUMS. Methods: This descriptive cross-sectional study was conducted on 380 students who were studying in semester two or higher in 2009 in MUMS and were selected by stratified random sampling. Students' knowledge and technology information was measured using self-structured questionnaires whose validity and reliability had been confirmed. Mishra’s E-Learning Attitude Scale was used to measure attitude. Data were analyzed using Mann-Whitney, Kruskal-Wallis, One-way ANOVA, Student t-test and Spearman and Pearson correlation in SPSS software. Results: The mean score of attitude was 37.21±7.177 (minimum score: 11, maximum: 55) and the mean score of knowledge was 10.63±3.940 (minimum score: 0, maximum score: 20).There was a significant relationship between attitude and students' sex, study program and course of study. A significant relationship also was found between knowledge, the study program and duration of using computer and internet. Conclusion: Considering the poor knowledge and relatively positive attitude of students toward e-learning, it is recommended to implement training programs such as workshops to develop students’ awareness and ability to utilize e-learning as an effective learning tool.

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Introduction: Blended-E-Learning system uses various methods and technologies to improve learning quality. We developed some courses based on Instructional System Design Processes (analysis, design, implementation, and evaluation) for blended-e-learning, then we evaluated the effectiveness of this system in Tehran University of medical Science. Methods: In this partnership-based action research study, carried out in 2008-2009, firstly viewpoints of faculty members and also nursing and midwifery students of Tehran University of Medical Science on the blended e-learning were assessed via a valid and reliable questionnaire. Then a platform of blended e-learning was designed and voluntary faculty members participated in a workshop held to develop an e-learning course. Finally a blended learning program covering 22 courses (45 credits) for BS,MS and PhD students of nursing and midwifery was designed . At the end of the semester, we used questionnaires and check-lists to assess students' & faculty members' feedback on the learning outcome of this program. The collected data were analyzed using frequency, Chi square and Wilcoxon tests in SPSS software version 16. Results: 181 students filled out and returned questionnaires (response rate=82.2%). 67.4% students were highly satisfied with this system. Similarly 88.2% of faculty members were completely satisfied with teaching in blended e-learning system. Both students and faculty members preferred the blended e-learning system to the conventional method (P=0.000). Mean scores of students' grades and participation were significantly higher in blended learning method than students’ in the previous semester with face-to-face method (P<0.001). Conclusion: Because the blended e-learning uses benefits of both e-learning & face to face learning and provides more flexibility and satisfaction for learner and teacher, it can be considered as an effective alternative method for education in universities of medical sciences in Iran.

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Introduction: Usability is one of the issues that must be considered in designing effective e-learning courses. The aim of this study was evaluating employees’ opinion in Tehran University of Medical Sciences (TUMS) about usability of in-service electronic training courses. Methods: This descriptive cross sectional study was conducted on employees in Tehran University of Medical Sciences, working in the fields of health care, finance and logistics, cultural and educational affairs. They had participated in electronic in-service training courses. Random stratified sampling was used to select 651 eligible employees to complete a 21 item questionnaire on usability, learning ability, and satisfaction based on Likert scale. Content validity and reliability of the questionnaire were confirmed in a pilot study and by Cronbach’s alpha coefficient, respectively. Data were analyzed by statistical tests such as Student’s T test and One Way ANOVA with Bonferroni Post Hoc test based on the type of variable in SPSS 16. Results: The mean score and SD of the employees’ viewpoints regarding learning ability was 3.4 ± 0.5, satisfaction 3.7 ± 0.7, and usability 3.2 ± 0.5. Based on the results, variables of job field, location of computer access, ability to use computer, internet access, and motivation to participate in e-courses showed a significant correlation with usability. Conclusion: The findings showed that the usability of e-courses from the viewpoint of the university employees seems acceptable. Employees’ computer knowledge and their accessibility to software and hardware were influential to usability of educational courses.

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Introduction: In the classrooms of medical students, some times we can see problems that affect teaching quality. For solving common problems, some ways for effective teaching were selected. Including of pre-study, Computer-mediated learning package, quiz exam every teaching session, and group discussion. Then combination of this methods as PCQG model performed for pilot study in the kidney chapter of last edition of Robbins pathology text book. And the results were evaluated. Methods: This cross-sectional study was performed on Persian Bahman month according to solar year, term 88-89 for medical students of Isfahan University. Because of positive results again was done for next series of medical students in mehr 89. At first, student's were Asked to study before the classes, and for each of three sessions, one third of the text was determined (The pilot text was chapter of Kidney and urinary truct of 8th edition of Basic Pathology of Robbins). For this purpose a "training pakage" including of previous teachings and scan of the text was handovered a week before classes. Using Internet also was possible for the students. At the beginning of each sessions Quiz exam was given. In all sessions Insted of lecture, group discussion was conducted. Using multiple choice exam, likert scale questionnare and unstructural interviews with students, the effectiveness of this method was evaluated. Results: The results indicates that 75 percent of students received acceptable scors from Quiz exam, 71/9 percent received acceptable scors from MCQ exam (moderate or good), and 73/9 percent received acceptable scors from total exam. On the other hand in opinion of the students this method could engage students in active discussions properly. Also cause good assessment of students learning, during the course done. Conclusion: This method as a new effective teaching/learning model can be expanded for educating various courses for students of medical sciences. PCQG model can be applied in provincial and national levels. P= Per-study C= Computer mediated Communication Q= Quiz G= Group

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Introduction: E-learning is one of the usual educational methods all over the world. Rapid technological advances and easy access to Internet have had an effective role in the development of this method. The only factor needing more investigation is students' performance towards e-learning. This study was designed to compare the effect of two methods of e-learning and lecture on students' learning in the department of Health and Management of Mashad University of Medical Sciences. Methods: This quasi-experimental study was performed on 191students of different disciplines in the department of Health and Management. During the term, half of the courses were presented by lecture and the other half through e-learning. At the end of the term, the students' opinion toward the educational methods was asked using a researcher-made questionnaire. The exams covering the contents of both educational methods was administered in sparated sheets at the same time. The Data were analyzed by t-test and ANOVA through SPSS. Results: There was no significant difference between students' mean scores in attendance and e-learning courses. E-learning course was optimal regarding goal achievement and educational needs fulfillment, content, methodology, sequence, material and evaluation. There was a significant relationship between students' computer skills and their success in working with e-learning system as well as their scores on the on-line final exam (P=0.001). Conclusion: E-learning is a new and successful teaching method which needs continuity, enough time, and enhanced access to computer and internet in the whole society, in order to achieve its final goals. It is recommended to present some introductory courses in computer and internet for first term students to be able to overcome the problems of using e-learning system.

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Introduction: In recent years ETS has become a common method of training in many universities around the country but we do not have similar experiences in Medical Universities. The aim of the current study is to investigate the attitude and performance of MUMS faculties towards the implementation of ETS. Method: This descriptive – cross sectional study was carried out in 2009. The study population was faculties of MUMS (360). A stratified and randomize sampling method was used to select 86 faculties. Data gathering tool was a 38- item questionnaire. Data were analyzed using SPSS software. Result: About 65% of the study population was male and 35% female. 90.7% of faculties were completely agreed, 4.7% were totally agreed and 4.7% were totally disagreed with using ETS. About 46.5% of faculties were engaged in material preparation for the system, and 34.9% used ETS in their regular teaching courses. The common teaching methods among the faculties were lecture (3.72±1.3) and group discussion (3.47±1.07). Conclusion: Based on the positive attitude and performance of the MUMS faculties towards ETS, it is suggested that measures be taken to prepare the required infrastructure to use this system in teaching university courses.

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Introduction: With regard to general benefits of e-learning in medical education, and the necessity of paying attention to it, this study was to assess the strength and weak points of web-based teaching in medical mycology course. Methods: In this descriptive comparative study conducted on pharmacy students in the first semester of 2009-2010, parallel to attendance and the traditional teaching sessions (classroom training) for medical mycology, web-based training was simultaneously used. At the end of the semester, the effect of web based learning was investigated through comparison of the grade averages of students in experiment and control groups. The students’ viewpoints on the advantages, disadvantages, students’ interest, educational motivation,and the ability and capability of virtual education were also surveyed, using a researcher-made questionnaire. Results:Comparison of mean final test scores at the end of the course in experiment and control groups (16.83 vs 17) showed no significant difference between students’ learning in blended style,and traditional groups. In the survey, students indicated the advantages of web based learning as: constant teacher- sudent communication (91%), distance education and scientific exchage (79%), access to up to date world electronic sources (75%),and no time and place limitations (54%). The disadvantages and limitations were indicated as low university facilities and resourses, low speed of internet, and not easy and allowable access of all to internet. Conclusion: Despite the satisfaction expressed by the students from web-based education, comparison of students’ grade averages in experiment and control groups, revealed and evidence for lack of success in web based education.So, different aspects of e-learning, including computer literacy, infrastructure of telecommunications, the culture of Internet use, leisure and entertainment aspects of Internet content, and curriculum, should be revisited.

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Introduction: Designing e-learning systems based on the principles and prerequisites of teaching and learning theories requires a comprehensive and systematic approach to instructional design procedure. An experience of instructional design, implementation and evaluation of an e-learning system is represented in this study. Methods: In the present action research study, five steps of systematic instructional design, including analysis, design, development, implementation and evaluation, were performed in Tehran University of Medical Sciences for developing an e-learning system. The principles and prerequisites of teaching and learning procedure were identified. Then the supportive learning management system was designed and related regulations which were approved in associated university councils were developed. Faculty development workshops were held for e-teachers. This procedure was completed during 2007-2009. Results: Master degree program on medical education was chosen as the first discipline and 25 students enrolled in two academic years. The application of system as a supportive pedagogical instrument began by 44 faculty members who used the system for 450 students. Students' and teachers' evaluation of system showed their high satisfaction (88%). None of the students dismissed the course. Conclusion: A systematic instructional design before launching e-learning systems or purchasing softwares may guarantee its success. University's used the evaluation results for further revisions and updates of the system.

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Introduction: As there are different e-CME content formats, we need documented evidence for comparing them. In this study, we determined the proper e-content format for CME activities in Iran. Methods: We devised a questionnaire to gather the opinion of the faculty members who had the experience of e-CME content development about the proper e-CME content format for Iranian medical society. Based on their opinion, we developed 20 e-CME contents and delivered them to the medical society. Learners’ evaluation of the contents provided us with the evidence for assessing the experts’ opinion. Results: There was a significant difference among scores that faculty members had given to different types of contents (P<0.001). They believed that case-based interactive e-contents would improve learners’ performance and increase their interest more than other formats. But they declared that this kind of e-content development is more difficult and time-consuming than developing other types. Learners rated the programs as 4.56 (SD= 0.65) on the 1–5 Likert-type scale, which shows that they are satisfied with this e-content format. Conclusion: Considering the necessity to compare different e-learning strategies and also defining national models to apply them, this study’s results would help designers and providers of e-CME programs in decision making. But more studies should be performed to determine these programs’ learning outcomes.

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Introduction: Nowadays all educational institutes are trying to use technology in their structure. This effort has been faced with different barriers, including cost, time, and support. Therefore, using open source softwares can partially help us in using technology. In this article, we review main features of several open source learning management softwares, while presenting a tool which includes all the necessary features of a Learning Management System(LMS). Methods: An evaluation tool with 118 operational features for LMS softwares was developed. Five famous open source softwares of learning management system were compared based on its variables. These sofwares were: Moodle, Olat, Dokeos, ILIAS, and Docebo. Results: Most of the open source LMS softwares have operational characteristics such as mass media, curriculum and student management, personalization, and financial management. However, they are different in details. Conclusion: There are quite a number of similarities and some differences between open source LMS softwares. Generally, choosing an open source LMS would be based on the demands of any educational organization. In this article, necessary characteristics of a suitable open source learning management computer program are presented

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Introduction: Among medication errors, intravenous medication administration errors are especially important. The lack of medication information can be one of the causes of medication errors. Using electronic education may facilitate quick access to the update resources. The objective of this study is the evaluation of an appropriate educational strategy to reduce intravenous drug administration errors by staff, including error in drug dosage, before-, during- and after- prescription assessment, evaluation of injection site, proper solvent selection, volume of solvent, length of injection, and patient training. Methods: This is a single group interventional study, carried out in three hospital wards of Shiraz University of Medical Sciences in 2008-9. Samples were intravenous drugs prescribed by nursing staff. Intravenous administrations was observed and recorded before and 6 months after the educational intervention. Educational intervention for all nursing staff responsible for drug administration, was a workshop composed of a blend of lectures, practice, reflection and E-learning opportunities on medication errors and resources. Data analysis was done with MC-Nemar and binomial tests. Results: In this study, evaluations of errors in 603 administrations of intravenous medication (30 drugs) have been done regarding ten variables. After education, there was a decreased frequency of errors in before prescription assessment (60.5% to 6.6%), evaluation of injection site (25.3% to 3.4%), length of injection (50.1% to 27.6%), during prescription assessment (42.7% to 16.7), after prescription assessment (42.3% to 17.2%) and patient training (91.2% to 75.6%) (P < 0.05). Conclusion: The use of modern strategies and introducing rsources (electronic data bases and sofwares) in hospital wards is important in decreasing medication errors, as it facilitates the nurses’ access to the update sources of medication information.

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Introduction: Using standard authoring tools is essential to promote E-Learning in teaching-learning process. Learning content in medical sciences often consists of multimedia elements. On the other hand, it is frequently required to revise and update the medical content. Hence, access to the authoring tools that can encompass multimedia elements and allow easy content revision is helpful in e-learning promotion in medical sciences. In this paper, a standard interactive multimedia content authoring tool, developed by the authors after many investigations is introduced. Current authoring tools do not meet all the content qualifications and few of them are available as open source. Therefore, we aimed to produce an interactive multimedia content authoring tool that could be open source, feasible, and able to be updated or modified. In addition to providing the standard content, this engine allows knowledge management that could be enriched as technology progresses. To develop this engine, characteristics such as “component based architecture”, “exploiting the SCORM and IMS standards”, and providing the content both in online and offline modes were considered. Some parts of the learning content created in medical sciences have been provided as a sample.

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Introduction: The rapid expansion of e-learning elucidates the necessity of paying attention to this phenomenon by all educational centres especially medicals. Considering the importance of this subject and regarding the commencement of new courses in our country as well as the establishment of higher education disciplines, this paper aimed to review the structured analysis of requirements, challenges, problems, and barriers in the application of e-learning in education and thus provide a model and guide for choosing, designing, and implementing an electronic course. Methods: Theoretically viewing, this is a review study. Researcher selected and studied total 100 articles (literature review and original research articles published from 2003 and afterwards) out of 4700 Articles found from databases of ERIC, ACM, GUIDE Association, Digital Learning, OECDT, and Becta, using search engines of Google and Yahoo. The keywords used in this search were “requirements, challenges and e-learning”. Then the findings were combined with results of an experimental study by the researcher extracted from a satisfaction questionnaire, and finally analyzed. Results: After discussion and summing up the reports and opinions of experts regarding the requirements and challenges of setting up an e-learning system, main factors and infrastructures were summarized in the following domains: 1) IT, 2) human resources, 3) pedagogical, 4) cultural, social and values, 5) economic, 6) management, and 7) administrative and supportive. Then a fundamental approach for the stages of analysis, design, implementation, and evaluation of an electronic course was proposed. Conclusion: The spectrum of requirements and challenges of e-learning in our country is so extensive, as it includes: changes in traditional perspectives to creation of cultural, communicative, and hardware infrastructures, formal and public policymaking, legislation and creating legal platforms in education systems, creation of an e-learning management system, development of the fields for content production based on international standards, and privatization for the production of local e-content. Presentiation of an executive model considering the above-mentioned findings could help the managers and decision makers for a successful implementation and further efficacy of this approach.

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Introduction: The rapid development of science and technology has endowed a fresh significance to continuing education as its necessity has become undeniable. Considering the significance of keeping physicians’ knowledge up-to-date and their limited free time to participate in their classes on the other hand, e-learning could be a useful option to train these people. The main objective of this study is to identify main factors which deter these physicians to participate in e-learning courses of continuing medical education in Mashhad University of Medical Sciences. Methods: This descriptive cross-sectional study was performed during summer 2011 in Mashhad University of Medical Sciences. Study population included 378 physicians subject to continuing medical education which were selected through stratified sampling method. Data gathering tool was a reliable and valid questionnaire made by researcher. Descriptive and inferential statistics were used for data analysis. Results: Considering the weighted mean achieved, contextual issues (2.71±.63) showed the highest and personal issues (2.15±.70) and attitudinal issues (1.98±.64)( out of 4) showed the lowest deterrence rate respectively. Personal concerns of individuals formerly participated in e-learning courses were lower than that of individuals who didn’t participate beforehand (p<0.01, F=6.51). The scores attributed to each of these three fields of personal, contextual, and attitudinal problems to attend e-learning courses were higher for men compared to woman (f=86.1, p<0.01). Conclusion: Contextual problems were the most important deterring factor among community of continuing medical education to participate in e-learning courses.

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Introduction: Promoting meaningful learning is one of the main objectives of education and an important factor in promoting creative thinking, critical thinking and problem-solving abilities in learners. Also, evaluating students’ learning is a teachers’ duty. The aim of this study was to compare the effect of teaching by lecture or concept mapping on cognitive learning levels of midwifery students and their satisfaction with concept mapping as the assignment. Methods: In a quasi-experimental study, 35 third-semester midwifery students in “maternal and child heath course were selected by census method in Qom University of Medical Sciences in 2011. Students received education using lecture or concept mapping (using web-based tools), respectively, for 8 sessions in 2 months. Two researcher-made questionnaires were used for assessing their knowledge and satisfaction. The collected data was analyzed using descriptive statistics and independent t-test. Results: Compared to conventional teaching, the concept mapping method had a significant effect (p=0.001, t=3.24) on promoting high levels of cognitive levels (meaningful learning). However, there were no significant differences between the two methods regarding lower cognitive domains (p=0.06). Also, among various forms of assignments, drawing a concept map received the highest score (0.95 out of 1). Conclusion: Considering the positive effect of concept mapping method on students’ meaningful learning, it is recommended this method be employed in teaching and also in student assignments for courses which require a deep learning and high level of understanding.

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Introduction: It is impossible to be successful in virtual training unless we consider individuals’ viewpoints toward it. Despite this fact, less attention has been paid to students’ attitudes at the end of a virtual course in the published studies. This study investigates the effect of a virtual training course on the students` attitudes toward virtual education and its relationship with learning styles. Methods: This was a quasi-experimental study based on pre- and post- tests. Study population included undergraduate nursing students of second semester entered to Razi Faculty of Nursing and Midwifery of Kerman University of Medical Sciences in year 2009 and were studying the course titled “fluid and electrolyte disorders”. Students were divided into two groups of traditional or virtual learning, randomly. Course content was presented to the virtual group via website while traditional group were taught in classroom. Students’ attitudes toward virtual education were collected via a researcher-made questionnaire. Their learning styles were assessed by Gaziano & Liesen questionnaire. Data was analyzed by descriptive statistics (mean, standard deviation, and frequency distribution) and analytical statistics (independent t-test and paired t). Results: Before training, the mean score (out of 5) of attitude toward virtual education was 3.19±0.48 in virtual group and 3.21±0.33 in traditional group the difference between mean scores was not significant. At the end of the semester, the score was 3.55±0.45 for virtual group and 3.21 ± 0.46 for traditional group which showed a statistically significant difference (p=0.03, t=2.15). The results of ANOVA revealed no significant relationship between learning style and attitude toward virtual training (p=0.07). Conclusion: This study showed that passing a virtual training course could improve students’ attitudes toward virtual education. There is no difference in attitude toward virtual education among people with different learning styles.