Iranian Journal of Medical Education

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Introduction: One of the main criteria for a complete care system in mental health is using evaluation data to identify and focus on potential capacities for future planning. The goal of this study was to evaluate educational programs of center for mental health education and consultation in Isfahan University of Medical Sciences. Methods: In this evaluation study, the participants of educational programs of this center, from March 2001 until August 2003 were investigated. A researcher made questionnaire was used to study the knowledge, attitude and practice of people referring to this center, in 11 educational subjects presented in the educational programs. The demographic characteristics were also asked along with the main questionnaire. The data analysis was made using descriptive and inferential statistics, t-test, and ANOVA by SPSS software. Results: Center for consultation and education of mental health, has had a successful performance regarding identifying mild mental problems. Based on the designed criteria for evaluating educational programs in this center, these programs were relatively successful in promoting the knowledge and practice of referred people. Conclusion: Considering the increasing complications of societies and the necessity to educate people for the purpose of preventing acute mental disorders, it seems that implementing and developing such centers is one of the priorities of health system and medical education in the country.

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Introduction: At the end of their education, nursing students have to acquire the minimum capabilities, essential for their professional job. The aim of this study was to determine the achievement of minimum learning requirements by midwifery students in School of Nursing and Midwifery of Isfahan University of Medical Sciences. Methods: A descriptive study as an educational evaluation based on CIPP (Context, Input, Process, and Product) model was performed. The study sample included 36 midwifery students from two educational periods who were prepared for their final practical exam. Data collection tool was a questionnaire which was developed through Delphi technique using experts’ views. The questionnaire assessed 12 courses including 61 units by asking about watching, listening, reading, and experiencing some tasks as well as their capability in doing those tasks. The data was analyzed by SPSS software as frequency distribution. Results: More than 90% of the courses were taught according to the outline approved by Cultural Revolution Committee. Concerning clinical education, the students did not have enough experience in uncommon cases such as breech delivery, using forceps and women’s cancer. In some cases such as neonate resuscitation, the student had no experience at all. Conclusion: In some cases, the students did not have enough experience in gaining the needed skills. It is suggested that teachers use new and active methods of teaching and take advantage of film, moulage and other audio-visual equipments for teaching unique cases.

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Introduction: Self-learning is an appropriate method for continuing medical education programs and has been used in many countries. In order to evaluate new method of self-learning in CME (Continuing Medical Education) programs, this study was conducted to determine the viewpoints of CME participants about the quality of books, questions, and teaching method of self-learning in Isfahan University of Medical Sciences. Methods: In a descriptive cross-sectional study, 3712 physicians among the ones participating in CME programs of Isfahan University of Medical Sciences in 2004-2005, were selected through census sampling. The data collection tool was a questionnaire containing demographic questions and 39 items asking about self-learning method, quality of the books and questions which was distributed along with the book at the time of registration for self-learning. The data was analyzed by SPSS software using frequency distribution, mean, standard deviation, t-test, ANOVA, and linear regression. Results: The mean and standard deviation of the participants' viewpoints toward self-learning teaching method, quality of books, and quality of questions were 3.96±0.39, 3.80±0.35 and 3.74±0.56 out of 5, respectively. The mean scores achieved by older participants were higher significantly. Conclusion: The results demonstrated the good quality of self-learning method, the provided books, and the designed questions. The physicians had a positive attitude toward this method. This teaching method is recommended to be used in other universities.

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Introduction: Evaluation is an ongoing process which contemplates students' recognition, their learning promotion, and the necessary changes for achieving educational objectives. The aim of this study was to examine the capabilities of dental students of Shiraz University of Medical Sciences through determining their viewpoints toward the amount of their achievement to learning objectives of practical and theoretical courses of orthodontics in academic year of 2007-2008. Methods: In this descriptive cross-sectional study performed in academic year of 2007-2008, 122 dental students (86 female and 36 male) passing the courses of theoretical orthodontics (1, 2, and 3) and practical orthodontics (1, 2, 3, and 4) were selected as study sample. Questionnaires were developed for each one of the orthodontics courses and delivered to the students. At the end, each score given to the ability mentioned in the questionnaire by the students themselves was calculated based on total score of one hundred. The data was analyzed based on descriptive statistics indices including mean, standard deviation, one-way analysis of variance, and Tukey HSD. Results: The mean of students' agreement for ability to achieve the objectives of the courses of theoretical orthodontics 1, 2, and 3 were 76.6, 72.6, and 76.8 respectively (out of total score of one hundred). For the courses of practical orthodontics 1, 2, 3, and 4 they were 77.6, 70.8, 75.8, and 68.4, respectively. The courses of theoretical orthodontics 3 and practical orthodontics 1 had the best agreement in achievement ability and the courses of theoretical orthodontics 2 and practical orthodontics 4 had the lowest agreement in achievement ability according to the students' viewpoints. Conclusion: From the students' viewpoints, their ability in achieving educational objectives of orthodontics is desirable. Even though, revealing the weakness and the strength points of them in each of orthodontics courses, it seems that there is a need to revise and modify the educational program of this part.

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Introduction: One of the most important changes in medical education programs in Iran has been designing and implementing course of Introduction to Clinical Medicine (ICM) in Isfahan University of Medical Sciences. This study determines the methods and results of process evaluation (from CIPP evaluation) used for ICM revision and evaluation program. This study aimed to provide evidences about its efficiency and extract its executive disadvantages and limitation. Method: This is an evaluation study conducted in Isfahan University of Medical Sciences. Data were collected through descriptive studies and in most cases, self-administrated questionnaire was used. In some cases, comparing the final MCQ scores was used. This evaluation was done during conducting new ICM program. Separate evaluation tools were prepared in several steps and used for each course at the end of that. These Steps are literature review, preparing draft questionnaire, getting feedback from, and consulting with main stakeholders of evaluation and preparing the final questionnaires. The content and face validity of the questionnaires were confirmed by experts of education after conducting a pilot study and the reliability were checked by Cronbach's Alpha coefficient. Results: The results showed that the students have more positive attitude toward EBM course. Students believed that ICM was an appropriate section for learning medical records. They were not satisfied with management of medical records course by nursing department, identifying learning objectives and the extent of accessing to them, time devoted to this lesson, teaching method, sources and evaluation method. Evaluation of communication skills course showed students’ positive attitude toward this course and their learning of this course. Overall students' satisfaction in most items of ICM course (volume of ICM course, resources, evaluation methods, exams intervals, content of tests, arrangement of packages, volume of lessons, arrangement of practical courses, giving information) was more in old ICM program than the new one. Clinical students agreed with all changes. Mean score of sign and symptom and pathophysiology of disease showed a slight increase in new ICM program (insignificant statistically). Frequency of the failed student decreased from 18 student-units in old ICM program to 10 student-units in new one. Conclusion: The results showed a relatively successful experience in reviewing and evaluating a medical education program. Regarding complexity of reviewing and evaluating medical education programs, this study can be used as a guide for designing other similar researches that are effective in future planning and decision-makings.

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Introduction: Various studies show that Log book can be also used in evaluation of medical course curriculum in clinical level in addition to evaluation of students’ achievement and their level of competencies. This article was to investigate the applicability of this new usage of Log book . Methods: Logbooks were designed by faculty members through various sessions in clinical departments in six sections of introduction, outcomes and essentials of learning, disease exposure case reports, communication skills evaluation, procedural skills learning in the morning and at the time of shift. Logbooks were filled by students and returned.Then, frequency of observed cases by students and the fields used by the departments were calculated. Results: The students had not observed 5 diseases (26%) in orthopedic Dept., 6 diseases (50%) in neurology Dept., 15diseases (68%) in infectious diseases Dept. and 1 disease (6%) in toxicology Dept. But, all diseases had been observed in ENT Dept by students. Log books in Dept. of internal medicine were so incomplete that their data were not usable. Departments of orthopedics and neurology from outpatient clinics, Department of infectious diseases from hospitalization ward, Department of toxicology from emergency had the highest usage. Discussion: If students, faculty members and residents in educational departments know well about the importance and role of logbook and observe its function results, logbook can be used for evaluation of educational curriculum.

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Introduction: Community-Based Medical Education (CBE) is considered as a new educational approach in the school of medicine. This study was designed to determine the quality of education during the internship in community medicine course in medical universities in Tehran. Methods: This is a descriptive cross-sectional study conducted on community medicine internship in medical schools of Tehran during 2008-2009. A nonrandom sample of 180 interns was selected by convenience. The data, collected by a researcher made questionnaire whose validity and reliability had been confirmed, were analyzed by Ҳ2, Mann-Whitney and Spearman coefficient tests. Results: Over 75% of interns were satisfied with the course planning, the applied content of the workshop, the presence of faculty members and their responsiveness to the students’ questions. In addition, 78% the students were satisfied with teaching on health care system. There was a significant correlation between students, satisfaction with internship and the university they were studying in (p<0.002). Conclusion: It seems that medical schools in Tehran follow the educational out lines well, and community medicine interns are relatively satisfied with the course.

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Introduction: In order to equip health system administrators with further education, for the first time in Iran, Kerman Medical University enrolled 30 of them as MPH (Master of Public Health) distance learning students in 2008. It seemed necessary to document the experiences of this course to design better programs in the future. Methods: This study was a qualitative descriptive study. All third semester distance MPH students were invited to participate in two focus groups. The total participants were 19 students. Open-unstructured questions were asked. Each focus group lasted for about 1.5 hours. The discussions were recorded and transcribed verbatim. The data analysis was done by thematic analysis. Results: Students commented on two main themes: benefits and shortcomings. The data was categorized in several subthemes. Among the benefits, they mentioned saving time and money, not commuting, active participation in learning, students’ interaction, and the benefits of cuncurrent study and work. In the shortcomings they spoke about the weak infrastructure, limited access to teachers, learning less, the difficulties of scuncurrent study and work, inappropriateness of the learning material, pile up of undone assignment and absence from educational environment. Conclusion: In this study the benefits and shortcomings of the distance learning program were discussed. Comments such as embarkment on distance learning only after a successful experience of running the same degree program in attended format, providing high speed internet and proper software infra-structure, familiarizing teachers about distance teaching, constant quality surveillance and conducting workshops for some topics were made for the improvementof the course.

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Introduction: Morning report along with clinical rounds and ambulatory teaching are three common, useful and valuable methods (Gold Standards) in clinical education. This program has some characteristics and standards that, when properly applied, will play an effective role in students’ clinical learning. The main aim of this study is to determine the characteristics of morning report sessions in internal medicine wards affiliated to Tehran University of Medical Sciences, and also to assess students’ view points on the benefit and satisfaction from the content of these programs and the related factors. Methods: In this cross- sectional study, the structural characteristics of morning report sessions and the students’ rate of benefit from their content were investigated in year 2010. A sample 300 internship and clerkship medical students were asked to fill out a researcher- made questionnaire. The validity and reliability were confirmed by experts and the calculation of Cronbach’s alpha respectively. Results: The structural characteristics of the sessions were as follows: The average starting time of the sessions was at 8 a.m., the average duration of sessions was one hour, the average number of meetings was 5 times a week, the patient presenter in most cases was an intern, the cases presented were complicated and difficult ones, the average number of cases presented in each session was three, the average time for presenting each case was 20 minutes. Air conditioning, temperature, lighting, and sound quality were favorable. Faculty members usually sat in the front row and with their back to the audience. The main audience at the sessions were not defined and usually the experts of other fields such as pharmacists, nutritionists , pathologists or radiologists were absent. Total benefit rate according to the students was: 55 people (18.3%) high, 152 people (50.7%) moderate and 93 people (31%) low. There was a significant correlation between their benefit rate and most of the structural parameters of morning report sessions (P<0/005). Conclusion: Despite the structural conformity of the morning report sessions in internal medicine wards of Tehran University of Medical Sciences with those in most similar studies, some more efforts should be spent on promoting the students’ satisfaction.

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Introduction: Due to the increasing development of science and technology in today’s world and updates in organizational factors, staff development becomes more essential. An educational program could be considered effective if it could appropriately change in participants’ knowledge and behavior. The aim of this study is to assess the training course of working with ECT (DC Shock device) for nurses based on the Kirkpatrick’s model. Methods: This evaluation study is based on the Kirkpatrick’s model, in which the efficacy of training course of working with ECT to nurses is assessed. A volunteer sample of 160 nurses participated in the project with informed consent. The training course was evaluated concerning four areas including reaction, learning, behavior, and outcome then the overall efficacy rate of the course was calculated. Data was collected through researcher- made questionnaires whose validity and reliability were confirmed in a pilot study. Data was analyzed by Student t-test. Results: The mean scores of participants’ reaction(first level in Kirkpatrick model) to the content, instructor and facilities were 4.3±.35, 4.8±.41, and 4.1±.27,out of 5, respectively. The desirability rates (mean scores) for the four levels were: reaction (4.4±.45), learning (4.35±.24), behavior (3.85±.18), and the impact (4.33±.18). The mean of overall desirability rate of this course was 4.16±.41. Conclusion: The training course of working with ECT for nurses resulted in favorable outcomes in the three evaluated levels of reaction, learning and behavior, and was able to develop efficient changes in the impact level.

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Introduction: It is necessary to choose and implement proper teaching and evaluation method for implementing an effective education. This study aimed to evaluate the implementation quality and to determine suitable teaching methods in department of anesthesiology at Isfahan University of Medical Sciences. Methods: In this descriptive cross-sectional study, all anesthesiology residents (40) who participated in class in 2011 were selected. Data collection was done through a researcher-made questionnaire. Data analysis was done through descriptive and inferential statistics. Results: The questionnaire response rate was 100 percent. Mean age and duration of medical practice were 34.75±3.9 and 7.6±4.8 years, respectively. 85.5 percent of participants had the high satisfaction with quality of program implementation, 12.5 percent had moderate and 2 percent had poor satisfaction. The most preferred teaching method was lecture along with showing films and PowerPoint presentations and the least one was lecture without film and slide. There was no significant difference between female and male residents regarding to the satisfaction of teaching method and program implementation (P>0.3). Conclusion: Using educational material and active teaching methods involving students in teaching process is effective in learners’ satisfaction and teaching quality.

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Introduction: One of the common models for evaluation in the organization and in-service training model is four-level Kirkpatrick’s model. Users must be aware of strengths and areas of application of this model. The aim of this paper is to clarify the characteristics of this model according to Kirkpatrick and to summarize the critics of scholars to this model. At the end, the reforms that have been carried out on this model are described. Methods: At first, we manually searched library sources for the publications on Kirkpatrick’s model. Then using Google Scholar and databases such as Eric, Ebsco, Elsevier, and Proquest, articles having terms such as Kirkpatrick, model, and evaluation in title or keywords were retrieved. Finally, all the articles that were available were downloaded and reviewed. Results: Five books were found in searching library resources. Eighteen articles and 3 dissertations were also retrieved which were downloadable. This model emphasizes collecting evidence at 4 levels to judge the effectiveness of educational programs. This model comprises several assumptions that are determined by the predominant users of the model. However, some of the critics to this model related to the assumptions established on it. Some experts have proposed additional levels to extend the model to other surfaces. However, Kirkpatrick refused these proposals. Conclusion: This model provides a general insight on key indicators of the effectiveness of the program to users. Yet, it neglected some variables that affect the evaluation of training program’s effectiveness. This model is suitable for the evaluation of short-term and in-service trainings in organizations. It is not recommended for evaluating all educational programs.

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Introduction: Curriculum reform of MD program in Tehran University of Medical Sciences involves fundamental changes in many aspects of the program. Three years after implementation of the new curriculum, evaluation of program outcomes is necessary. The aim of this study was to compare academic achievement and educational environment of basic sciences phase of the previous curriculum with those of the revised curriculum. Methods: In this retrospective cohort study, the average score of basic sciences courses for all medical students accepted to Tehran University of Medical Sciences in 2011 and previous three years (2008-10) was extracted. The results of the 44th, 46th, 48th and 50th basic sciences comprehensive exams, including university rank and the standard score were analyzed. DREEM questionnaire was used to assess the educational environment which was completed by students admitted in 2010 and 2011 at the end of basic sciences phase. The data were analyzed by means of ANOVA, Chi-Square and t-test. Results: The total number of medical students from 2008 to 2011 was 1032, of whom 589 students (57%) were female. The difference between the basic sciences average score, number of probationary and failed semesters over the years was not statistically significant. Based on the results of comprehensive exams, the university ranked third in 2008 and first in three subsequent years. University’s standard scores in all comprehensive exams were 0.61, 0.96, 0.85 and 0.94 respectively. The DREEM questionnaire scores were 91.5±0.46 and 93.5±0.41 (out of 200) respectively before and after the reform. This difference and differences between scores of questionnaire’s five areas were significant for the two groups. Conclusion: Although slight improvements could be seen in most of the assessed outcomes after the reform, they are not statistically significant. This could be attributed to near-perfect performance of the university in previous years or to the short interval between the intervention and outcome evaluation and therefore, concerns about academic failure following the curriculum reform do not seem to be valid. Regular monitoring of the outcomes is necessary for assessing long-term effectiveness of the curriculum reform.