Iranian Journal of Medical Education

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This article reviews some of the ethical aspects of collaborative research or collaboration of national and international centers in health car researches. Scientific collaborations are of potential advantages, but, it’s a challenging task to successfully accomplish a collaborative research on ethically sound grounds. Current trends in international collaborative healthcare researches reflect limited benefits for the majority of world population. Collaborative research among scientists and researchers of universities and industry section usually has financial considerations. Successful cross-cultural and international collaborations have to overcome many regional and global barriers. Despite these difficulties, most scientific collaborations usually begin with an informal meeting or contact. With the advancement in global communications, scientists have greater responsibility towards world community while considering the impact of their collaborative partnerships. This article reviews the main factors required for developing a collaborative partnership and discusses the needed strategies for sustaining this relationship. Finally, it is concluded that healthcare researchers can play an important role in establishing harmony and resolving international and global problems in the field of collaboration.

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Introduction: Medical ethics education is a key subject in medical occupations, as learning ethics is fundamental for their relationship with patients. Teachers are of the most important elements in medical ethics education, because they are one of the most important factors of forming the morality and the professional character in students. The aim of this study is to explain challenges and problems which threaten the medical ethics education. Methods: Fourteen medical ethics teachers of universities of medical sciences in Tehran took part in this qualitative content analysis study performed in year 2010. Data was collected through semi-structured interviews and analyzed via content analysis approach (Mayring method). Results: The analysis of participants’ interviews led to the extraction of three themes as follows: 1)professional capability of medical ethics teachers 2)medical ethics education using active teaching methods and 3)the gap between teaching in theory and practice. Each of these themes includes several major and minor classifications, each describe a specific aspect of existing challenges in medical ethics teaching related to the teachers. Conclusion: Results indicate that medical educators in general and medical ethics teachers in particular, haven’t been efficient enough in moral development of students. Therefore, short-term professional teaching courses on medical ethics and active teaching methods are suggested to be held for all medical teachers. Besides, all medical teachers are recommended to be obliged to, as behavioral models, facilitate moral and professional development of their students in practice.

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Introduction: Cloning technology has been strengthened a long human desire for eternal life. The possibility of human cloning is the new challenges in medical education and medical ethics. The present study discussed the different perspectives in this field. Methods: This study is a review article. Related books and some database such as SID, Irandoc, Elsevier, PubMed, Magiran were searched using keywords including human cloning, therapeutic cloning, reproductive cloning, ethics and medical education. The retrieved documents were reviewed. Results: Application of this technique for human being is condemned and opponents believed that this technique impairs human dignity and takes him down to the level of worthless merchandise. Different perspectives show that opponents consider fear of human dignity failure and its consequences as the most important points. Conclusion: It seems that cloning technologies are ahead of the law. Given the well-developed laws in Iran, Iran University of Medical Science can initiate this new science and technology in regional level

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Introduction: Euthanasia is one of the most frequent question and challenging issue in clinical education. This paper aimed to investigate different views in this matter. Methods: This review article was prepared through searching scientific databases and literature that was published during 2000-2011. Results: Considering the ethical and religious principles, current views about euthanasia are different and some sometimes are opposite. Even in the societies that agree to Euthanasia, there are many limitations. Therefore, it seems that answering for the question "Euthanasia Yes or No?" is still a dilemma in medical education. Conclusion: Since there are many limitations for its fulfilling in societies which agree to euthanasia, and considering that not all the conditions can be meet, it seems that answering for the question "Euthanasia Yes or No" is still a dilemma and needs further investigations and studies.

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Introduction: Although analyzing suicide is related to religion, ethics, social psychology and sociology, its consequences affect medical education and health systems intensively. In this review study, data bases and texts on the subject were reviewed. Suicide is an unacceptable phenomenon in religion and also ethics.Challenging this ever increasing phenomenon requires extensive intersectional cooperation.

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Introduction: Medical ethics is an analytical attempt that deals with various aspects of ethical decision making in medicine. According to the importance and goals of medical ethics, this study is an endeavor to evaluate strengths and weaknesses (internal factors) as well as opportunities and threats to medical ethics education (external factors) using SWOT (Strengths,Weakness, Opportunities, and Threats) model and represent helpful strategies in medical ethics education in Isfahan University of Medical Sciences. Methods: In this cross sectional study, the opinions of 48 faculty members of Isfahan University of Medical Sciences in year 2011 were studied. After collecting the opinions, each factor was weighed (level of importance) and ranked and finally the strategies were formulated in SWOT model. Results: Evaluating internal factors of strength points, it was deriven that the most importance level (weight) belongs to “having rich Islamic and historical resources on medical ethics” with the weight of 0.10 and the grade of 2.9. Among weekness points, the top importance belonged to “using traditional methods for medical ethics education” with weight of 0.12 and ranking of 2.6. Furthermore, the sum of grades in analysis table was 2.85 for internal factors and 2.87 for external factors. The results showed that the first three priorities of formulated strategies were “inter-disciplinary medical ethics education by medical ethics and clinical sciences teachers”, “teaching medical ethics in clinical settings”, and “employing new methods in medical ethics education”, respectively. Conclusion:The analysis of internal and external factors in medical ethics education in Isfahan University of Medical Sciences which studies the weekness and strength points, opportunities, and threats to medical ethics education shows that the faculty reaction to these factors is lower than medium. On the other hand, the validity of strategies for medical ethics education development using SWOT model is high, so these strategies can play an important role in strategic planning of medical ethics education in Isfahan University of Medical Sciences.

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Introduction: Midwifery care based on the professional ethics leads to mothers’ increased prosperity and satisfaction. This study was performed to compare the effect of integration of two teaching approaches, role-modeling and narration methods, on the midwifery students’ performance in professional ethics in Qom University of Medical Sciences. Methods: This quasi-experimental before- and after- two group study was performed on all midwifery students (N=36) assigned randomly to the experiment or control groups. All were enrolled in Maternal Child Health Course, as a clinical rotation. For the experiment group, professional ethics issues were taught by role-modeling and narrative methods, while the control one experienced only the role-modeling technique. Students' performances in professional ethics in both groups were assessed before and after the instruction using a researcher-made observation checklist (score range: 0-27). Data were analyzed using independent t and paired t-tests. Results: Mean scores of students’ performance in control group was improved significantly in post test (16.85±1.39) compared to the pretest (12.34±1.42) results (t=.71, p=.001). Also in the experiment group, post test scores (20.85±2.39) were significantly different from the pretest (11.96±1.89) findings (t=.82, p=.001). Independent t test implied that the difference of post test scores in two groups was significant (t=0.8, P=0.000). Conclusion: Although both methods were effective in improving students’ performance in professional ethics in clinical setting, a blend of two methods (narration and role modeling) was more effective than role modeling alone. It is recommended that role-modeling and narration methods be used in teaching ethical issues to midwifery students.

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Introduction: Observing the criteria of professional ethics is an innate trait of nursing profession by which an individual gets committed to perform appropriately so that make no harm to the clients and improve their health status. This study aimed to determine barriers to observe professional ethics from nurses’ viewpoints in year 2012. Methods: This descriptive cross-sectional study was conducted on a census sample of nurses working in hospitals affiliated to Jahrom University of Medical Sciences (n=152). Data gathering tool was a researcher-made questionnaire about three categories of barriers to compliance with professional ethics standards, including “managerial”, “environmental” and “individual care-giving” obstacles. Data was analyzed by calculating frequency of responses to items, and weighted frequencies in each category. Results: Most responders agreed to the barrier role of environmental (68.5%), individual care-giving (62.7%) and managerial (61.6%) items in meeting ethical standards in practice. The most important barriers were lack of staff (80.3%) regarding management area, overcrowded wards (75.6%) considering environmental area, and failure in fulfillment of basic needs such as sufficient income or enough break-time for nursing staffs (84.8%). Conclusion: Environmental areas were the most important barriers of compliance with professional ethics. Therefore it is recommended that health organizations especially hospitals put emphasis on principles and standards of health care, including environmental factors via precise planning, drawing attention to importance of professional ethics in patients’ recovery, advantages of regarding these ethics and disadvantages of violating them, as well as providing desirable situation for nurses to overcome these barriers.

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Introduction: Faculties’ behavior and performance in educational settings will be judged by different groups. Due to their direct exposure to the teacher, students’ judgment is counted more significantly and their experiences could be employed in order to improve faculties’ teaching performance. The aim of this study is to explain the characteristics of a desirable teacher from the viewpoints of students. Methods: This qualitative study was performed on 15 students of a Medical University in Tehran who were selected through purposeful sampling. Data was collected through semi-structured interviews. Qualitative content analysis was used to analyze data. Results: Two fundamental themes, including teacher’s behavior attractive learning, were emerged from analysis of the declarations of participants about their teachers’ performance. Each theme includes several categories and subthemes and any of these describes a specific aspect of students’ experience of teachers’ performance. Conclusion: Based on the experiences of participants, teaching competencies and qualifications of teachers not only depends on their knowledge and professional skills, but also depends on their capabilities in effective interaction with students. In fact, observing ethics in communication with students and attractive course presentations are keys to successful teaching.

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Introduction: For years, the importance of medical ethics education in medical schools has been emphasized but there is no consensus over learning goals yet. This study aimed to investigate the learning outcomes of medical ethics education based on models of moral reasoning. Methods: This study is a review using proper keywords in databases such as Medline, Web of Science, Scoupus, and Eric limiting the results to papers published from 1990 to 2012 which resulted in finding61 articles. Seven articles related to learning objectives and 12 articles related to the model were investigated. Results: Researchers have different views on learning objectives of medical ethics education. Some believe that the goal of ethics education is to train virtuous physicians. Others believe that the more practical and measurable goal is moral reasoning skills. Showing the cognitive and attitudinal elements of an ethical behavior, however, Rest Model postulates the four components for ethical behavior to flourish. Conclusion: For teaching ethics education, skills such as emotional control, tolerance of ambiguity for multiple perspectives, and empathy in difficult situations should be taught in addition to teaching ethical principles. Moreover, appropriate environments regarding role modeling and encouraging ethical values must be provided for learners. Providing reflective opportunities also will bring insight on ethical codes that results in increasing moral commitment.

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Introduction: Dualism in the professional identity of medical faculty members and residents and conflict between the role of education and patient care have caused problems at professional performance level. This study was conducted to examine the viewpoints of faculty members and residents regarding clinical and educational performance compliance with professional ethics. Methods: This cross-sectional descriptive study was performed on all residents and clinical faculty members of Qazvin University of Medical Sciences in 2013. Data collection tools were questionnaires retrieved from Iranian-Islamic sources, whose validity and reliability had been verified. The questionnaires consisted of three parts: demographic data, ethical performance in educational and clinical fields. The collected data were analyzed using Chi-square test Kruskal- Wallis and Mann-Whitney tests. Results: Findings showed that in the field of clinical performance, the highest and lowest scores belonged to conscience domain and confession of error domain respectively (90.3% versus 50% for faculty members and 93% versus 62.1% for residents). In the educational field, the most known performance problems of faculty members and residents were lack of attention to learners’ educational problems (65.5%) and the lack of interest to participate in teaching weaker students (68.8%). Conclusion: Results indicated that the state of ethical-professional performance of faculty members and residents were moderate in the clinical and educational fields, which was far from the desirable status. Hence, comprehensive and codified interventions are suggested for improving professional practice of faculty members and residents in educational centers in order to reduce the distance between the quality of education and patient care.

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Introduction: Regular assessment of academic textbooks and revision of teaching methods are critical for making such textbooks more efficient in meeting the needs of the new generation and conveying values to them. Therefore, in line with the necessity of textbook evaluation, this research examined the extent to which the Medical Ethics book named “physicians and ethical considerations” observed Allport’s value components. Methods: The research was carried out by means of content analysis with a quantitative approach and was categorical in type. The Medical Ethics Book (physician and ethical considerations) published in 2004 by deputy of education and university affairs, Ministry of Health and Medical Education was subject to analysis. Analyses were based on Allport’s value system. Units of content analysis were sentences which directly or indirectly (their concepts) referred to one of Allport’s value components. Scott’s formula was used to determine the reliability. In order to check the reliability, ten percent of the total content of the book along with definitions associated with value components and related indicators were recoded by a second rater and the agreement was found at 0.90 as the reliability index. Results: The mean of value orientation in a total of 879 sentences referring to values was 146.5±1 with the standard deviation of 2.766. Findings showed, were ranked as social values (30.83% with 271 sentences), religious values (23.43% with 206 sentences), political values (23.09% with 203 sentences), theoretical values (10.35% with 91 sentences), economic values (9.55% with 84 sentences) and aesthetic values (2.73% with 24 sentences). Conclusion: Social values were highly expressed in the book and aesthetic values were dealt with to a lesser degree. Therefore, considering the importance of the matter, it is suggested that the content of this book be revised and take theoretical, economic and aesthetic aspects into account in order to bring balance to even content distribution.

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Introduction: Nursing is inherently a moral and ethical practice and health care quality is largely contingent upon how nurses fulfill their duties. Therefore, this study evaluated professional ethics observance in nursing practice from viewpoints of nurses and patients in teaching hospitals of Shahid Beheshti University of Medical Sciences in 2014. Methods: This descriptive cross-sectional study was performed on 210 inpatients and 210 nurses working in different wards of 5 teaching hospitals of Shahid Beheshti University of Medical sciences. Participants were selected by available sampling method. Data were collected through a researcher-made questionnaire according to Nursing Ethics in Iran. The collected data were analyzed using descriptive and inferential statistics (independent t-test, Mann-Whitney test, and Spearman and Pearson correlation coefficient). Results: Findings showed that 48.3% and 6.9% of patients evaluated nurses’ performance in observing professional ethics at bad and good level respectively, while most patients (91.7%) evaluated their performance as good. Findings also showed a significant difference between the views of patients and nurses in terms of observing professional ethics (p<0.001). Conclusion: Findings could have implications for nursing managers and planners in order to make effective plans to reduce the difference between the views of patients and nurses.

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Introduction: Considering the importance of professional ethics in managerial decision-making and promotion of organizational commitment and justice in providing high-quality services, the purpose of this study was to explore the relationship between professional ethics and organizational commitment mediated by organizational justice in Ministry of Health and Medical Education, Deputy of Education.
Methods: The research population of this descriptive, correlational study included all the staff of Ministry of Health and Medical Education, Deputy of Education in Tehran. A sample of 260 individuals was selected by means of systematic random sampling and Morgan’s table. Research instruments were Cadozier’s professional ethics questionnaire, Meyer and Allen’s organizational commitment scale, and Niehoff and Moorman’s organizational justice scale. Reliability and validity of the instruments were verified using Cronbach’s alpha. The data were analyzed by means of Pearson correlation coefficient and structural equation modeling
Results: There were positive and significant relationships between professional ethics and organizational commitment (r=0.69, p≤0.01), professional ethics and organizational justice (r=0.81, p≤0.01), and organizational justice and organizational commitment (r=0.74, p≤0.01).
Conclusion: The structural equation model for the relationships between professional ethics and organizational commitment mediated by organizational justice showed a good fit for the population in question. Accordingly, it is applicable to this selected population.
 

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Introduction: Over the last two decades, members of the medical education community have devoted a great deal of time and effort trying to ensure that medical professionalism is being inculcated in medical students and residents. There is a set of educational principles that apply to professionalism teaching during undergraduate and postgraduate education. This study aimed to investigate whether and how teaching medical professionalism is possible in medical education. 
Methods: This review study was conducted by searching through the databases of Medlib, Magiran, SID, ERIC, Scopus, Medline, and Web of Science for publications from 1995-2015, using the keywords professionalism, medical professionalism, medical education, medical ethics, and medical ethics curriculum. Out of 60 articles and 4 e-booksfound, a number of 28 articles and two books were selected for review. 
Results:Review of the publications showed that professionalism in medical education is achieved in two explicit and implicit forms. The result will be a physicianas a “professional” with all of the necessary qualities
Conclusion:Moving towards the teachings of situated learning theory shows that there should be a balance between explicit teaching of the cognitive basis of professionalism and providing opportunities for making learning happen in real-life settings. In doing so, the curriculum of medical education needs to be reformed. 

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Introduction: Professional ethics is defined as one of the necessities in the medical profession; this way, it can be conceptualized and integrated for students in the form of teachers’ relationship to others. Effective communication with the patient is one of the important interactions of educational authorities. In view of that, the purpose of this study was to investigate the role of students' perception of the relationship between faculty members and patients on their professional ethics in Birjand University of Medical Sciences.
Methods: This study is a descriptive cross-sectional type. The population included medical students of Birjand University of Medical Sciences in 2018. In this study, 151 subjects were sampled using Morgan table and stratified-random sampling method (based on educational grade). Data collection instrument was a researcher-made questionnaire. Data were analyzed both descriptively and inferentially (correlation & multiple regressions.
Results: Findings revealed that the relationship between faculty members and the patient can predict the professional ethics of the students in education and research (R2 = 0.09, P <0.01) as well as their relationship with colleagues (R2 = 0.04, P <0.01).
Conclusion: Seeing as the relationship between the faculty members and the patient affects the development of professional ethics of medical students, the interaction of the faculty with other people is one of the important issues affecting the development of professional ethics of students; accordingly, planning to improve the relationship between teachers and the patient through running workshops and in-service training courses seems indispensable.
 

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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.

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Introduction: Professional ethics is one of the key issues in the field of treatment and its observance can be the main factor for satisfaction and trust of the medical staff. This study endeavored to investigate the relationship between Islamic spirituality and spiritual health and professional ethics among Internal residents of Universities of Medical Sciences in Tehran.
Methods: This study is quantitative descriptive-survey. The population consisted of all Internal residents of Universities of Medical Sciences in Tehran who were selected by cluster sampling method. Data were collected using three researcher-made questionnaires. Their face validity was confirmed. And their reliability was calculated through Cronbach's alpha coefficient. Pearson correlation test and structural equations were used for data analysis and PLS software.
Results: The results showed that there is a significant relationship (P=0/001) between Islamic spirituality and spiritual health (β = 0.54), between Islamic spirituality and professional ethics (β = 0.25) as well as between Islamic spirituality and professional ethics with mediating role of spiritual health (β = 0.58).
Conclusion: Considering the findings of this study and the positive and significant relationship between Islamic spirituality and spiritual health with professional ethics, to expand and strengthen professional ethics it is recommended to consider the values of spiritual aspects and principles in medical science curricula.

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Introduction: Professional ethics in the medical sciences is an intellectual field of study that requires educating the medical team about the thoughts, ideas, and behaviors of ethical principles and values that are carefully evaluated until these principles and skills are institutionalized. In so doing, this study endeavored to develop a professional ethics curriculum template for medical students.
Methods: This study was conducted using a combination method in the academic year 2020 in two phases like this qualitative (model design) and quantitative (model accreditation). Qualitative data analysis was performed by interviewing 17 members of experts in the field of education, research, treatment, and ethics in medical sciences and accreditation by 10 members of curriculum specialists and Medical ethics of different universities by using Delphi method who were selected by purposive sampling method through Brown and Clark analytical method using Atlas TI.
Results: After summarizing the concepts and categories in the form of curriculum components (i.e., objectives, educational content, implementation or educational strategies and evaluation), a total of 150 conceptual propositions, one major category with four subcategories along with a sub-category, final analysis, and report a model of professionalism curriculum was presented for medical sciences students. Finally, the validation of the developed model was done by curriculum and medical ethics experts using Delphi method.
Conclusion: The results revealed that the development of uniform and codified professional ethics training programs from upstream sources seems to be essential. It is also necessary to explain the educational content of practical and applicable professional ethics, training and continuous evaluation of the principles of professional ethics in all courses and disciplines to institutionalize the principles of professional ethics in three areas of education, research, and treatment.

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Introduction: In this era, with the increase in research, the issue of ignoring the basic principles of research ethics, including determining the share of authors, is raised more than before. Different models for writing this section have been presented in reputable journals and the study endeavors to compare them to provide a practical model for writing participation in the guidelines of Persian language journals.
Methods: This review article uses English and Persian keywords: Writing Instructions, Authors' Participation Guide, Authors' Collaboration Statement, to review and compare how to write the Authors' Participation section on the website of medical publishers and instructions of reputable Persian and English journals in the databaseses such as Iranmedex, Google Scholar.
Results: After reviewing websites and magazines and removing duplicates, twelve writing patterns were identified and compared in terms of different aspects. Finally, combining different patterns and taking the strengths of each, in compliance with ICMJE and COPE criteria, the use of visual patterns to facilitate its completion, the possibility of accurate monitoring of the order of names, and ease of understanding by readers, a pattern was offered. In this template, while providing definitions of ICMJE criteria, the authors' contribution in the predefined Excel file is determined and finally, the amount of participation is presented in a table with a color spectrum called "Color-Coded Contributions" with the ability to be included in the article.
Conclusion: The proposed model in this study, based on the strengths of previous models, has provided a simple application framework. Therefore, its use in journals to comply with authors' criteria, which is one of the important indicators in the field of research ethics, could be useful.