Journal of Advances in Medical Education & Professionalism

Abstract Introduction: Programs must demonstrate that their residentsare taught and assessed in professionalism. Most programsstruggle with finding viable ways to teach and assess this criticalcompetency. UTHSCSA Family and Community MedicineResidency developed an innovative option for interactive learningand assessment of residents in this competency which would betransferrable to other programs and specialties.Methods: The innovative approach uses an asynchronous onlineformat on Blackboard. Threaded discussions on Blackboardrequire thoughtful reflective writing after case assessmentand critical evaluation of other resident posts. Participation,content and progress of all resident postings are monitored byadministrative staff and faculty. Faculty can further engage theresidents at any point to deepen the discussion and learning.Results: 100% of all senior residents attained the required learningobjectives. All were actively engaged in the assignments. Six caseshave been developed using a Learning Matrix to demonstrateevaluation areas from the specialty specific competencies. Writtenfeedback from residents verified the validity of case content incontext of their current clinical practice. Postings by residentshave provided value and insight for the faculty to access theprofessional development of our Family Medicine residents. TheClinical Competency Committee evaluates all third year residentsusing this information specific to the professionalism milestones.By using an asynchronous online approach to case discussion, allresidents are involved with all aspects of this curriculum.Conclusions: More specific measurable learning outcomesare possible using this approach. Resident participation andengagement is easier to track and monitor than a lecture-basedformat and easier to capture valuable data than relying onevaluation feedback. Our Annual Review process will identifyareas for improvement in the existing cases and help createsupplemental cases based on a needs assessment by the faculty.Keywords: Milestones; Professionalism; Residency; e-learning

Abstract Introduction: Stress is an important factor in the educationalprocess. Teaching and learning are stressful processes. Thisstress can affect one’s ability and change his/her performance.The purpose of this study was to investigate stressors of clinicaleducation from the perspective of medical students in YazdUniversity of Medical Sciences.Methods: This descriptive-analytic study was conducted in YazdUniversity of Medical Science during year 2014-2015. The samplesize was 170 medical students who were selected randomly. Thedata were collected by a questionnaire including four components:interpersonal relationship, educational environment, clinicalexperience and the unpleasant emotions. A significance level of0.05 was considered for analysis. The statistical analyses includeddescriptive statistics, ANOVA and T-tests, using SPSS software,version 14.Results: The results showed that the highest domain score belongedto interpersonal relationship (3.33±0.3) followed by unpleasantemotions domain (3.3±0.3). The lowest domain score of clinicaleducation stressors was educational environment (3.12±0.1). Theresults showed that the mean score of interpersonal relationshipdomain was more in women than in men (p<0.05).Conclusion: The relationship between teachers and students is aneffective factor in all dimensions of clinical education stressors.So proper measures such as the promotion of scientific awarenessof teachers and educational staff about factors that lead to stressand the best way to communicate with students should be taken toreduce the students’ stress.Keywords: Clinical; Education; Stressors; Medical trainees

Abstract Introduction: Efficiency evaluation of universities and facultiesis one of the tools that help managers to identify the departments’strengths and weakness. The main objective of the presentresearch was to measure and compare the technical efficiency ofShiraz school of medicine departments using Data EnvelopmentAnalysis (DEA) technique.Methods: This cross-sectional and retrospective study wasperformed on clinical and non-clinical departments in researchand education domains over the period of 2006 to 2011. Differentinputs and outputs were considered for research and educationaldomain separately. Efficiency was measured based on theobserved optimal performance.Results: Findings showed that pathology and anatomydepartments achieved the score of 100 in technical efficiency ineducation during 2006 to 2011. During this period, parasitology,psychiatric and pediatrics department’s achieved the score of100 for technical efficiency in research domain. The lowestmean of relative educational efficiency belonged to orthopedicdepartment; as to relative research efficiency, the lowest meanwas shown in orthopedics and genetics departments. The meantechnical efficiency of non-medical departments in education andresearch domain was 91.93 and 76.08, respectively, while the meantechnical efficiency of the clinical department in educational andresearch fields was 91.02 and 82.23, respectively.Conclusion: Using multiple input and output in DEA techniqueprovided a comprehensive evaluation of efficiency in Shiraz schoolof medicine departments. The DEA could successfully estimatethe technical efficiency of the departments in research andeducational fields. Moreover, the deficiency in each departmentwas found; this could help them to plan for improvement.Keywords: Education; Medical school; Efficiency; Resource allocation

Abstract Introduction: Teacher evaluation, as an important strategyfor improving the quality of education, has been considered byuniversities and leads to a better understanding of the strengthsand weaknesses of education. Analysis of instructors’ scoresis one of the main fields of educational research. Since outliersaffect analysis and interpretation of information processes bothstructurally and conceptually, understanding the methods ofdetecting outliers in collected data can be helpful for scholars,data analysts, and researchers. The present study aimed to presentand compare the available techniques for detecting outliers.Methods: In this cross-sectional study, the statistical populationincluded the evaluation forms of instructors completed bythe students of Shiraz School of Health in the first and secondsemesters of the academic year 2012-2013. All the forms relatedto these years (N=1317) were entered into analysis throughcensus. Then, four methods (Dixon, Gauss, Grubb, and Graphicalmethods) were used for determining outliers. Kappa coefficientwas also used to determine the agreement among the methods.Results: In this study 1317 forms were completed by 203undergraduate and 1114 postgraduate students. The mean scoresgiven by undergraduates and postgraduates were 17.24±3.04 and18.91±1.82, respectively. The results showed that Dixon and Grubbwere the most appropriate methods to determine the outliers ofevaluation scores in small samples, because they had appropriateagreement. On the other hand, NPP and QQ plot were the mostappropriate methods in large samples.Conclusion: The results showed that each of the studied methodscould help us, in some way, determine outliers. Researchers andanalysts who intend to select and use the methods must firstreview the observations with the help of descriptive informationand overview of the distribution. Determination of outliers isimportant in evaluation of instructors, because by determiningthe outliers and removing the data that might have been recordedincorrectly, more accurate and reliable results can be obtained.Keywords: Outliers; Professors; Students; Evaluation

Abstract Introduction: Research in education is a globally significant issuewithout a long history. Due to the importance of the issue in HealthSystem Development programs, this study intended to determineresearch priorities in medical education, considering their detailsand functions. By determining barriers existing in research ineducation progress, it is tried to make research priorities morefunctional by recommending acceptable strategies.Methods: This is a qualitative-descriptive study in two descriptivephases. The goal of these phases was to determine researchpriorities subcategories in medical education by Nominal GroupTechnique (NGT) and two rounds of Delphi method. Through thefirst phase, subcategories of research priorities were determined,using Nominal Group Technique under medical education experts’supervision. Through two rounds of Delphi, a questionnaire wasconstructed based on the subcategories. Eventually, researchpriorities were determined based on their highest score (scoresmore than 7 out of 10).Results: In the first phase (NGT), 35 priorities in 5 major fieldsof medical education were presented. In the second phase,priorities were scored, using Delphi method. Medical Ethicsand professionalism gained the highest scores (7.63±1.26) andeducational evaluation the lowest (7.28±1.52). In this stage, 7items were omitted but 2 of them were added again after experts’revision in the third round of Delphi.Conclusion: According to the results of the present study andbased on previous studies, it really seems that the fields of“Learning and Teaching Approaches” and “Medical Ethics andProfessionalism” were more important. Because of financial andresource limitations in our country and the importance of researchpriorities, it is recommended to frequently study “researchpriorities determination program” at universities.Keywords: Research priorities; Medical education; Delphi method

Abstract Introduction: Establishment of effective communicationbetween the clinician and patient is essential in order to increasethe effectiveness of treatment. These skills have been lessinvestigated among dental students. This study aimed to evaluatecommunication skills of dental students in Shiraz with patientsthrough direct observation, patients’ perspectives and students’self-assessments.Methods: This cross-sectional study enrolled the fifth and sixthyear dental students and one of each student’s patients whowas chosen using simple random sampling method. We used achecklist for data collection. Students’ communication skills wereassessed at three steps of the student-patient interview – at thebeginning of the interview, during the interview, and at the endof the interview. The checklist was completed by three groups: 1)an observer, 2) the patient and 3) the student, as self-assessment.The validity of the checklist was confirmed by clinical professorsand the reliability was determined by Cronbach’s alpha test. Datawere analyzed using descriptive statistics and Student’s t test.A repeated measure MANOVA was used to compare the meancommunication skills in the researcher, patients, and students ateach step of the patient interviews.Results: There were 110 students (mean age: 22.3±8.4 years)and 110 patients (mean age: 32±8.8 years) who completed thechecklists. Overall, the communication skills of dental studentswere rated as good according to the patients. However, the observerand student participants rated the skills at the moderate level. Weobserved significant differences between communication skills inall three groups and in the three steps of the patient interviews(p<0.001). According to patients’ beliefs and students’ selfassessments, there were no differences between male and femalestudents in communication skills in the three steps of the patientinterviews (all p>0.05). However from the observer’s viewpoint,female students showed better communication skills during theinterviews (p=0.001).Conclusion: There was a degree of failure in communication skillsof dental students with patients in the interview process. It will benecessary that communication skills be taught, particularly forstudents involved in clinical practice.Keywords: Communication skill; Relationship; Dental student

Abstract Introduction: Integration of public health and medicaleducation has been thought to have an important role in medicalstudents’ training. Shiraz University of Medical Sciences hasdeveloped an MD/MPH dual degree educational program forthe talented volunteer students. The aim of this study was toassess the students’ viewpoints about various aspects of ShirazMD/MPH program.Methods: This cross-sectional study was conducted on Shirazundergraduate medical students, who were enrolled in MD/MPHprogram. A self-structured questionnaire in Persian consistingof 4 parts was used; it included demographic factors including16 questions which evaluated the students’ perspective of thegoals, content, skill development, applicability and meeting theirexpectations; 7 questions evaluating the self-reported increase ofknowledge; and 3 multiple choice questions to assess the students’motivations and opinions on the impact of the program on theirfuture career. Descriptive statistics was used for data analysis.Results: All MD/MPH students (89) with a mean age of 21.4±1.34participated in this study. Forty one of the students (46.1%) weremale and 48 (53.9%) female. Overall, 86.1% of them had positiveviews about the goals of the program; also, 83.5%, 81.2% and81.9% of them reported a positive viewpoint about the contents,the applicability and development of specific skills, and meetingtheir expectations, respectively. The students’ most frequentmotivation was “learning how to research systematically”(73%). The majority of the students reported this program to bemoderately to highly effective in increasing their knowledge inthe provided courses.Conclusion: The students had a positive view about almost allof the aspects of the MD/MPH program; this may be indicativeof the program being successful in delivering the goals,increasing the students’ knowledge and skills, and meeting theirexpectations to date. Students’ enthusiasm for the educationalprogram may lead to their motivation for better learning andthus in the program’s success.Keywords: Students; Medical education; Public health; Satisfaction