Journal of Advances in Medical Education & Professionalism

Abstract Introduction: Systems-Based Practice (SBP) is one of the sixcompetencies introduced by the ACGME for physicians toprovide high quality of care and also the most challenging of themin performance, training, and evaluation of medical students.This concept analysis clarifies the concept of SBP by identifyingits components to make it possible to differentiate it from othersimilar concepts. For proper training of SBP and to ensure thesecompetencies in physicians, it is necessary to have an operationaldefinition, and SBP’s components must be precisely defined inorder to provide valid and reliable assessment tools.Methods: Walker & Avant’s approach to concept analysis wasperformed in eight stages: choosing a concept, determining thepurpose of analysis, identifying all uses of the concept, definingattributes, identifying a model case, identifying borderline, related,and contrary cases, identifying antecedents and consequences,and defining empirical referents.Results: Based on the analysis undertaken, the attributes ofSBP includes knowledge of the system, balanced decisionbetween patients’ need and system goals, effective role playingin interprofessional health care team, system level of healthadvocacy, and acting for system improvement. System thinkingand a functional system are antecedents and system goals areconsequences. A case model, as well as border, and contrary casesof SBP, has been introduced.Conclusion: The identification of SBP attributes in this studycontributes to the body of knowledge in SBP and reduces theambiguity of this concept to make it possible for applying it intraining of different medical specialties. Also, it would be possibleto develop and use more precise tools to evaluate SBP competencyby using empirical referents of the analysis.Keywords: Accreditation; Medical education; Competency-based education

Abstract Introduction: Continuing Medical Education (CME) has beenconsidered as a lifelong commitment for doctors to provide theoptimal care for patients. Despite a long history of creating CMEprograms, outcomes are far from ideal. The present qualitativestudy aims to clarify the barriers affecting effectiveness of the CMEprograms in Iran based on the experiences of general practitioners.Methods: Sixteen general practitioners were recruited toparticipate in in-depth interviews and field observationsconcerning experiences with CME. The study was performedusing a qualitative content analysis method. The codes, categoriesand themes were explored through an inductive process in whichthe researchers moved from specific to general.Results: The participants’ experiences identified a numberof barriers, particularly insufficient interaction with theinstructors; additional problems included the teachers’ use ofan undifferentiated approach; unreal and abstract CME; andignorance of the diverse reasons to participate in CME.Conclusion: Based on the study results, there are multiple barriers toeffective implementation of CME in Iran. The key barriers includeinsufficient interaction between the trainees and providers, whichmust be considered by other stakeholders and program designers.Such interactions would facilitate improved program design, invitemore specific tailoring of the education to the participants, allow formore effective educational methods and set the stage for outcomeevaluation from the learners actually applying their new knowledgein practice. Replication of these findings with another sample wouldimprove confidence in these recommendations, but these findingsare broadly consistent with findings in the educational literature onimproving the efficacy of CME.Keywords: Continuing medical education; General practitioners; Qualitative study

Abstract Introduction: In medical education, particularly in residencycourses, most of the training occurs in real clinical environments.Workplace-based learning profoundly affects students’ knowledge,attitudes, and practice; therefore, it should be properly planned.Due to the extensiveness of the clinical environment and itsimportance in training residents, investigating how residentslearn in these environments and detecting factors that influenceeffectiveness will help curriculum designers to promoteresidents’ learning by improving their learning environment.Therefore, our qualitative content analysis study, aimed to examinethe experiences and perspectives of internal and surgical residentsand their attending physicians about learning in clinical settings.Methods: This qualitative content analysis study was conductedthrough purposeful sampling. Semi-structured interviews wereconducted with 15 internal and surgical residents and 15 of theirattending physicians at educational hospitals of Tehran Universityof Medical Sciences.Results: The main categories explored in this study were hiddencurriculum, learning resources, and learning conditions. In thecontext of clinical environment and under its individual culture,residents learn professionalism and learn to improve theircommunication skills with patients and colleagues. Because ofclinical obligations such as priority of treating the patients foreducation or workload of the attending physicians, residentsacquire most of their practical knowledge from colleagues, fellows,or follow-up patients in different learning conditions (such as:educational rounds, morning reports and outpatient clinics). Theysee some of their attending physicians as role models.Conclusion: Changing cultural and contextual factors is ofprime importance to promote a learning-oriented environmentin a clinical setting. The present findings will help curriculumplanners and attending physicians to improve residents’ learningby means of appropriate workplace planning and by consideringthe components involved in clinical learning.Keywords: Learning; Teaching hospitals; Workplace; Curriculum; Medical students

Abstract Introduction: Research on medical students shows that adoptingself-regulation of effort, time, and study strategies can positivelyinfluence academic achievement. The purpose of the current studywas to assess learning and study strategies in medical students.Methods: This cross-sectional study was carried out in 2014-2015at Isfahan University of Medical Sciences. The sample size wasdetermined 360 students based on the results of a pilot study on 30members of the study population. Medical students in the first tofourth year of their studies were selected through simple samplingrandomly. A valid and reliable Persian translation of Learningand Study Strategies Inventory (LASSI) questionnaire wascompleted by the students. It measures three latent factors of selfregulatedlearning: Skill, Will, and Self-Regulation. It consistsof 80 questions in ten different scales (each scale including eightquestions and a variable score of 8-40). Data were analyzed usingt-test, correlation analysis, and ANOVA.Results: Considering the ten LASSI scales, the highest meanscore belonged to test strategies (28.67±4.44), and the lowestmean to self-testing (21.91±4.91). The results showed significantstatistical differences between male and female students inselecting the main idea, attitude, and self-testing. ANOVA andpost hoc Tukey tests showed a significant difference between themean scores of different areas of LASSI among students withdifferent grade point average (GPA) in the university. In all areasexcept the study aids, the mean scores of students with GPAhigher than 17.5 were significantly higher than those of studentswith GPA lower than 14.5.Conclusion: The results showed that students need help andconsultation in most areas of learning and study strategies. Using10 areas of LASSI can determine the strengths and weaknesses ofstudents in various areas. Knowing their own limitations, studentswill be able to improve their study habits. Hence, it is suggestedto evaluate the students when enrolling at universities and designeducational programs based on the students’ characteristics.Keywords: Learning; Medical student; Assessment

Abstract Introduction: In this study, the authors aimed to examine theeffects of cooperative learning methods using Web Quest andteam-based learning on students’ self-direction, self-regulation,and academic achievement.Methods: This is a comparative study of students taking a course inmental health and psychiatric disorders. In two consecutive years,a group of students were trained using the Web Quest approachas a teaching strategy (n=38), while the other group was taughtusing team-based learning (n=39). Data gathering was based onGuglielmino’s self-directed learning readiness scale (SDLRS) andBuford’s self-regulation questionnaire. The data were analyzed bydescriptive test using M (IQR), Wilcoxon signed-rank test, andthe Mann–Whitney U-test in SPSS software, version 13. p<0.05was considered as the significance level.Results: The results of the Mann–Whitney U test showed that theparticipants’ self- directed (self-management) and self-regulatedlearning differed between the two groups (p=0.04 and p=0.01,respectively). Wilcoxon test revealed that self-directed learningindices (self-control and self-management) were differed betweenthe two strategies before and after the intervention. However, thescores related to learning (students’ final scores) were higher inthe WebQuest approach than in team-based learning.Conclusion: By employing modern educational approaches,students are not only more successful in their studies but alsoacquire the necessary professional skills for future performance.Further research to compare the effects of new methods ofteaching is required.Keywords: Clinical; Nursing; Training; Students learning; Internet; Problem-based learning

Abstract Introduction: Obtaining clinical competency in clinical educationis one of the problems in nursing and use of the new methods ofclinical training is very important. Clinical supervision is one ofthe methods used as a mechanism to promote knowledge and skillfor promoting professional performance in nursing students. Thisstudy is carried out to determine the impact of clinical supervisionon field training of nursing students at Urmia University ofMedical Sciences.Methods: In the present experimental study, 32 nursing studentswere enrolled in the study based on census and randomlyassigned into two groups of experimental and control by blockrandomization. Clinical supervision was used in the experimentalgroup and the control group received routine clinical trainingsin the field. The students’ clinical skills were assessed using aresearcher-made checklist, the validity of which was confirmedthrough content validity method by 13 faculty members andits reliability was approved by test-retest method on 20 nursingstudents in the form of a pilot study and through Cronbach’s alpha(87%). Data were analyzed using SPSS, version 14.Results: There was a significant difference between theexperimental and control groups in clinical skills such asrecognition and administration of medication, team participation,patients and their relatives’ education, considering the safety,infection prevention and nursing process (p<0.005).Conclusion: The study demonstrated that in clinical supervisionprocess, students have a better communication and cooperationwith their instructor and with each other and their confidence andunderstanding and the amount of learning in practical skills wasenhanced more than routine clinical training. The implementationof this clinical training method for students of nursing and otherfields of medical sciences is recommendable.Keywords: Clinical; Nursing; Training; Students

Abstract Introduction: The script concordance test (SCT) is one the besttools used to evaluate clinical reasoning in ill-defined clinicalsituations. The aim of this study was to demonstrate SCTapplication in otolaryngology residency training.Methods: A 20 item otolaryngology SCT containing 60 questionswas administered to 26 otolaryngology residents. The test wasprepared by two otolaryngologists familiar to medical education.These questions have been validated by otolaryngologyexperts. The panel consisted of 9 academic staff in the field ofotolaryngology. Pearson correlation test was used to assess thereliability of the test.Results: The obtained mean scores were 68.4±5.8 (out of 100)for residents and 78.2±6.4 (out of 100) for experts. There wasa significant difference between the two scores (p<0.005).Cronbach’s alpha value was 0.80.Conclusion: The SCT is a reliable tool to evaluate clinicalreasoning in otolaryngology residents. It should be included inotolaryngology residency training.Keywords: Training; Otolaryngology; Validity; Reliability

Abstract Introduction: India has the highest number of medical collegesin the world and subsequently the higher number of medicalteachers. There is a dire need of adopting a systematic approach tofaculty development to enhance quality education to meet healthchallenges for 21st Century. This manuscript provides a landscapeof faculty development programs in India, identifying gaps andopportunities for reforms in faculty development.Methods: Conventionally, FDPs are organized by medical collegesand universities through Basic Courses and Advanced Coursesfocusing on pedagogy. Medical Council of India is facilitatingFDPs through 18 selected regional centers to enable medicalteachers to avail modern education technology for teaching fromJuly 2009. Foundation for Advancement of International MedicalEducation and Research has three Regional Institutes in India.Results: Recommendations include the need for formulating anational strategy for faculty development to not only enhancethe quantity of medical teachers but also the quality of medicaleducation; providing support for Departments of MedicalEducation/Regional Centers in terms of finance and staffing andincorporation of teaching skills in postgraduate training.Conclusion: Distance learning courses focusing on educationalleadership and pedagogy for medical teachers can be an optionto reach a wider audience. FDPs can be an asset in recruiting andretaining teachers as they offer valued professional developmentopportunities.Keywords: Faculty; Development; Pedagogy; Medical education