Journal of Advances in Medical Education & Professionalism

Abstract Introduction: Medical students’ ability to learn clinicalprocedures and competently apply these skills is an essentialcomponent of medical education. Complex skills with limitedopportunity for practice have been shown to degrade withoutcontinued refresher training. To our knowledge there is noevidence that objectively evaluates temporal degradation ofclinical skills in undergraduate medical education. The purposeof this study was to evaluate temporal retention of clinical skillsamong third year medical students.Methods: This was a cross-sectional study conducted at fourseparate time intervals in the cadaver laboratory at a publicmedical school. Forty-five novice third year medical studentswere evaluated for retention of skills in the following threeprocedures: pigtail thoracostomy, femoral line placement, andendotracheal intubation. Prior to the start of third-year medicalclerkships, medical students participated in a two-hour didacticsession designed to teach clinically relevant materials includingthe procedures. Prior to the start of their respective surgeryclerkships, students were asked to perform the same threeprocedures and were evaluated by trained emergency medicineand surgery faculty for retention rates, using three validatedchecklists. Students were then reassessed at six week intervalsin four separate groups based on the start date of their respectivesurgical clerkships. We compared the evaluation results betweenstudents tested one week after training and those tested atthree later dates for statistically significant differences in scoredistribution using a one-tailed Wilcoxon Mann-Whitney U-testfor non-parametric rank-sum analysis.Results: Retention rates were shown to have a statisticallysignificant decline between six and 12 weeks for all threeprocedural skills.Conclusion: In the instruction of medical students, skilldegradation should be considered when teaching complextechnical skills. Based on the statistically significant decline inprocedural skills noted in our investigation, instructors shouldconsider administering a refresher course between six and twelveweeks from initial training.Keywords: Clinical skills, Assessment, Medical education

Abstract Introduction: Identity is formed through our understanding ofourselves and what others perceive of our actions and how we dothings. Formation of professional identity includes development,advancement and socialization through social learning of specificknowledge and skills obtained within the context of professionalroles, new attitudes and values.Methods: This qualitative study used content analysis approachto explain the professionalization process of 22 social workersworking in 14 public hospitals in Tehran based on theirexperiences. The data were collected through semi-structuredinterviews, observation and writing in the field.Results: Eleven categories and three themes of entry into theprofession, identity formation, and identity ownership wereextracted out of data analysis. Revealing the process, barriers andfacilitators of professionalization of hospital social workers wasthe results of this study.Conclusion: Certain individual characteristics were factorsfor the tendency of participants to choose this profession. Theparticipants’ understanding of their profession was formed, whenstudying in the university through learning relevant knowledge,skills, views and professional expectations. Achieving a singleidentity and professional pride and self-esteem are achievementsof identity ownership.Keywords: Content analysis, Hospital, Social worker, Professionalism

Abstract Introduction: Communication skill (CS) has been regarded as one of thefundamental competencies for medical and other health care professionals.Student’s attitude toward learning CS is a key factor in designing educationalinterventions. The original CSAS, as positive and negative subscales, wasdeveloped in the UK; however, there is no scale to measure these attitudesin Iran. The aim of this study was to assess the psychometric characteristicof the Communication Skills Attitude Scale (CSAS), in an Iranian contextand to understand if it is a valid tool to assess attitude toward learningcommunication skills among health care professionals.Methods: Psychometric characteristics of the CSAS were assessed byusing a cross-sectional design. In the current study, 410 medical studentswere selected using stratified sampling framework. The face validity of thescale was estimated through students and experts’ opinion. Content validityof CSAS was assessed qualitatively and quantitatively. Reliability wasexamined through two methods including Chronbach’s alpha coefficient andIntra class Correlation of Coefficient (ICC). Construct validity of CSAS wasassessed using confirmatory factor analysis (CFA) and explanatory factoranalysis (PCA) followed by varimax rotation. Convergent and discriminantvalidity of the scale was measured through Spearman correlation. Statisticalanalysis was performed using SPSS 19 and EQS, 6.1.Results: The internal consistency and reproducibility of the total CSASscore were 0.84 (Cronbach’s alpha) and 0.81, which demonstrates anacceptable reliability of the questionnaire. The item-level contentvalidity index (I-CVI) and the scale-level content validity index (S-CVI/Ave) demonstrated appropriate results: 0.97 and 0.94, respectively. Anexploratory factor analysis (EFA) on the 25 items of the CSAS revealed4-factor structure that all together explained %55 of the variance. Resultsof the confirmatory factor analysis indicated an acceptable goodness-offitbetween the model and the observed data. [χ2/df=2.36, ComparativeFit Index (CFI)=0.95, the GFI=0.96, Root Mean Square Error ofApproximation (RMSEA)=0.05].Conclusion: The Persian version of CSAS is a multidimensional, validand reliable tool for assessing attitudes towards communication skillamong medical students.Keywords: Communication skills, Attitude, Psychometrics

Abstract Introduction: We evaluated the effects of implementing Team-Based Learning (TBL) on student engagement, accountability,satisfaction, and preference for lecture or team-based learning.Moreover, we assessed the effect of TBL on knowledge retentionand application over time through short answer questions based onclinical scenarios addressing history taking and diagnosis skills inmedical students.Methods: The study was conducted in a quasi-experimental design.The study population were all of the third-year medical students(n=84) participating in a course of rheumatology in ShariatiHospital, which is a teaching hospital affiliated to Tehran Universityof Medical Sciences. We compared TBL with the conventionallecture-based method. The assessments were performed afterimplementation of TBL by the Classroom Engagement Survey(CES) and Team-Based Learning Student Assessment Instrument(TBL-SAI). The assessment for application of knowledge wasconducted in 3 time-points through short answer questions onrheumatic diseases. The comparison of results was made byStudent’s t-test and repeated-measures analysis of variance (RMANOVA)using SPSS software, version 16.Results: The CES scores indicated a high level of engagement inTBL (Mean±SD=26.7±3.70, p=0.0001) but not in the lecture-basedsessions (Mean±SD=23.80±4.35, p=0.09). The total mean score(SD) for TBL-SAI was 159.68 (14.14) for TBL sessions indicatinga favorable outcome (p=0.0001). The student scores obtained fromthe short answer questions showed that over time the students’scores had declined significantly less for the TBL sessions incomparison to the lecture-based sessions, F (2, 166)=4.624,p=0.011.Conclusion: The results indicated higher student engagement,satisfaction and long term learning by TBL.Keywords: Learning; Team-based learning; Outcome

Abstract Introduction: Recognition of professional and unprofessionalbehaviors is the most important and fundamental factor whichaffects the relationships between the doctors and patients.Therefore, in order to progress in their professional life, doctorsare supposed to understand and follow these behaviors.Methods: This is a cross-sectional, descriptive analytical study.All students in teaching hospital of Shiraz University of MedicalSciences were eligible to participate (374 individuals with censusmethod). The data were collected using a questionnaire containing29 questions about the concept of medical professionalism. Here,participation of medical students in unprofessional behaviorsand the relevance of this participation with the perception ofthese behaviors were considered. Data were analyzed throughSPSS version 15, using descriptive statistics, t-test and Pearsoncorrelation test.Results: According to the obtained data, despite the fact thatall students (140 students in the junior and 234 in the senioryears as interns) had passed the course of professionalism(95.7%), the perception of unprofessional behaviors between thetwo groups was significantly different (p<0.001) and the meanof the perception among junior students was higher than theinterns. No significant difference was observed in participationin unprofessional behavior rates of the two groups (p=0.451).Moreover, the data did not reveal a strong relationship betweenparticipation in unprofessional behavior and what is taught in thecurriculum (p=0.079).Conclusion: Medical students’ perception of unprofessionalbehaviors as acceptable may increase their participation inthese behaviors. Thus, medical policy makers should considerapproaches beyond simply providing ethical and professionalguidelines or policies, and students should be regularly evaluatedfor their activities; their professional behaviors should be evaluatedin order to temper them, when appropriate.Keywords: Professional; Behavior; Perception, Teaching; Hospital, Medical student, Clinical medicine

Abstract Introduction: Clinical reasoning is one of the most importantskills in the process of training a medical student to become anefficient physician. Assessment of the reasoning skills in a medicalschool program is important to direct students’ learning. One ofthe tests for measuring the clinical reasoning ability is ClinicalReasoning Problems (CRPs). The major aim of this study is tomeasure psychometric properties of CRPs and define correlationbetween this test and routine MCQ in cardiology department ofShiraz medical school.Methods: This study was a descriptive study conducted ontotal cardiology residents of Shiraz Medical School. The studypopulation consists of 40 residents in 2014. The routine CRPsand the MCQ tests was designed based on similar objectives andwere carried out simultaneously. Reliability, item difficulty, itemdiscrimination, and correlation between each item and the totalscore of CRPs were all measured by Excel and SPSS softwarefor checking psycometeric CRPs test. Furthermore, we calculatedthe correlation between CRPs test and MCQ test. The meandifferences of CRPs test score between residents’ academic year[second, third and fourth year] were also evaluated by Analysis ofvariances test (One Way ANOVA) using SPSS software (version20)(α=0.05).Results: The mean and standard deviation of score in CRPs was10.19±3.39 out of 20; in MCQ, it was 13.15±3.81 out of 20. Itemdifficulty was in the range of 0.27-0.72; item discrimination was0.30-0.75 with question No.3 being the exception (that was 0.24).The correlation between each item and the total score of CRP was0.26-0.87; the correlation between CRPs test and MCQ test was0.68 (p<0.001). The reliability of the CRPs was 0.72 as calculatedby using Cronbach’s alpha. The mean score of CRPs was differentamong residents based on their academic year and this differencewas statistically significant (p<0.001).Conclusion: The results of this present investigation revealed thatCRPs could be reliable test for measuring clinical reasoning inresidents. It can be included in cardiology residency assessmentprograms.Keywords: Cardiovascular, Clinical reasoning, Reliability

Abstract Introduction: Academic institutions are the most importantorganizations for implementation of internationalization policiesand practices for integrating an international, intercultural andglobal dimension in higher education system. Also, a globallyincreasing demand for higher education has been seen in the pasttwo decades so that the number of students enrolled in highereducation institutions in the worldwide nation-states has increaseddramatically. The National Plan of International Developmentof Medical Education was designed with the aim of identifyingavailable potentials in all the universities of medical sciences,encouraging the development of international standards ofmedical education, and planning for the utilization of the existingcapacity in Islamic republic of Iran.Methods: Authors have tried to review the several aspectsof international activities in higher education in the world anddescribe national experiences and main policies in globalization ofmedical education in Iran within implementation of the NationalPlan for Development and Innovation in Medical Education.Results: The findings of some global experiences providethe policy makers with clear directions in order to developinternationalization of higher education.Conclusion: The Program for International Development ofMedical Education was designed by the Deputy of Educationin the Ministry of Health and the effective implementationof this Program was so important for promotion of Iranianmedical education. But there were some challenges in thisregard; addressing them through inter-sectoral collaborationis one of the most important strategies for the development ofinternationalization of education in the field of medical sciences.Keywords: Medical education, Higher education, Innovation

Abstract The importance of role models in medicaleducation cannot be understated. Theyallow for professional development, aid in careermotivation and inspire and educate throughexample. Unfortunately, I cannot admit knowingmore than three female role models throughoutmy time at medical school, and now as a finalyear student, I am more disappointed than everfor this deficit.My admiration and respect for doctorsremains sky high, but from the age of 15, Iremember being put off and discouraged froma career in medicine. My first work experienceplacement was met with disgruntled medicalstudents and doctors warning me to ‘steer clear’of this career choice. Notably, female doctorswould state their reservations about whether theycould adequately bring up a stable family togetherwith the demands of this profession. This wasan extremely frustrating resolution for me to seeas a young, inspired medic- who passionatelyfelt I would work hard to do both. I sought tofind out more about the challenges for womenin medicine.There lies no dispute that having a stablefamily life and successful career is no easy featfor women. Yet, the mere choice between a familyand/or career is far more intricate than it mayseem; it is really a question exploring personallife priorities, resolute character traits and, mostimportantly, equal gender opportunities and thenecessity for greater support for women withfamilies (1).Gender equity and empowerment areinextricably linked to a woman’s entitlementand contribution to the workplace. Evidently, theendless unpaid hours of bringing up a family needgreater recognition- arguably a full time job initself; some people still don’t deem the demandingwork of a mother as a career- illustrated byCatherine Deveny’s Guardian article (2).Women are often invited to defend their lifechoices, or fulfil gender expectations. Maybe,as women we need to alter our own insight intowhat it means to be a successful career womanand mother. What defines doing ‘well’ whendescribing family life, a subjective word for sucha prevalent aspiration.The deplorable deluge of negative headlinesafter the report from the Royal College ofPhysicians (2009) stating women will predominatethe workforce in 2017 inflamed public perceptionwith assertions including, “Women docs weakenmedicine” (3). This was a shocking flavour ofnegativism for women in medicine- and addedto both my curiosity and anger at the situation.The apparent vulnerability of women isparticularly evident amongst certain geographicalpopulations; for example, in Iran, there arepalpable traditional differences between genders,rendering unequal social rights, salaries andemployment opportunities (4), with furthersignificance on health status. Article 158,of the Third Development plan, instigated aresolute initiative for increasing awarenessand incorporation of women in society, whichincluded the promotion of job opportunitiesfor women (5). Furthermore, accessibility ofadvanced surgical training is highly limited,with Dr Sakineh Pari, born in 1902, being thefirst Iranian female surgeon (6). Despite theevolution of greater gender equality in Iranianmedical employment, it is clear that we needfurther progress towards true equality.I want to pose a note of reflection: why dothese negative perceptions still exist even in2017? We need to act now to ensure the womenof the future have confidence that they can bothcultivate a great family and career; it is possible,with the appropriate communication, support andflexibility that are essential to both motherhoodand top career posts, especially within countrieswhere gender inequalities are rife.