Strides in Development of Medical Education

Document Type : Review

Authors

1 Medical Education Leadership and Management Research Center, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

4 Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Context In order to improve the quality of clinical education, it is necessary to investigate the current situation in clinical settings and identify its problems. This step is the most important part of modifying a clinical education program and meeting learning goals. The purpose of this study was to identify the challenges and problems of clinical medical education in Iran. Evidence Acquisition This systematic review was performed to determine the challenges and problems of clinical medical education in Iran in 2017. In order to retrieve articles, the following keywords: Clinical education, bedside teaching, clinical teaching, teaching round, ward round, ward round teaching, bedside round, teaching round, medical education, clinical round, ambulatory education, clinic education, grand round, and education in emergency were searched in reliable Persian and English databases. Then, the articles related to the research objective were carefully reviewed and key information was extracted. Data were analyzed using MAXQDA software version 10. Conclusions The problems of clinical education are in different areas. Identifying these areas and planning for them can improve clinical education status, achieve educational goals, and provide medical students with a more effective education.

Keywords

  1. Esmaeili M, Haghdoost A, Beigzadeh A, Bahman Bijari B, Bazrafshan A. [Personal and scientific characteristics of positive and negative role models among medical educators from the viewpoint of dentistry and pharmacy students in Kerman University of Medical Sciences, Iran]. Strides Dev Med Educ. 2013;10(3). Persian. e60692.
  2. Beigzadeh A, Adibi P, Bahaadinbeigy K, Yamani N. Strategies for teaching in clinical rounds: A systematic review of the literature. J Res Med Sci. 2019;24:33. doi: 10.4103/jrms.JRMS_460_18. [PubMed: 31143234]. [PubMed Central: PMC6521742].
  3. Beigzadeh A, Bahaadinbeigy K, Adibi P, Yamani N. Identifying the challenges to good clinical rounds: A focus-group study of medical teachers. J Adv Med Educ Prof. 2019;7(2):62–73. doi:10.30476/jamp.2019.44710.
  4. Adibi P, Alizadeh R. [The effects of clinical rounds on patients in internal wards of hospitals affiliated to Isfahan University of Medical Sciences: The viewpoints of clinical care team]. Iran J Med Educ. 2007; 7(1):15–22. Persian.
  5. Zaighami R, Faseleh M, Jahanmiri SH, Ghodsbin F. [Nursing students’ viewpoints about the problems of clinical teaching]. J Qazvin Univ Med Sci. 2004;8(1):51–5. Persian.
  6. Alavi A, Parvin N. [The view point of nursing and midwifery students about characteristics of effective clinical instructors]. Avicenna J Nurs Midwifery Care. Persian.
  7. Hadizadeh F, Firoozi M, Shamaeyan Razavi N. [Nursing and midwifery students perspective on clinical education in Gonabad University of Medical Sciences]. Iran J Med Educ. 2005;5(1):70–8. Persian.
  8. Peirce AG. Preceptorial students’ view of their clinical experience. J Nurse Educ. 1991;30(6):244–50. doi: 10.3928/0148-4834-19910601-04.
  9. Ahmadinejad Z, Ziaee V, Morravedgi A. [A survey on student’s satisfaction of clinical education and its related factor]. Iran J Med Educ. 2002;2:15–6. Persian.
  10. Spencer J. Learning and teaching in the clinical environment. BMJ. 2003;326(7389):591–4. doi:10.1136/bmj.326.7389.591. [PubMed:12637408]. [PubMed Central: PMC1125480].
  11. Nair BR, Coughlan JL, Hensley MJ. Impediments to bed-side teaching. Med Educ. 1998;32(2):159–62. doi: 10.1046/j.1365-2923.1998.00185.x. [PubMed: 9743767].
  12. Hendry RG, Kawai GK, Moody WE, Sheppard JE, Smith LC, Richardson M, et al. Consultant attitudes to undertaking undergraduate teaching duties: Perspectives from hospitals serving a large medical school. Med Educ. 2005;39(11):1129–39. doi: 10.1111/j.1365-2929.2005.02320.x. [PubMed: 16262809].
  13. Ahmady S, Hosseini M, Homam SM, Farajpour A, Ghitaghi M, HosseiniAbardeh M. [Challenges of medical education at Islamic Azad University, Iran, from faculty perspective: A qualitative content analysis]. Strides Dev Med Educ. 2016;13(2). Persian. e57943.
  14. Rohani M, Baradaran HR, Sanagoo A, Sarani M, Yazdani S, Alizadeh HR. [Attitudes of medical students , interns, residents and attending professors toward morning report]. Razi J Med Sci. 2016; 23(147):115–24. Persian.
  15. Salari A, Moaddab F, Rouhi Balasi L, Dadgaran I, Nourisaeed A, Pourali H, et al. [Medical interns’ satisfaction of clinical education’s quality in Rasht hospitals]. Educ Res Med Sci. 2016;5(2):97–102. Persian.
  16. Jamaazghandi A, Emadzadeh A, Vakili V, Bazaz SM. Quality of bedside teaching in internal wards of Qaem and Imam Reza hospitals in Mashhad. Electron Physician. 2015;7(4):1205–13. doi:10.14661/2015.1205-1213. [PubMed: 26396735]. [PubMed Central: PMC4578541].
  17. Iranmanesh F, Hamzei Moghaddam A, Shafa MA. [Evaluation of the quality of teaching in neurology ward, Kerman University of Medical Sciences, Iran, from the point of view of medical students]. Strides Dev Med Educ. 2013;10(2). Persian. e60979.
  18. Niroumand E, Khazaei MR, Vaziri S, Najafi F, Karami Matin B. [Quality of ambulatory education from the viewpoint of the clinical medical students at Kermanshah University of Medical Sciences in 2013]. Educ Res Med Sci. 2014;3(1):3–9. Persian.
  19. Fani Pakdel A, Anvari K, Rostami S. [Evaluation perspective of clinical assistants of Mashhad University of Medical Sciences toward educational grant round program]. Horizon Med Educ Dev J. 2011;4(4):83–6. Persian.
  20. Ala M, Khashayar P, Baradaran HR, Larijani B, Aghaee Mybodi HR. [Factors affecting the quality of grand round from the perspectives of stagers, interns, residents and fellows]. IJDLD. 2013;12(2):160–6. Persian.
  21. Arabshahi KS, Haghani F, Bigdeli S, Omid A, Adibi P. Challenges of the ward round teaching based on the experiences of medical clinical teachers. J Res Med Sci. 2015;20(3):273–80. [PubMed: 26109975]. [PubMed Central: PMC4468233].
  22. Jalalvandi F, Yeganeh N, Shahsavari S, Ghorbani S, Moradi O, Ahmadi S, et al. [Evaluation of medical students’ views on the current state ofclinical education]. J Clin Res Paramed Sci. 2014;2(4):260–6. Persian.
  23. Sarchami R, Sarreshtehdari M, Yazdi Z, Sharifi M, Ziaee A, Ovesi S, et al. [Quality of clinical teaching in teaching hospitals of Qazvin from the viewpoints of stagers, interns and residents in 2010-2011]. J Med Educ Dev. 2011;5(1):9–16. Persian.
  24. Azemian A, Motamed N, Yousefi MR. [Barriers and facilitating factors in learning of effective clinical teaching in Bushehr University of Medical Sciences: Clinical students, point of view - 2010]. Educ Dev Jundishapur. 2015;6(1):8–17. Persian.
  25. Masoomi B, Dastgiri M. [Medical students’ satisfaction about quality of education in Medial Emergency Ward in Isfahan University of Medical Sciences]. J Isfahan Med Sch. 2011;28(121). Persian.
  26. Ghaffarifar S, Ghojazadeh M, Alizadeh M, Ghaffari MR, SadeghiGhyassi F. An academic medical center: A customized strategy to overcome the shortcomings of interns’ ambulatory education. Shiraz EMed J. 2012;13(3):113–21.
  27. Gandomkar R, Salsali M, Mirzazadeh A. [Factors influencing medical education in clinical environment: Experiences of clinical faculty members]. Iran J Med Educ. 2011;11(3):279–90. Persian.
  28. Anbari Z, Syros A, Godarzi D, Zamani H. [Satisfaction of medical students from the medical education process in externship and internship periods in internal and obstetric wards in Arak University of Medical Sciences]. J Health Care. 2009;11(2):33–25. Persian.
  29. Anbari Z, Ramezani M. [The obstacles of clinical education and strategies for the improvement of quality of education at Arak University of Medical Sciences in 2008]. J Arak Univ Med Sci. 2010; 13(2): 110–8. Persian.
  30. Jamshidian S, Shams B, Changiz T. [Educational challenges in ambulatory pediatrics teaching programs based on the experiences of interns and attends: A qualitative study]. Strides Dev Med Educ. 2010;7(2). Persian. e60511.
  31. Sharifi B, Ghafarian Shirazi HR, Momeninejad M, Saniee F, Hashemi N, Jabarnejad A, et al. [A survey of the quality and quantity of clinical education from the viewpoint of medical students]. J Pars Jahrom Univ Med Sci. 2012;10(2):57–64. Persian. doi: 10.29252/jmj.10.2.57.
  32. Bazazi N, Falahi Nia G, Yavari Kia A, Houshmand B. [Medical students’ viewpoints about the quality of education in outpatient clinics in Hamedan University of Medical Sciences in 2007]. Iran J Med Educ. 2011;11(2):167–73. Persian.
  33. Siabani S, Moradi MR, Siabani H, Rezaei M, Siabani S, Amolaei KH, et al. [Students’ view points on the educational problems in medical school of Kermanshah University of Medcial Sciences (2007)]. J Kermanshah Unive Med Sci. 2009;13(2):162–71. Persian.
  34. Nasri K, Kahbazy M, Noroozy A, Nasri S. [The medical education problems and possible Solutions in stagers and intern’s view points of Arak University of Medical Sciences, 2006-07]. J Arak Univ Med Sci. 2010;12(4):111–21. Persian.
  35. Khorasani GA, Mahmoudi M, Vahidshahi K, Shahbaznejad L, Ghafari M. [Evaluation of faculty members’ and students’ attitude towards ambulatory teaching quality]. J Mazandaran Univ Med Sci. 2007;17(58):87–100. Persian.
  36. Roodpeyma SH, Salemi H. Medical students’ perceptions of their clinical training in the pediatric ward of a teaching hospital, Iran. Middle East J Family Med. 2011;9(6):28–32.
  37. Zamanzad B, Moezzi M. [Rate of satisfaction and evaluation of medical students (interns and externs) from the quality of clinical education in the Shahrekord University of Medical Sciences-2005]. Koomesh. 2007;9(1):13–20. Persian.
  38. Adibi P, Anjevian M. [The clinical rounds on patients’ bedside in internal ward from patients’ viewpoints]. Iran J Med Educ. 2006;6(1):15–20. Persian.
  39. Zahedi M, Amirmaleki Tabrizi H. [Medical education effectiveness from the viewpoints of medical students of Tehran University of Med ical Sciences]. Iran J Med Educ. 2008;7(2):289–98. Persian.
  40. Fasihi Harandi T, Soltani Arabshahi S, Tahami S, Mohammadalizadeh S. [Viewpoints of medical students about the quality of clinical education]. J Qazvin Univ Med Sci. 2004;8(30):4–9. Persian.
  41. Hosseinpour M, Behdad A, Samii H. [Assessment of medical interns opinion about education in surgery courses in Isfahan University of Medical Sciences]. Iran J Med Educ. 2001;1(3):30–5. Persian.
  42. Ziaee V, Ahmadinejad Z, Morravedji AR. An evaluation on medical students’ satisfaction with clinical education and its effective factors. Med Educ Online. 2004;9(1):4365. doi: 10.3402/meo.v9i.4365. [PubMed:28253123].
  43. Mortazavi SAA, Razmara A. [Medical student satisfaction in different educational locations]. Iran J Med Educ. 2001;1(3):51–4. Persian.
  44. Fekri A, Sarafinejad A. [A survey of medical Students opionion regarding the quality of clinical medical education in 3 different educational groups]. Teb va Tazkiyeh. 2001;10(1):25–33. Persian.
  45. Karimi Monaghi H, Derakhshan A, Khajedalouei M, Dashti Rahmat Abadi M, Binaghi T. [Lived clinical learning experiences of medical students: A qualitative approach]. Iran J Med Educ. 2012;11(6):635–47. Persian.
  46. Avizhgan M, Farzanfar E, Najafi MR, Shams B, Ashoorion V. [Ambulatory education quality in Al-Zahra Hospital clinics in Isfahan, veiw of clerkships students and interns]. Iran J Med Educ. 2011; 10(5): 896–905. Persian.
  47. Esteghamati A, Baradaran H, Monajemi A, Khankeh HR, Geranmayeh M. Core components of clinical education: A qualitative study with attending physicians and their residents. J Adv Med Educ Prof. 2016; 4(2):64–71. [PubMed: 27104200]. [PubMed Central: PMC4827758].
  48. Haghani F, Arabshahi SK, Bigdeli S, Alavi M, Omid A. Medical academia clinical experiences of Ward Round Teaching curriculum. Adv Biomed Res. 2014;3:50. doi: 10.4103/2277-9175.125771. [PubMed:24627858]. [PubMed Central: PMC3949336].
  49. Rezaee R, Ebrahimi S. Clinical learning environment at Shiraz Medical School. Acta Med Iran. 2013; 51(1):62–5. [PubMed: 23456587].
  50. Mosalanejad L, Hojjat M, Badeyepeyma Z. A comprehensive evaluation of the quality and barriers of bedside teaching from professors’ point of view. Int J Nurs Educ. 2013;5(2):233. doi: 10.5958/j.0974-9357.5.2.102.
  51. Castiglioni A, Shewchuk RM, Willett LL, Heudebert GR, Centor RM. A pilot study using nominal group technique to assess residents’ perceptions of successful attending rounds. J Gen Intern Med. 2008; 23(7):1060–5. doi: 10.1007/s11606-008-0668-z. [PubMed:18612745]. [PubMed Central: PMC2517943].
  52. Jones P, Rai BP. The status of bedside teaching in the United Kingdom: The student perspective. Adv Med Educ Pract. 2015;6:421–9. doi:10.2147/AMEP.S83407. [PubMed: 26082672]. [PubMed Central:PMC4461119].
  53. Yaghoobi T, Saleme F, editors. [Assessment of clinical education problem and improving strategies from the viewpoint of medical student at Mazandaran Medical University 2003-4]. Procedings of the 7th National Congress of Medical Education. Tabriz, Iran. 2005. Persian.
  54. Jaye C, Egan T, Smith-Han K, Thompson-Fawcett M. Teaching and learning in the hospital ward. N Z Med J. 2009;122(1304):13–22. [PubMed: 19859088].
  55. Masic I, Novo A, Deljkovic S, Omerhodzic I, Piralic A. How to assess and improve quality of medical education: Lessons learned from Faculty of Medicine in Sarajevo. Bosn J Basic Med Sci. 2007;7(1):74–8. doi:10.17305/bjbms.2007.3097. [PubMed: 17489774]. [PubMed Central:PMC5802293].
  1. Dybowski C, Harendza S. Bedside teaching: General and discipline-specific teacher characteristics, criteria for patient selection and difficulties. GMS Z Med Ausbild. 2013;30(2):Doc23. doi:10.3205/zma000866. [PubMed: 23737920]. [PubMed Central:PMC3671319].
  1. Claridge A. What is the educational value of ward rounds? A learner and teacher perspective. Clin Med (Lond). 2011;11(6):558–62. doi:10.7861/clinmedicine.11-6-558. [PubMed: 22268309]. [PubMed Central: PMC4952336].
  2. Ramani S, Orlander JD, Strunin L, Barber TW. Whither bedside teaching? A focus-group study of clinical teachers. Acad Med. 2003;78(4):384–90. doi: 10.1097/00001888-200304000-00014. [PubMed: 12691971].
  3. Obeidi N, Motamed N. [Comparison of students’ and teachers’ viewpoints about clinical education environment: A study in paramedical and nursing and midwifery schools of Bushehr University of Medical Sciences]. Strides Dev Med Educ. 2011;8(1). Persian. e59621.
  4. Williams KN, Ramani S, Fraser B, Orlander JD. Improving bedside teaching: Findings from a focus group study of learners. Acad Med. 2008;83(3):257–64. doi: 10.1097/ACM.0b013e3181637f3e. [PubMed:18316871].
  5. Gonzalo JD, Heist BS, Duffy BL, Dyrbye L, Fagan MJ, Ferenchick G, et al. Identifying and overcoming the barriers to bedside rounds: A multicenter qualitative study. Acad Med. 2014;89(2):326–34. doi:10.1097/ACM.0000000000000100. [PubMed: 24362381].
  6. Force J, Thomas I, Buckley F. Reviving post-take surgical ward round teaching. Clin Teach. 2014; 11(2):109–15. doi: 10.1111/tct.12071. [PubMed:24629247].
  7. Khan IA. Bedside teaching-making it an effective instructional tool. J Ayub Med Coll Abbottabad. 2014;26(3):286–9.
  8. Holla R, Shrisha M, Unnikrishnan B, Sharma N, Janani S, Thapar R, et al. Facilitators and barriers for bedside teaching in the teaching hospitals of coastal south india. Asian J Pharmaceut Clin Res. 2015; 8(2):271–3.
  9. Shehab A. Clinical teachers’ opinions about bedside-based clinical teaching. Sultan Qaboos Univ Med J. 2013;13(1):121–6. doi: 10.12816/0003205. [PubMed: 23573392]. [PubMed Central:PMC3616777].
  10. Al-Swailmi FK, Khan IA, Mehmood Y, Al-Enazi SA, Alrowaili M, Al-Enazi MM. Students’ perspective of bedside teaching: A qualitative study. Pak J Med Sci. 2016;32(2):351–5. doi: 10.12669/pjms.322.9194. [PubMed:27182238]. [PubMed Central: PMC4859021].
  11. Dewhurst G. Time for change: Teaching and learning on busy post-take ward rounds. Clin Med (Lond). 2010;10(3):231–4. doi:10.7861/clinmedicine.10-3-231. [PubMed: 20726450].
  12. Wiseman C. Is patient satisfaction affected by a student? Clin Teach. 2014;11(1):62–3. doi:10.1111/tct.12078. [PubMed: 24405924].
  13. Gonzalo JD, Masters PA, Simons RJ, Chuang CH. Attending rounds and bedside case presentations: Medical student and medicine resident experiences and attitudes. Teach Learn Med. 2009;21(2):105–10. doi: 10.1080/10401330902791156. [PubMed: 19330687]. [PubMed Central: PMC2696474].
  14. Janicik RW, Fletcher KE. Teaching at the bedside: A new model. Med Teach. 2003;25(2):127–30. doi:10.1080/0142159031000092490. [PubMed: 12745518].
  15. Mazor KM, Stone SL, Carlin M, Alper E. What do medicine clerkship preceptors do best? Acad Med. 2002;77(8):837–40. doi:10.1097/00001888-200208000-00018. [PubMed: 12176701].
  16. Mahoori K, Sadeghi Hassanabadi A, Karimi A, Tabatabaei HR, editors. [The viewpoint of clinical faculty members of Shiraz University of Medical Sciences about the participation of private sector’s physicians concerning outpatient education to medical students]. Procedings of the 1st National Congress of Ambulatory. Shiraz University of Medical Science, Shiraz, Iran. 2011. Persian.
  17. Wolpaw TM, Wolpaw DR, Papp KK. SNAPPS: A learner-centered model for outpatient education. Acad Med. 2003;78(9):893–8. doi:10.1097/00001888-200309000-00010. [PubMed: 14507619].
  18. Beigzadeh A, Okhovati M, Mehrolhasani MH, Shokoohi M, Bazrafshan A. [Challenges of the bachelor program of health services management: A qualitative study]. J Health Admin. 2014;17(55):29–42. Persian.
  19. Fakhari A, Kargarmaher M, Gholizadegan A, editors. [Viewpoint of Interns in medical school about exam method at clinical department]. Procedings of the 7th National Congress of Medical Education. Tabriz, Iran. 2005. Persian.
  20. Vali L, Shokoohi M, Beigzadeh A. [Characteristics of a capable university teacher the viewpoints of faculty members of Health Services Management Department in Iranian medical universities]. Iran J Med Educ. 2014;14(2):90–100. Persian.
  21. Beigzadeh A, Shokoohi M, Vali L. [Characteristics of a capable university lecturer from the viewpoints of health services management students in Iranian medical universities]. Strides Dev Med Educ. 2014; 11(3):330–41. Persian.
  22. Bahman Bijari B, Zare M, Haghdoost AA, Bazrafshan A, Beigzadeh A, Esmaili M. Factors associated with students’ perceptions of role modelling. Int J Med Educ. 2016;7:333–9. doi:10.5116/ijme.57eb.cca2. [PubMed: 27743447]. [PubMed Central: PMC5116367].
  23. Razavi Asl M. [Investigate the relationship between economic- social factors and job satisfaction in government agencies and institutions in Dehdasht] [dissertation]. Shiraz: University of Shiraz; 1997. Persian.
  24. Nair BR, Coughlan JL, Hensley MJ. Student and patient perspectives on bedside teaching. Med Educ. 1997;31(5):341–6. doi: 10.1046/j.1365-2923.1997.00673.x. [PubMed: 9488854].
  25. Kern DC, Parrino TA, Korst DR. The lasting value of clinical skills. JAMA. 1985;254(1):70–6. [PubMed:3999353].
  26. Tonesk X. The house officer as a teacher: What schools expect and measure. J Med Educ. 1979; 54(8):613–6. [PubMed: 469909].
  27. Tremonti LP, Biddle WB. Teaching behaviors of residents and faculty members. J Med Educ. 1982;57(11):854–9. doi: 10.1097/00001888-198211000-00006. [PubMed: 7131507].
  28. Seabrook MA. Medical teachers’ concerns about the clinical teaching context. Med Educ. 2003;37(3):213–22. doi: 10.1046/j.1365-2923.2003.01437.x. [PubMed: 12603760].
  29. Hoffman KG, Donaldson JF. Contextual tensions of the clinical environment and their influence on teaching and learning. Med Educ. 2004;38(4):448–54. doi: 10.1046/j.1365-2923.2004.01799.x. [PubMed:15025646].
  30. Zygmont DM, Schaefer KM. Assessing the critical thinking skills of faculty: What do the findings mean for nursing education? Nurs Educ Perspect. 2006;27(5):260–8. [PubMed: 17036684].
  31. Aghakhani N, Baghaee R, Rahbar N. [Procedings of the clinical evaluation of students’ learning difficulties, Urmia University of Medical Sciences]. Seminar on Emerging Trends in Medical Education Evaluating. Mashhad, Iran. 2010. Persian.
  32. Bahmanbijari B, Beigzadeh A, Etminan A, Najarkolai AR, Khodaei M, Askari SMS. The perspective of medical students regarding the roles and characteristics of a clinical role model. Electron Physician. 2017;9(4):4124–30. doi: 10.19082/4124. [PubMed: 28607645]. [PubMed Central: PMC5459282].