Strides in Development of Medical Education

Document Type : Letter to editor


Professor Assistants, Department of Medical Education, Education Development Center, Bushehr University of Medical Sciences, Bushehr, Iran


Dear Editor,

In the third millennium, the most important mission of educational organizations in the health field is to meet the various and variable health-related needs of the public. In 1973, The World Health Organization (WHO) warned about the incapability of graduates in various medical fields to provide efficient team care. Accordingly, the WHO offered multi-professional education programs to improve healthcare quality. Then in 1988, it introduced the inter-professional education as the most effective strategy for providing efficient team care and delivering strong performance in healthcare settings by adopting a patient-oriented approach (1). Inter-professional education indeed occurs only when two or more professionals cooperate closely in learning about each other and from each other, which not only promotes the quality of services via increased cooperation but does also lead to increased problem-solving and clinical decision-making skills, improved healthcare quality, patient safety, improved communication skills, and enhanced understanding of each other’s roles in healthcare settings (2).

From among the health sciences having close interactions in all clinical wards, nursing and medical fields are the oldest, the most challenging and, simultaneously, the most necessary sciences that enjoy close inter-professional relations in the health system, so that their interaction’s positive and negative consequences affect the patients’ safety and care quality directly and/or indirectly. Such interactions and cooperation are very close, particularly in special wards (ICU, CCU) and the operating room; this cooperation, however, is less observable in general wards, such as surgery, internal, pediatrics, and maternity wards. Although a close interactive cooperation is an absolute requirement for meeting the patient’s health needs and creating positive attitudes among nursing and medical students (3), the inter-professional cooperation is still faced with major barriers created by the authoritative viewpoint towards the medical profession and field prevailed in the clinical setting and educational hospitals. Given the significant role of medical specialists as exemplars for medical students, this authoritative viewpoint leads to creation of different attitudes and perceptions among medical students toward nurses as simply administrators of the doctor’s orders while, in effect, nurses play more crucial roles in decision-making processes, roles that are not still appreciated by doctors with traditional attitude. These doctors still consider themselves as the ones who assign the duties for the nurses, which leads to nurses’ job dissatisfaction and increases the incidence of conflicts between doctors and nurses in clinical wards. A sociological study by Mehrabi et al (2016) on professional relationships between nurses and doctors indicated that any problematic relationship between these two groups negatively affected the patients’ safe care (4). Several studies have suggested that the medical professors have positive attitudes (5); however, a limited number of studies have investigated the medical professors’ attitudes toward inter-professional cooperation and recognition of the nurses’ duties and roles. The doctors’ authoritative behaviors and attitudes toward nurses as major barriers can negatively affect the successful implementation of inter-professional education, creation of change, and stabilization of attitudes toward medical students’ education concerning inter-professional cooperation.

Given that the fast and extensive changes in society have forced healthcare provider and organizations to get prepared for present and future challenges in order for providing health care with patients’ complicated and extensive needs, the capability of the health providers to meet these needs is the most significant determinant of the patients’ health quality and safety; furthermore, it is essential to train a new generation of health providers capable of appreciating each other’s roles and abilities as well as making necessary preparations for dealing with upcoming challenges by changing and benefitting from modern educational approaches toward team-oriented care. To this end, the doctors and nurses – medical and nursing professors, in particular – should adopt new attitude toward the modern approach of inter-professional education and change the attitude of medical authoritative viewpoint, which can crucially contribute to modifying and changing the traditional attitude, forming interaction and inter-professional cooperation among medical and nursing students and, ultimately, promoting the quality of health services.

  1. Vafadar Z, Vanaki Z, Ebadi A. Interprofessional Education a Response to Health System Challenges. Iran J Med Educ. 2014; 14(2): 148-64. [In Persian]
  2. Maharajan MK, Rajiah K, Khoo SP, Chellappan DK, Alwis RD, Chui HC, et al. Attitudes and readiness of students of healthcare professions towards interprofessional learning. PLoS One. 2017 Jan 6;12(1):e0168863. doi: 10.1371/journal.pone.0168863. [PMID: 28060838] [PMCID: PMC5217964]
  3. Yamani N, Jafaei Delouie R, Karimi Moonaghi H, Iraj Pour AR, Jarahi L. Readiness of Medical, Nursing and Radiology Students for Interprofessional Education at Mashhad University of Medical Sciences. Journal of Medical Education Development. 2015; 8(17): 113-21. [In Persian]
  4. Mehrabi M, Madanipour A, Ahmadnia S. The sociological study of nurse-physician professional relationship in Iran. Iran J Nurs Midwifery Res. 2016 Nov-Dec;21(6):583-588. doi: 10.4103/1735-9066.197680. [PMID: 28194197] [PMCID: PMC5301064]
  5. Valipour Khajehghyasi R, Mirshah Jafari SE, Shahbaznejad L. A survey of the perception of interprofessional education among faculty members of Mazandaran University of Medical Sciences. Strides Dev Med Educ. 2017:14(2): e64086.