Strides in Development of Medical Education

Document Type : Letter to editor

Authors

1 Assistant Professor of Internal Medicine, Department of Internal Medicine, School of Medicine, Endocrinology and Metabolism Research Center, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran

2 Associate Professor of Thoracic Surgery, Department of General Surgery, School of Medicine, Research Center for Hydatid Disease, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran

3 Department of Pediatrics, Afzalipour Medical Center, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

4 Assistant Professor of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran

5 PhD Student in Human Resource Management, Faculty of Management, Islamic Azad Kerman University, Kerman, Iran

6 Education Expert, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran

Keywords

Dear Editor,

Education and evaluation are pillars of the educational system, and education is not effective without evaluation and feedback (1, 2). Furthermore, the management has been widely affected and changed by, first, the need to increase the quality of educational programs (e.g., morning reports, clinical rounds, etc.) and other programs implemented in an educational medical center and, second, new requirements for accountability toward the accreditations in educational medical centers. Change refers to transformation and shifting from one state to another, which is constantly observed in the universal phenomena. Some experts have discussed targeted changes caused by individuals willfully and purposefully (3). In a study at the University of Madison, New Jersey, Wentworth et al (2018) attempted to implement and institutionalize a new system in which the investigation of the new system replaced a widely used system having been already implemented for over twenty years without any change but been extensively criticized by faculty members and students (4).

By performing educational management appropriately to create changes in educational settings, a favorable and efficient environment is created.
This environment enjoys sensitive characteristics, including a sense of belonging to the educational environment, mutual trust among individuals, participation in educational decision-making, work-related information provision, and attention to the faculty members’ suggestions (5). The educational medical centers generally lack this environment, particularly in terms of a collaborative culture creation. Change is based on dynamism; therefore, any changes in educational organization also requires the dynamism of the educational system. The presence of an effective clinical environment is indeed one of the characteristics of favorable clinical education, which requires the standardization of educational processes in clinical education (6). This study aimed to change the educational system processes toward mission orientation and accountability in an educational medical center.

The need for changes in the ongoing educational and research procedures followed at Afzalipoor Medical Education Center affiliated with Kerman University of Medical Sciences was first expressed and highlighted by the faculty members, residents, interns, and trainees. As the result, a team consisting of the members from the educational departments of the educational medical center was formed. The team members included the center’s educational
vice-chancellor, research vice chancellor, medical education development manager, and other team members (e.g., representatives of all clinical education departments, who, in turn, constituted the coalition; then the members of this group attempted to achieve the specified goals through effective interaction and teamwork. In the next stage, the members held regular meetings and determined a proper perspective according to the goals in attempt to reform all events associated with the promotion of the education and research system performance, including the improvement of the processes occurred in the mission-oriented and responsive education system in the center’s medical and paramedical fields, the center’s clinical and applied research excellence, improvement of performance and empowerment of faculty members, and development of educational, research, and welfare infrastructures to promote the learners’ performance.

In the following stage, sharing insights was remarkably important. The departments’ representatives had an essential role in this step in which the required information was shared in their groups as soon as possible, and they were assigned to important responsibilities for providing educational and evaluation opportunities. Formal and informal feedback from professors, management, and staff indicated that these reports played a crucial role in implementing change in an educational system.

The next step was institutionalizing the approach, which involved stabilizing the change and ensuring that it became part of a developing system. Monitoring the various sectors’ performance regularly, holding various meetings, making efforts to stabilize it in Afzalipoor Hospital of Kerman, and generalizing this change to other educational medical centers of Kerman University of Medical Sciences were among the goals of institutionalizing this approach.

Communication was also a principal factor contributing to the change. Various communication channels were used to ensure that all individuals were aware of the changes as well as understand the new system and the reason for choosing it. A specific website was created for the staff, faculty members, and students to use. Moreover, staff provided explanations and education to faculty members through monthly updates.

In our case, the new system for collecting students’ feedback regarding professors’ teaching was found extremely effective during the process. According to the potential consequences, it was normal to be concerned about the changes. The implementation process largely occurred during the coronavirus disease 2019 (COVID-19) period, and significantly affected the students’ evaluation and exam quality. Some criticisms were also expressed by both professors and students about the process implementation. In this study, therefore, attempts were made to address the criticisms by making preparations and using internal experiences and experts, and the attempts culminated in many changes in the program.

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