Background

Healthcare service management is a pivotal discipline in the healthcare field. As public awareness and expectations enhance, the healthcare system must take influential measures to achieve its goals. The nurture of specialized human resources, particularly in the field of healthcare service management, plays a crucial role in this process. This field of study was first established in 1934 at the University of Chicago in the United States and was introduced in Iran at the University of Tehran in 1956 (1).

Healthcare service management focuses on the management of health, treatment, and medical education and aims to nurture competent professionals to improve health services in the areas of management, policymaking, and health economics (2). Theoretical and practical training, along with internship courses, help students to apply the learned concepts in practice (3). The purpose of internship courses is to provide practical acquaintance with various components of the healthcare network and to acquire professional skills because theoretical knowledge alone is not sufficient and there may be a gap between theory and practice (4). Proper and timely training through internship courses helps prevent the nurture of unprofessional human resourses and improve practical skills (5-7).

By attending internship courses, students serve as valuable resources for identifying shortcomings and challenges within the healthcare system (5, 8). Their practical training and skill development should be a focus of attention and evaluation (5). The constantly evolving needs of the healthcare sector necessitate continuous updates and improvements to curricular and educational programs (4). In line with these findings, Tebrizi et al.’s study demonstrated that students encountered difficulties in acquiring the necessary skills during internship courses and expressed a desire for improved educational processes (5). Additionally, Ghaffari and Davari Dowlatabadi’s study investigated the challenges of internship courses in three areas: Professors, fields, and logbooks (8).

Although there are some quantitative studies on the status of internship courses in the field of healthcare service management, they were unable to deeply explore the students’ experiences and feelings (9, 10). Thus, the present research adopted a qualitative approach to gain a more comprehensive understanding of the challenges and opportunities in educational and healthcare settings. Considering the complex and context-dependent nature of this topic, a thorough examination of various dimensions is necessary. Consequently, this research was conducted to investigate the experiences of students and graduates during internship courses at Bam University of Medical Sciences.

Objectives

The present research adopted a qualitative approach to gain a more comprehensive understanding of the challenges and opportunities in educational and healthcare settings.

Methods

This qualitative research, conducted in 2023, employed content analysis to investigate the experiences of students and graduates in the field of healthcare service management. Participants were selected purposefully and interviews were carried out with students who had completed at least one internship course. Furthermore, interviews were conducted both in-person and online after obtaining informed consent using semi-structured questions. Interview duration ranged from 40 to 60 minutes, and data saturation was reached after 20 interviews. Data were analyzed using Braun and Clarke’s thematic analysis (9). Then, the research team extracted and interpreted meaningful patterns by repeatedly reviewing interviews and coding and categorizing themes. In order to ensure the credibility of the findings, research documentation was maintained throughout all stages, and team efforts were employed to assess the quality and reliability of the results.

Results

The findings of the current research were categorized into two main categories: Curriculum planning opportunities and curriculum planning challenges. Each of these categories had main themes and subthemes (Table 1).

including the subtheme of “appropriate semester-based scheduling.”

Appropriate Semester-Based Scheduling: Appropriate semester-based scheduling should contribute to students’ satisfaction with the sequence of courses, particularly internship courses, within the Healthcare Service Management Department. Internship courses should commence from the fourth semester, after the theoretical courses, to enable students to enter the practical field with a more comprehensive perspective.

Additionally, by covering various levels of the healthcare system, these courses prepare students to better understand real-world needs and challenges and make informed decisions as future managers. In this regard, one student stated, “Its strength lies in its arrangement based on the hierarchy of service provision; i.e., it starts from the bottom and moves up... from health centers at hospitals and then to central offices.” (Participant 9)

Another student commented, “The semester-based scheduling is very good; first, you learn the theory and then you go for an internship.” (Participant 10)

2. Communication with Professors: This theme examines participants’ perspectives on internship professors and consists of the subtheme of “professors’ comprehensive and thorough planning and responsiveness to students.”

Professors’ Comprehensive and Thorough Planning and Responsiveness to Students: Participants mentioned that most internship professors were adept at answering their questions and elevated students’ productivity and motivation through detailed planning and collaboration. One participant stated, “Professors visit all departments daily, take the time to address our challenges, and provide explanations when we have questions.” (Participant 8)

Another participant commented, “The internship program is very precise and complete. Everything is clearly outlined day by day, which helps prevent confusion. We know the daily schedule from the beginning of the semester.” (Participant 1)

3. Evaluation: This theme delves into participants’ experiences with internship course evaluations and includes the subtheme of “appropriate evaluation using logbooks.”

Appropriate Evaluation Using Logbooks: This subtheme explores the method of evaluating internship courses, which is carried out based on a completed logbook provided to students at the beginning of the semester. Some participants believe that the logbook helps students’ activities be targeted. One participant stated, “The strength of the logbook is that it gives students a clear overview of what they should be looking for.” (Participant 8)

Table 1. Curriculum planning opportunities and challenges

1. A) Curriculum Planning Opportunities

This category encompasses three main themes and three subthemes.

1. Curriculum Planning: This theme delves into the strengths related to internship curriculum planning,
2. B) Curriculum Planning Challenges

This primary category includes five main themes and eight subthemes.

1. Challenges Related to Internship Field Staff: Despite significant student interaction with staff, challenges exist in this area. Two subthemes include “staff limited awareness of collaboration with students” and “staff unawareness of the healthcare service management field position.”

Staff Limited Awareness of Collaboration with Students: One of the obvious responsibilities of staff in medical universities is to educate students. However, it seems that some staff members are not fully aware of this responsibility, culminating in decreasing students’ motivation to complete internship courses. One participant stated, “Some staff members are not even aware that one of their duties is to teach and collaborate with students.” (Participant 11)

Staff Unawareness of the Healthcare Service Management Field Position: Some participants mentioned that certain staff lack sufficient knowledge about this field of study and mistakenly believe that medical university students are only medical students. Consequently, they are less inclined to collaborate with students from this field. One participant stated, “They do not recognize the position of the management field of study and prefer to collaborate mostly with clinical disciplines. It would be better if someone could convince the staff to also value management students.” (Participant 2)

2. Challenges Related to Internship Professors: Regarding this main theme, it is worth noting that professors play a pivotal role in teaching and learning. Identifying the related challenges is essential for improving the objectives of internship courses. Two identified subthemes for this theme include “lack of mid-term evaluations” and “lack of face-to-face introductions of students to staff by professors.”

Lack of Mid-Term Evaluations: Focusing solely on final evaluations can negatively impact student performance. Continuous evaluation and feedback throughout the internship course contribute to learning and provide opportunities to compensate for learning. One interviewee stated, “Mid-term evaluations can increase student activity and reduce end-of-term pressure.” (Participant 10)

Lack of Face-to-Face Introductions of Students to Staff by Professors: Some participants mentioned that students sometimes face rejection from internship field staff. This issue may arise from the lack of face-to-face introductions of students to staff at the beginning of the internship course. One participant stated: “The cooperation of staff is not good until the professor comes and talks to them.” (Participant 6)

3. Challenges Related to Logbooks: In this main theme, although many participants expressed satisfaction, some pointed out problems with the content of logbooks. These problems included “lack of dynamism and clarity in the logbook content.”

Lack of Dynamism and Clarity in Logbook Content: The lack of dynamism and clarity refers to the presence of technical jargon, general questions, and inattention to details, which staff are unable to properly comprehend. One interviewee pointed out, “A major drawback of the logbook is the generality of its questions” and suggested that “questions should be more specific and technical.” (Participant 5)

4. Challenges Related to Welfare Facilities: This main theme highlights the need for adequate welfare facilities to carry out internship courses more effectively. Students believed that existing problems with welfare facilities caused distress and reduced the quality of learning, including the subtheme of “insufficient attention to students’ transportation and dressing rooms.”

Insufficient Attention to Students’ Transportation and Dressing Rooms: Some participants pointed out the lack of coordination between the transportation service schedule and the internship hours, causing problems. Students, who in addition to internship courses, also take theoretical courses, face the situation of having internship courses in the morning and theoretical classes in the afternoon, leading to fatigue and reduced efficiency. Many students stated that no attention was paid to the time interval between the internship and the classes. A student stated, “We have to wait until 12:40 and the service takes us to the campus at 1:30; we cannot even have lunch.” (Participant 10)

Other challenges include “the lack of transportation service for local students” and “the lack of a dressing room at the hospital.”

5. Challenges Related to Lesson Plans: This main theme refers to the lesson plan, which is considered the overall roadmap for education. An inadequate lesson plan can hinder the achievement of the primary objectives of internship courses. The subthemes of this main theme encompass “unclear learning objectives for students” and “incompleteness of the internship shift scheduling.”

Unclear Learning Objectives for Students: This subtheme indicates that some students, despite professors’ explanations during the orientation session, are confused about the internship learning objectives. One of them said, “The professor explained them in the orientation session, but we get confused in the field... Maybe the staff members cause such confusion.” (Participant 4)

Incompleteness of the Internship Shift Scheduling: In this subtheme, some interviewees believed that students should also be familiar with evening and night shifts, as hospitals operate 24 hours a day. “We should also pay attention to the challenges of evening and night shifts.” (Participant 7)

Discussion

The present research explored the experiences of students and graduates in healthcare service management at Bam University of Medical Sciences regarding their internship course credits. The findings included two primary categories (curriculum planning opportunities and curriculum planning challenges)
and eight themes. In the curriculum planning opportunities category, the main themes encompassed “curriculum planning, communication with professors, and evaluation.” Participants positively evaluated the semester-based planning, professors’ responsiveness, and evaluation using logbooks. In this regard, the findings of Gottschalk et al.’s study demonstrated that appropriate planning and professors’ responsiveness contributed to improved student performance (10). According to the results of Omer’s research, logbooks are beneficial for learning; however, more careful monitoring by professors can increase their effectiveness (11).

In the curriculum planning challenges category, the main themes identified were “challenges related to field staff, challenges related to professors, challenges related to logbooks, challenges related to welafare facilities, and challenges related to lesson plans. Participants pointed to problems with staff and their unawareness of the healthcare service management field, which aligns with the findings of Remmen et al.’s research highlighting the lack of orientation for hospital staff (12). Furthermore, in Bordbar et al.’s study, the lack of cooperation from staff and their low motivation to teach were mentioned (13). Additionally, Nourouzi et al. assessed the students’ intrinsic motivation and identified poor staff cooperation during internship courses as a factor reducing students’ intrinsic motivation (14). The results of Kohan and Keshmiri’s study revealed that due to supervisors’ busy schedules and their unfamiliarity with the trainees’ educational needs, along with the limited time students have in departments, answering all questions and becoming sufficiently familiar with departments was not performed properly (15). Moreover, Griffin and Baverstock’s study reported inappropriate behavior, discrimination, and lack of cooperation from internship staff as major challenges in this area (16).

Another challenge is related to problems with internship professors, which include “lack of mid-term evaluations and lack of face-to-face introductions of students to staff by professors.” Some participants believed that mid-term evaluations could help improve student performance. The results of Seligman et al.’s research demonstrated that continuous evaluation and feedback every two weeks had a positive impact on student performance (17). According to Augusto et al.’s research, the presence of competent and enthusiastic professors in internship fields contributes to student success and the effectiveness of discussions (18). Sultan Althaqafi et al.’s study also highlighted the quality of mentoring provided (19). Another challenge is related to problems with logbooks. Some participants pointed to the lack of dynamism and clarity in logbook content. As demonstrated by Babadi et al.’s research, the use of logbooks in internship courses is important, but appropriate content and the correct design of logbooks are among influential factors (20).

Challenges related to welfare facilities were another identified problem. Some participants pointed out the limited availability of welfare facilities, such as the lack of dressing rooms and difficulties in coordinating transportation services. The findings of Ahmadi et al.’s research revealed that welfare facilities had a significant impact on students’ motivation and performance in internship courses, and students were dissatisfied with rest areas (21). The final challenge identified was related to problems with the lesson plans. Some participants believed that the multifaceted nature of activities in the internship course caused them confusion, while others suggested the presence of students in evening and night shifts. The findings of Tabrizi et al.’s study showed that the absence of a clear lesson plan was one of the root problems of internship courses in the healthcare service management field (22).

Limitations: This research was limited to Bam University of Medical Sciences. Therefore, there may be other challenges and strengths from the perspectives of students in other universities and regions that should be considered when utilizing the results.

Conclusion

The current qualitative study aimed to investigate the experiences of students and graduates in healthcare service management during their internship courses. The findings revealed that opportunities provided students with a comprehensive and systematic perspective and familiarized them with real-world needs of society and challenges in the healthcare sector. Thus, educational policymakers and decision-makers can employ these strengths to enrich internship courses. Numerous challenges were identified in the planning and implementation of internship courses, hindering the achievement of educational goals. In order to mitigate these challenges, the following recommendations are proposed: Holding training courses for field staff to enhance their awareness of their responsibilities and the importance of collaborating with students; implementing mid-term evaluations and providing ongoing feedback to students to improve learning; reviewing and updating logbooks with a focus on details and technical questions; providing adequate welfare facilities, such as providing transportation services coordinated with internship course hours and appropriate dressing rooms; and providing more precise explanations of learning objectives and lesson plans to students and ensuring their full comprehension.

The aforementioned actions can contribute to improving the quality of internship courses and better prepare students for managerial roles in healthcare. Some challenges require interdepartmental collaboration at the level of various university vice-chancellors. Hence, it is recommended that joint meetings be held to develop operational protocols and strengthen interdepartmental collaboration.