Journal of Education and Health Promotion

Abstract BACKGROUND AND PURPOSE: Most patients experience anxiety before heart surgery. On the 
other hand, spiritual health can improve the candidate patient’s adaptation to surgery. Therefore, 
this study aimed to investigate the effect of group logotherapy on spirituality and anxiety of patients 
undergoing cardiac surgery.
MATERIALS AND METHODS: In this quasi‑experimental study, 60 hospitalized candidates for 
cardiac surgery were randomly assigned to two groups (30 in the experimental group, 30 in the 
control group). To measure anxiety and relationship with God, Beck Anxiety Questionnaire and the 
researcher‑made scale about relationship with God (reconstruction of Lawrence’s scale of perception 
of God) were used, respectively. In the intervention group, in addition to drug therapy, individuals 
received two sessions of group discussion and spiritual skills training using the behavioral‑cognitive 
method with emphasis on spiritual thoughts and problem‑solving methods, but the control group 
received only drug therapy. Data were analyzed using SPSS software.
RESULTS: In the experimental group, the anxiety scores mean in the posttest and follow‑up were 
significantly lower than the pretest (P < 0.05), while the mean anxiety in the control group in the 
posttest stage was not significantly different, but at the follow‑up stage, it was significantly lower 
than the pretest, but the decrease in mean anxiety in the experimental group was greater (P < 0.05). 
The mean subscales of relationship with god (influence, divine providence, acceptance, presence, 
challenge, benevolence) were significantly higher in the experimental and control groups in the 
follow‑up stage than the pretest, but the increase in the mean of these variables was more in the 
experimental group in the follow‑up stage (P < 0.05).
CONCLUSION: Findings showed that the components of relationship with God are a good predictor 
of pre‑surgery anxiety, so by focusing on spiritual training of patients who are candidates for surgery, 
the incidence or severity of anxiety can be reduced.

Abstract BACKGROUND: This study was designed to assess the clinical judgment of medical students in
surgery clinical decision‑making by a standard examination after lecture‑based learning (LBL) or
problem‑based learning (PBL).
MATERIALS AND METHODS: A prospective randomized trial study on 175 medical students
whom were randomly allocated to three groups was performed during November 2017 and January
2018. LBL group (n = 103), PBL group led by an attending (n = 39), and PBL group (n = 33) led by
an intern. Chi‑squared test and independent student t‑test were used to compare between the two
groups. All the analyses were performed by the two‑sided method using the Statistical Package for
the Social Sciences software (SPSS version 22; SPSS, Inc., Chicago, IL, USA), and a P < 0.05 set
as statistically significant.
RESULTS: The students in the PBL group scored significantly higher on the posttraining multiple‑choice
examination, compared to the LBL group (P = 0.048). However, there was no significant difference
between the PBL group led by an attending and the PBL group led by an intern (P = 0.892).
CONCLUSION: We concluded that PBL remarkably increased the students’ scores in the
problem‑solving examination, as compared to the conventional method. We found no significant
differences in PBL facilitated by an attending or an intern.