Journal of Education and Health Promotion

Abstract BACKGROUND: Access to online patient education information can lead to more effective self‑care
and disease management. However, the large amount of online information provided through
unknown or unreliable sources can challenge patients to trust and use this information. This study
was designed to examine the opinions of Iranian gastrointestinal patients about the quality of online
information used.
MATERIALS AND METHODS: A qualitative study was conducted using thematic analysis. Data
were gathered via a semi‑structured interview with 29 gastrointestinal patients, and data analysis
was performed by qualitative content analysis using open coding with MAXQDA 2018 software.
RESULTS: Based on the study, 22 codes were extracted in nine subcategories named as: “Emphasis
on the identity of providers,” “Nature of online information,” “Distrust on online information,” “Poor
quality of information,” “Giving misinformation,” “False impact,” “Improve communication,” “Positive
effect on the patient,” “Better Diagnosis.”
CONCLUSIONS: In the current situation, Iranian patients are not confident enough about the quality
of available online information. They believe that the use of current poor‑quality information has
negative consequences. However, they tend to use online patient education materials are produced in
Persian by reputable scientific authorities. Using online information can increase patients’ knowledge
and lead to better communication with medical staff and other similar patients. They can use this
information for self‑care with more confidence, and such an approach can also have significant
benefits for the national health system.

Abstract BACKGROUND: The main purpose of this study was to evaluate the use of Telegram as an Instant
messaging application in clinical teaching of medical students, especially clinical ward rounds.
MATERIALS AND METHODS: In this quasi‑experimental study, Telegram as an Instant messaging
application was employed. To do this, a Telegram group entitled as “Lavender” was created and then
selected patients were divided between students and externs daily. After that, students and externs
were asked to take medical histories, perform complete physical examinations, and then share their
data in the Lavender group. Ultimately, to evaluate the effects of this intervention, two quantitative
and qualitative approaches were used.
RESULTS: From the students’ point of view the highest average was associated with “Readiness
for teaching round” (3.71 ± 1.34) and the lowest average was related to “Time‑saving for studying
about illnesses” (2.08 ± 1.44). In addition, medical trainees mentioned that reporting patients’ daily
medical histories and progress notes could create a reflective process. The suggestion made by
many medical trainees was to select and discuss simpler cases who have more teaching points
for them, while other trainees recommended focusing on common illnesses in the Lavender group.
CONCLUSION: The use of messaging software applications such as Telegram in medical education
has created a new paradigm, which could facilitate interpersonal interactions among trainees.

Abstract BACKGROUND: Nowadays, providing access to the required information by clinical informationist (CI)
is vital for clinical teams to make the best decision. This study was carried out to identifying how CIs
should participate in grand round (GR).
MATERIALS AND METHODS: The current study is an action research study. It was conducted in the
GR sessions of the Gastroenterology department of Al‑Zahra Hospital affiliated with Isfahan University
of Medical Sciences in 2017. Participants included attending physicians, fellowship students of the
Gastroenterology departments, a CI, and two supervising medical librarians. Data were collected
through observation and discussion. Qualitative content analysis and concept mapping were used
for data analysis.
RESULTS: The findings indicated that existing problems were related to the CI, medical team, and
infrastructural ones. The participation of the CI in medical team was arranged based on the following
steps: planning, action, evaluation, and suggestions. It started from an initial diagnosis of patients
and ended in GR meetings. During evaluation step, suggestions were made to remove the existing
problems and in the fifth step, results were summarized and a framework for the participation of the
CI in GR sessions was suggested.
CONCLUSIONS: Medical team members were satisfied with the participation of the CI, but it is
necessary to remove the existing structural and personal barriers (related to the CI and medical
team members), in order to improve the efficiency of this participation.

Abstract Abstract:
BACKGROUND: Any prediction of a person’s ability to succeed in a motor skill depends on the
detection and accurate measurement of the basic abilities for the performance of that skill. Task
analysis is needed to determine the psychomotor skills and abilities required to perform an action.
This study aimed to determine the components of psychomotor abilities for diagnostic upper
gastrointestinal (GI) endoscopy through procedural task analysis (PTA) and expert review.
MATERIAL AND METHODS: A multisource, multimethod task analysis was conducted in six
metropolitan teaching hospitals affiliated with the adult gastroenterology and hepatology training
centers in the Islamic Republic of Iran in 2019. Observation, video-recording, and think-aloud protocols
were used while diagnostic upper GI endoscopy was performed. To confirm the accuracy of the
PTA, the incorporated the views of the adult gastroenterology and hepatology subspecialty experts
through the checklist of PTA assessment criteria. Finally, to determine the psychomotor abilities for
each stage of the procedure, the study incorporated a panel of experts from occupational therapy,
physical education, physical medicine, and adult gastroenterology and hepatology subspecialty.
RESULTS: Of the 15 psychomotor abilities examined, 11 were determined for upper GI endoscopy
procedure, of which six cases (including visuospatial and perceptual abilities, hand–eye coordination,
multilimb coordination, finger dexterity, arm–hand steadiness, and manual dexterity) were the most
frequent.
CONCLUSIONS: PTA techniques and subsequent expert review were used to identify the components
of psychomotor abilities for diagnostic upper GI endoscopy. It is suggested that PTA is performed
for other procedures, and after psychomotor abilities are specified, proportional tests are developed.

Abstract BACKGROUND: To determine functional gastrointestinal disorder (FGID) aspects, there should
be a guideline to retrieve documents in this area for researchers with different levels of knowledge
about these disorders. the objective of this study was conducted in order to compile different terms
related to different categories of these disorders and to determine the sensitivity of them.
MATERIALS AND METHODS: To set a proper search, some strategies were used to enhance
the precision and sensitivity. After preparing the list of terms according to some sources such as
thesauruses, Rome classification, related review articles, and so on, they were divided into seven
categories and the queries in each of them were searched on the Scopus.
RESULTS: The sensitivity for each of the terms in categories were calculated, and the highest values
were as follow: FGIDs with 189 queries (“digestive* system* function* disorder*”), irritable bowel
syndrome with 142 queries (“irritable colon*”), functional constipation with 13 queries (“function*
disorder*” and constipation), functional diarrhea with 16 queries (“function* disorder*” and diarrhea),
functional bloating with 29 queries (“function* disorder*” and bloat*), Functional Dyspepsia with 29
queries (“functional dyspep*”), and neurogenic bowel with 7 queries (“neurogenic bowel*”).
CONCLUSION: Given the values calculated for sensitivity, and considering the type of study, in
order to retrieve documents in this area, it is necessary to apply all or part of the proposed queries
to the search strategy.

Abstract INTRODUCTION: Clinical rounds provide opportunities for medical students to acquire essential
skills to practice medicine in the real world. Although this kind of training is one of the most important
components of medical education, it is replete with barriers in its effective implementation. This study
aimed to investigate medical students’ experiences concerning the barriers and strategies of clinical
rounds in Kerman University of Medical Sciences (KMU).
MATERIALS AND METHODS: This qualitative research was conducted on 12 medical students
in KMU in 2017. Purposive sampling was used and participants in three grades (stagers, interns,
and residents) were selected, and individual semi‑structured interviews were conducted until data
saturation. The average of the interview time differed among the three batches (stagers, 51 min;
interns, 38 min; and residents, 31 min). Content analysis using deductive approach was used for
data analysis. MAXQDA version 10 was used for data analysis.
RESULTS: Data analysis yielded the identification of six themes related to the system of clinical
education, fields of clinical education, clinical environment, educational program, medical teachers,
and medical students concerning the barriers and five themes related to the strategies for clinical
rounds.
CONCLUSIONS: Findings revealed a deeper understanding of medical students’ experiences. Our
investigation identified multiple challenges embedded in our context and strategies to overcome
them. As teaching in clinical rounds is invaluable, there is a need to take into account the identified
challenges and overcome them. Thus, more effective rounds with higher efficacy toward students’
professional development can be implemented.

Abstract Clinical informationist (CI) is one of the current trends in the field of medical librarianship and
information science. CIs are members of clinical care teams, and their main duty is to fill the gap in
the information needs of health‑care workers and patients using information sources. They need an
official and standard education. This study aims to identify the educational goals and needs of CIs.
To this end, a scoping review was conducted using the Preferred Reporting Item for Systematic
Reviews and Meta‑analyses guidelines. The ISI Web of Science, Scopus, Proquest (MEDLINE),
Science Direct, Emerald, ERIC, Cochrane, and Library, Information Science and Technology Abstracts
were searched. The Journal of the European Association for Health Information and Libraries was
hand searched for relevant studies. A total of 1026 studies were extracted, and 38 studies were
selected for the final review. The review resulted in identifying 18 goals in cognitive, emotional, and
psychomotor areas. Furthermore, the educational needs were identified in eight educational needs
including research method and statistics, education, medical knowledge, information and librarianship
science, clinical environment knowledge, evidence‑based knowledge, information technologies and
systems, management, and leadership. Although part of these educational needs can be met through
general medical librarianship and information science education, further specialized education for
CIs requires specific aims and curriculum. Thus, the results of this study can be the basis for future
studies regarding the competencies of CI in order to provide a more precise and detailed curriculum
based on these educational needs.

Abstract INTRODUCTION: Internationalization of higher education involves mutual exchanges as well as a
consensus based. Political, economic, sociocultural, and scientific reasons recommend the need to
move toward the internationalization of higher education. The current study highlights the strengths
of the internationalization of Iran’s medical sciences education.
MATERIALS AND METHODS: This descriptive exploratory study was carried out in 2016–2017 in
Iran. The techniques used for data collection included review of articles, interview with subject experts,
and the focus group and the nominal technique group to explore the views of various stakeholders.
The data were analyzed with the qualitative content analysis method.
RESULTS: The inductive qualitative content analysis of all data generated 13 categories and 88
subcategories. The categories were geographical and geostrategic position of Iran; the historical,
cultural, religious, and tourist attractions of Iran; the security of Iran; priority to internationalization
policies and programs in Iran’s macro plans; the existence of regulations, laws, and approvals for
international activities; same language with neighboring and regional countries; the low cost of
studying and living in Iran; the ability of Iranian faculty members and experts for internationalization;
the background, reputation, and the progress of medical education, health, and care in Iran; the
cheaper forces of Iran and their welcome to foreigners; the existence of motivation, zeal, and belief
for internationalization; the existence of proper infrastructure; and the existence of a suitable capacity
for internationalization.
CONCLUSIONS: Iran has some positive points that can be used to promote international activities,
provided it does some good advertising in this regard. It is suggested that the challenges, opportunities,
and threats to Iran’s internationalization should be collated from the perspective of the various
stakeholders.

Abstract INTRODUCTION: Due to time constraints and a significant increase in medical information, one
of the ways to keep physicians and medical teams up to date is to use evidence‑based medicine.
The current research focused on the effects of the educational role of clinical informationist (CI) on
improving clinical education among medical students based on the Kirkpatrick (KP) model.
METHODS: The method was semiexperimental research in two group designed with pretest and
posttest. The research population included thirty medical students for each group that was selected
by the convenience time‑based sequential sampling method. The study data were collected using a
researcher‑made two questionnaires and a checklist. Data were analyzed by the descriptive statistics
and inferential statistics using SPSS version 20 software.
RESULTS: Based on the first level of the KP model, the total mean of medical students’ satisfaction
in the experimental group was 4.06 from 5. Based on the second, third, and fourth levels of the model,
the independent t‑test showed that before the intervention, the mean scores of attitude, knowledge,
information‑seeking skills and behaviors, and also clinical skills were not significantly different in both
the intervention and control groups (P > 0.05). After the intervention, the results of covariance test
showed that attitude, knowledge, information‑seeking skills and behaviors, and also clinical skills of
the intervention group are significantly better than that of the control group (P < 0.001).
CONCLUSION: Training and the presence of the CIs in the clinical round had resulted in the
improved satisfaction, attitude, knowledge, and information‑seeking skills while also improving
information‑seeking behaviors and clinical skills of medical students.

Abstract INTRODUCTION: Studies about globalization and internationalization demonstrate different attitudes
in explaining these concepts. Since there is no consensus among Iranian specialists about these
concepts, the purpose of this study is to explain the concepts of internationalization and globalization
in Iran.
MATERIALS AND METHODS: This study is a systematic review done in the first half of 2016.
To explain the concept of globalization and internationalization, articles in  Scientific Information
D atabase, Magiran database, and Google Scholar were searched with the keywords such as
globalization, scientific exchange, international cooperation, curriculum exchange, student exchange,
faculty exchange, multinational cooperation, transnational cooperation, and collaborative research.
Articles, used in this study, were in Persian and were devoted to internationalization and globalization
between 2001 and 2016. The criterion of discarding the articles was duplicity.
RESULTS: As many as 180 Persian articles were found on this topic. After discarding repetitive
articles, 64 remained. Among those, 39 articles mentioned the differences between globalization
and internationalization. Definitions of globalization were categorized in four categories, including
globalization, globalizing, globalization of higher education, and globalizing of higher education.
Definitions about internationalization were categorized in five categories such as internationalization,
internationalization of higher education, internationalization of the curriculum, internationalization of
curriculum studies, and internationalization of curriculum profession.
CONCLUSION: The spectrum of the globalization of higher education moves from dissonance and
multipolarization to unification and single polarization of the world. One end of the spectrum, which
is unification and single polarization of the world, is interpreted as globalization. The other side of the
spectrum, which is dissonance and multipolarization, is interpreted as globalizing. The definition of
internalization is the same as that of globalizing. In other words, it is possible to say that internalization
is similar to globalizing but different from globalization.

Abstract Introduction: Holding bedside round teaching and involving patients in the teaching of the
students might lead to patients’ dissatisfaction. This study was carried out in order to find the
viewpoints of the patients and the medical team about the effect of clinical round on patients
hospitalized in Isfahan University of Medical Sciences. Materials and Methods: This study
is of cross‑sectional descriptive type which is carried out in Isfahan University of Medical
Sciences using researcher‑made tools. The statistical population included the hospitalized
patients, interns, residents, and nurses of the internal wards of educational hospitals. In this
study, 110 patients and 150 health team staff are participated. The analysis of the data was
done through software Statistical Package for Social Science (SPSS) 11.5 and descriptive
and inferential statistics were applied. Statistical analysis of the variance did not show any
significant difference among the interns’, nurses’, and residents’ perception of patient’s
satisfaction. Results: Generally, the patients had a positive viewpoint toward things happening
during a round, whereas the medical team’s viewpoint was negative. In both groups, the
highest satisfaction average pertained to the number of times and the duration of visits, but
both groups believed that lack of a definite responsible medical doctor, feeling of insecurity
during the incongruous and unclear discussions, and the level of respect for the patient were
the causes of dissatisfaction with the clinical round process. Conclusion: The current method
of clinical rounds can result in patients’ dissatisfaction. On the other hand, proper relationship
with them leads to the development of a more positive attitude in them. Therefore, revision and
correction of the current clinical round procedures and teaching the communication skills to
the medical team could help improve this process.

Abstract Background: Although some tests for clinical reasoning assessment are now available, the
theories of medical expertise have not played a major role in this filed. In this paper, illness
script theory was chose as a theoretical framework and contemporary clinical reasoning tests
were put together based on this theoretical model. Materials and Methods: This paper is a
qualitative study performed with an action research approach. This style of research is performed in a context where authorities focus on promoting their organizations’ performance
and is carried out in the form of teamwork called participatory research. Results: Results are
presented in four parts as basic concepts, clinical reasoning assessment, test framework,
and scoring. Conclusion: we concluded that no single test could thoroughly assess clinical
reasoning competency, and therefore a battery of clinical reasoning tests is needed. This battery should cover all three parts of clinical reasoning process: script activation, selection and
verification. In addition, not only both analytical and non-analytical reasoning, but also both
diagnostic and management reasoning should evenly take into consideration in this battery.
This paper explains the process of designing and implementing the battery of clinical reasoning in the Olympiad for medical sciences students through an action research.

Abstract Background: Information and communication technology (ICT) has brought many changes in
medical education and practice in the last couple of decades. Teaching and learning medicine
particularly has gone under profound changes due to computer technologies, and medical
schools around the world have invested heavily either in new computer technologies or in
the process of adapting to this technological revolution. In order to catch up with the rest of
the world, developing countries need to research their options in adapting to new computer
technologies. Materials and Methods: This descriptive survey study was designed to assess
medical students’ computer and Internet skills and their attitude toward ICT. Results: Research
findings showed that the mean score of self-perceived computer knowledge for male students in
general was greater than for female students. Also, students who had participated in various prior
computer workshops, had access to computer, Internet, and e-mail, and frequently checked
their e-mail had higher mean of self-perceived knowledge and skill score. Finally, students with
positive attitude toward ICT scored their computer knowledge higher than those who had no
opinion. Conclusions: The results have confirmed that the medical schools, particularly in
developing countries, need to bring fundamental changes such as curriculum modification
in order to integrate ICT into medical education, creating essential infrastructure for ICT use
in medical education and practice, and structured computer training for faculty and students.