Journal of Education and Health Promotion

Abstract Emotions are universal in academic and clinical settings. A student is likely to hope for success,
maybe be worried about failure, or may feel comfortable after an exam. These feelings undoubtedly
affect his/her motivation, effort, academic performance, and progress. This study aimed to investigate
the role of emotion in the learning and performance of medical students and its mechanism. This
study was a scoping review conducted in 2022 to examine the role of emotions in medical education.
The three databases PubMed, ERIC, and Science Direct and the search engine Google Scholar
were searched using the following keywords: “emotion,” “medical student,” “teaching,” “learning,”
and “medical education.” English articles published from 2010 to 2022 were reviewed, and finally,
34 articles that met the inclusion criteria were reviewed. Review of the selected articles showed that
there was a significant relationship between the cognitive system and emotions in the brain. The
conceptual framework of the relationship between cognition and emotion can be explained in the
form of dimensional and discrete views of emotions and based on cognitive load theory. Emotions
affect cognition with the four mechanisms of memory, cognitive resources, cognitive strategies,
and motivation and can be effective in learning self‑regulation, clinical reasoning, and academic
achievement of medical students. Emotions in medical education is a double‑edged sword. In other
words, it is highly recommended to divide emotions into activating and inactivating, instead of dividing
them into positive and negative ones. In this context, medical educators can use the positive aspects
of nearly all emotions to improve the quality of their teaching.

Abstract BACKGROUND: Role of multimedia training materials on Mini-CEX scores of internal medicine
residents. We aimed to assess the effect of multi multimedia training materials on Mini-CEX scores
of internal medicine residents of Isfahan University of Medical Sciences.
SETTINGS AND DESIGN: A quasi-experimental action research study on 1st, 2nd, and 3rd-year
internal medicine residents were implemented.
MATERIALS AND METHODS: The Mini-CEX test measures students’ performance in six core skills
necessary for medical practice. Mini-CEX scores of 135 internal medicine residents in 2017–2018
were compared before and after the training with prepared multimedia materials. We used repeated
measured ANOVA and Mann–Whitney U test to compare the distribution of Mini-CEX scores across
corresponding groups. Analysis was done using the SPSS software version 23 (IBM SPSS Statistics
for Windows. Armonk, NY, USA: IBM Corp).
RESULTS: The median Mini-CEX score (IQR) of students in preintervention and postintervention
groups were 16.14 (5.19) and 19.62 (3.13), respectively. Findings of this study showed a significant
increase in mini-CEX scores of the groups who used the multimedia learning material compared to
those who did not use it (P < 0.001).
CONCLUSIONS: Multimedia learning resources demonstrated a promising influence on internal
residents’ mini‑CEX scores in this study. They demonstrate significantly greater performance after
using multimedia learning materials compared to their same‑year residents who did not benefit from
it. This demonstrates the favorable effect of multimedia on the acquisition of practical skills such as
obtaining a history or performing a physical examination.

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: This study was conducted on accountability, aiming to design components for 
monitoring the curricula of universities of medical sciences.
MATERIALS AND METHODS: This study was a developmental one, conducted in Isfahan University 
of Medical Sciences with the document and literature review, a focus group, and a survey from 
2018 to 2020. The first version of the components was designed by the library research and content 
analysis method. Following developing the initial tool, its validity was evaluated with a focus group, 
and the questionnaire was prepared according to face and content validity.
RESULTS: In this study, 73 components were designed in eight domains for curriculum supervision, 
including requirements (12), needs and goals (6), content (10), teaching–learning strategies (10), 
educational materials and resources (5), educational time (2), educational setting (10), and 
evaluation (18).
CONCLUSION: The components of curriculum supervision were designed due to their importance in 
the evolution and innovation of medical sciences, particularly accountability in the education system, 
and lack of relevant research. With these components, the current and optimal status of curricula 
can be determined in universities.

Abstract BACKGROUND: Responsibility of individuals in adapting to life events depends on the intertwined
cooperation of intellectual and emotional capacities, and a person’s success in life depends on his
emotional responses. Given that health‑care providers are at the forefront of providing health services,
they need to improve their job performance with better control of their emotions and better social
relationships. The aim of this study was to determine the relationship between emotional intelligence,
social responsibility, and job performance in health‑care providers and caregivers.
MATERIALS AND METHODS: A cross‑sectional correlational study was performed on 270 health
workers working in the western cities of Isfahan province in the first quarter of 1998 by random
classification sampling method. To collect information, two questionnaires of Bradbury emotional
intelligence, responsibility, social responsibility, whose validity and reliability had been proven in
previous studies, and job performance scores of the samples were used. The collected data were
analyzed using descriptive tests and Pearson correlation.
RESULTS: The participants were 270 health workers and caregivers with a mean age of 34.54 ± 7.26.
87.5% of the samples were female and 21.5% were male. The mean score of social responsibility
was 124.95 ± 10.41, the mean score of emotional intelligence was 125.58 ± 15.86, and the mean
score of job performance was 86.91 ± 9.0.18. The results of Pearson correlation showed that all four
components of social responsibility and total emotional intelligence have a significant correlation at
the level of 0.01. Total emotional intelligence and each of its components did not show a significant
correlation with job performance. Between social responsibility and job performance of health workers,
only the moral component significantly predicts job performance (r = 0.133 and P = 0.026).
CONCLUSION: Although the results of the study showed that the job performance, social
responsibility, and emotional intelligence of the study group were desirable, the score of some
components of social responsibility and emotional intelligence is lower than their maximum score.
In addition, according to the results of the study that showed the relationship between emotional
intelligence and social responsibility and some of their components with job performance, improving
the knowledge and skills of health‑care providers and caregivers in the field of social responsibility
and emotional intelligence and their components seems necessary.

Abstract BACKGROUND: Paying attention to students’ opinions and suggestions on existing evaluation
methods and new methods of evaluation is an essential and important part of clinical education, so
this study aimed at determining the effectiveness of two evaluation techniques satisfaction among
undergraduate nursing students.
MATERIALS AND METHODS: This was a quasi‑experimental study conducted on 60 undergraduate
nursing students of Isfahan University of Medical Sciences in 2019. There were 30 samples in each
group (logbook and e‑logbook) that were selected by convenience sampling method. the Android
application (e‑logbook) was used in the intervention group to evaluate the clinical skills of students.
The User Satisfaction Questionnaire was conducted by undergraduate nursing students. Data were
analyzed using SPSS software version 14 and descriptive statistical tests.
RESULTS: The results showed that the mean (standard deviation) overall score of satisfaction
from both evaluation methods including logbook and e‑logbook was 39.7 (9.4) and 47.7 (12.2),
respectively. Also satisfaction score of the evaluation method was significantly different between
the two groups (P = 0.03).
CONCLUSION: According to the results of the present study, the use of new and active methods of
evaluation, including the application of e‑logbook, can be useful in evaluating nursing students and
cause student satisfaction, so using the application is useful.

Abstract INTRODUCTION: After graduation, public health students should be able to work as health care
givers providing first‑level health care services. Therefore, the educational objectives of public health
bachelor’s programs should ensure that they acquire the capabilities necessary for this purpose.
This study identified the educational objectives that are essential for these students and compared
them with the current curriculum in Isfahan, Iran.
METHODS: This needs assessment study was conducted in two phases. In the first phase, the
essential educational objectives were identified using a qualitative approach, which involved eight
focus group discussions held by a group consisting of experts of the public health headquarters and
public health network administration offices of Isfahan province and the public health graduates
working in the province’s comprehensive health service centers, who were chosen using the purposive
sampling method (n = 59). In the second phase, a comparative study was performed by turning the
list of essential educational objectives into a checklist and using it to compare these objectives with
the objectives in the current course plan in the examined curriculum. In the end, a list of educational
objectives not included in the current curriculum of the public health bachelor’s program was created.
RESULTS: The focus group discussions produced 433 educational objectives in the cognitive
domain, 79 objectives in the affective domain, and 179 objectives in the psychomotor domain, which
were arranged in eight competency categories. Comparison of the essential educational objectives
with the current curriculum showed that the current curriculum does not cover any of the essential
objectives regarding care for the age groups of 18–29 and 30–59 and the first aid and only partially
covers essential objectives in other competency categories.
CONCLUSION: This study found that considering the requirements of first‑level health services
and the tasks expected from public health graduates to be providing these services, the current
curriculum does not cover all essential learning objectives and should be revised to meet additional
essential educational objectives.

Abstract BACKGROUND: There are various instructional methods worldwide and virtual instruction is one
of them. This widely used method involves online instruction and e‑learning. The present study
compares the effects of lecture‑based and virtual instruction on student learning, satisfaction, and
content retention among surgical technology students at Isfahan University of Medical Sciences.
MATERIALS AND METHODS: The population of this two‑stage, quasi‑experimental study consisted
of 40 surgical technology students at the School of Nursing and Midwifery. After fulfilling inclusion
criteria, they were randomly assigned to the virtual instruction group (VG, n = 20) and the traditional,
lecture‑based instruction group (TG, n = 20). Data were collected via a researcher‑made student
satisfaction questionnaire and two learning examinations. Their validity and reliability had been
confirmed. The data were analyzed using SPSS 13 and analytical and descriptive tests (P < 0.05).
RESULTS: There was no statistically significant difference between the TG and the VG with respect
to the mean score in the first examination (P = 0.89). However, the two groups were significantly
different in terms of the mean score in the second examination (P = 0.03). Regarding content retention
and recall performance, the VG outperformed the TG. Furthermore, the mean satisfaction score of
the VG (132.24 ± 17.92) was higher than that of the TG (115.56 ± 17.57) (P < 0.05).
CONCLUSION: Virtual instruction and lecture‑based instruction had comparable short‑term learning
outcomes. Nevertheless, with the passage of time, it was revealed that virtual instruction could result
in better learning performance and higher content retention and satisfaction.

Abstract INTRODUCTION: Teaching is one of the most important needs of human societies, and selecting
the best method of teaching is so important to improve the teaching as well as learning of students.
The purpose of this study was to determine the effect of case‑based teaching (CBT) and flipped
classroom methods in comparison with lecture method on students’ learning and satisfaction at
internship of Department of General Surgery, Isfahan University of Medical Sciences.
MATERIALS AND METHODS: This experimental study was performed on fifty medical surgery
internship students in Isfahan University of Medical Sciences in 2017. Students were randomly
divided into two groups of control group and intervention group. The data were collected by a posttest
after holding every class and a researcher‑made form for evaluating students’ satisfaction after the
end of the project. The results of this study were analyzed by SPSS 21 software using descriptive
statistical methods (mean and standard deviation) and paired t‑test.
RESULTS: The comparison of the mean posttest scores in the three classes showed that the mean
scores of the students in the intervention group in the first and second sessions unlike the third
session were higher than that in the control group; this difference was statistically significant in the
first session (P = 005) and the third session (P = 0.002). Students’ satisfaction with case‑based
learning method (4.03 ± 0.87) was higher than that of lecture method (2.88 ± 0.78).
CONCLUSION: In CBT and flipped classroom, students’ learning and the quality of teaching were
improved. In addition, students were more satisfied with this method in comparison with the lecture
method. However, it should be noted that the success of using this teaching method depends on
choosing the appropriate subject.

Abstract BACKGROUND AND OBJECTIVES: This study was conducted to evaluate the health experts and
professionals’ education program in order to become multiprofessionals regarding health system
transformation plan by a descriptive and educational evaluation method based on the context, input,
process, and product (CIPP) evaluation model in 2018.
MATERIALS AND METHODS: The statistical population included managers and experts of health
deputy (13 people), managers and authorities in health networks (32 people), teachers (251 people),
and learners (1914 people). Data were collected by four researcher‑made questionnaires based on
the CIPP model and evaluation checklist of facilities and equipment. The view of experts was used to
measure the face validity and content validity of the questionnaire, and Cronbach’s alpha coefficient
was used to determine reliability. Data were entered into SPSS 23 software, and data were provided
using descriptive statistics (frequency, mean, and standard deviation).
RESULTS: The evaluation indicators of the educational course in the field of context were
evaluated desirable by province’s managers and experts (95% questions), city managers (100%
questions), teachers (95% questions), and health caregivers (80% questions). In the field of input,
it was evaluated desirable by managers and experts’ input of province (60% questions) and city
managers (70% questions) and it was evaluated semi‑desirable by teachers (78.95% questions)
and health caregivers (88.24% questions). In the field of process, it was evaluated desirable by
province’s managers and experts (73.68% questions) and city managers (66.67% questions) and
it was evaluated semi‑desirable by teachers (66.67% questions) and health caregivers (94.4%
questions). In the field of product, it was evaluated semi‑desirable by managers and experts of
province (63.63% questions), teachers (81.81% questions), and health caregivers (100% questions)
and it was evaluated desirable by city managers (72.72% questions).
CONCLUSION: Holding initial service education course of health caregivers has been necessary, and
the public health, family, and midwifery disciplines needed to be educated in a university appropriate
to the description of tasks of health caregivers.

Abstract INTRODUCTION: As a part of healthcare providers of the Health System Reform Program, midwives
are required to master the necessary knowledge and skills to meet the related demands of society.
This study was aimed to assess the knowledge and skills training needs of practicing midwives of
health and medical centers of Isfahan.
METHODS: This study is a descriptive cross-sectional study. The statistical target population was
midwifery experts working in Isfahan health centers and the samples were selected through simple
random sampling (sample size 250). Data were collected by two questionnaires to assess knowledge
and skill needs. The validity of the questionnaires was confirmed by experts of the province and
city health centers and medical education experts and its reliability was calculated by Cronbach’s
alpha (98%). Data were analyzed using SPSS 23 software and descriptive and analytical statistical
methods (frequency, mean, variance).
RESULTS: The first five knowledge training priorities of employed midwives in health and medical
centers, which comprise most of the means values, are pregnancy complications and abnormalities
(3.64 ± 1.21); mammography and its interpretation (64.3 ± 1.30); skills and principles of parenting
(3.59 ± 1.24); shortness of breath and palpitations during pregnancy (3.58 ± 1.16); and common
mental disorders (3.57 ± 1.16). The most important skills training needs were Excel (1.21 ± 3.59),
PowerPoint (27.1 ± 54.3), internet (3.52 ± 1.25), and parameters registration and reporting in the SIB
system (3.49 ± 1.28). Employed midwives of the health and medical centers displayed a significant
difference in feeling the need for training in some subjects.
CONCLUSION: Needs assessment is the foundation of purposeful training, and better training leads
to improved performance of personnel and organizations. Therefore, it is imperative that reliable
and documented data be utilized for promotion and improvement of in-service training programs
of employed midwives of the health and medical centers of Isfahan province and also for revising
university curriculums. Taking these measures would lead to the empowerment of personnel and
general development of society.

Abstract INTRODUCTION: The ability of physicians to perform endotracheal intubation by laryngoscope is one
of the essential skills. The purpose of this study was to evaluate the effectiveness of the four‑step
python training method with the Halsted’s “See one, Do one, and Teach one” training method in
endotracheal intubation competency in simulated environment.
MATERIALS AND METHODS: This quasi‑experimental study was performed on two independent
groups with posttest. The statistical society consisted of eighth‑semester medical students referred
to the emergency medicine unit. The experimental group received a modified four‑step python‘s
training method that modified for small groups, and the control group received the Halsted’s “See
one, Do one, and Teach one” training method. Researcher‑made checklist used to rate participant
competency as posttest. Data were analyzed using SPSS 19 software.
RESULTS: Sixty‑seven students volunteered for the experimental group and 57 students for
the control group. In posttest, the experimental group more competent than the control group
significantly (P < 0.001). Furthermore, the training course satisfaction of the experimental group was
significantly higher than the control group (P < 0.001).
DISCUSSION AND CONCLUSION: Modified python training method for small groups has shown
a better effect on student performance. This finding is consistent with previous researches.
Modified four‑step python’s training for small group with an emphasis on peer to peer teaching and
receiving feedback from peer can be related to the effectiveness of this training. Further research is
recommended in other clinical education settings.

Abstract BACKGROUND AND AIM: Recognized as one of the key elements of growth and development,
education is an important strategy for successful provision of services in all social dimensions. Moreover,
it is categorized among empowerment tools to achieve goals. In the field of health, health education
encourages people to be healthy. This study aimed to evaluate the health literacy of health‑care
providers and its relationship with strategies of using health literacy in the provision of health education.
MATERIALS AND METHODS: This cross‑section correlational study was carried out on a group
of health‑care providers in Isfahan, Iran, in the second trimester of the Persian year 1397 (2018).
Participants were selected by multistage sampling, for which two questionnaires of Test of Functional
Health Literacy in Adults and inventory of strategies of using health literacy in education were applied.
The validity and reliability of the research tools were formerly approved. In addition, data analysis was
performed in SPSS version 21 using Pearson’s correlation coefficient and linear regression model.
RESULTS: In total, 230 participants with a mean age of 34.32 ± 7.71 years were entered into
the study, 92.9% of whom were female and 7.1% were male. The mean health literacy score of
the participants was 79.60 ± 12.41. In the sections of knowledge, attitude, and performance were
related to the use of health literacy education strategies, and we obtained the means 5.20 ± 1.94,
43.11 ± 4.11, and 28.96 ± 6.73, respectively. Moreover, Pearson’s results were indicative of a
significant relationship between health literacy of health‑care providers and knowledge (r = 0.245;
P < 0.05) and performance (r = 0.208. P < 0.05) regarding the use of education strategies. However,
no significant association was found between health literacy of health‑care providers and attitude
toward the use of health literacy education strategies (r = 0.081; P = 0.225).
DISCUSSION AND CONCLUSION: While the results showed that 75% of health‑care providers had
a favorable level of health literacy, and despite the proper attitude toward the use of health literacy
education strategies, the knowledge and performance of the participants were estimated at < 60% in
this regard. It is suggested that the potential of health‑care providers in terms of achieving, processing,
and perceiving health‑related information and fundamental services be improved to enhance their
knowledge and performance regarding the use of health literacy education strategies.

Abstract INTRODUCTION: The Balint group’s seminars were developed by Michael and Enid Balint for the
purpose of a better understanding of doctor–patient relationships. This study aimed to introduce
the Balint group and its application to the medical science educational program and to provide an
up‑to‑date perspective on Balint group research.
MATERIALS AND METHODS: The study was carried out as a systematic literature search published
from January 2008 to September 2018 in the databases of PubMed, Scopus, Science Direct, and
Proquest, which were searched with keywords such as the Balint group and medical education
along with numerous related terms. Duplicates, non‑English language articles were discarded from
the review.
RESULTS: A total of nine papers entered the study. Among included articles, four used a qualitative
methodology, four used a quantitative methodology, and one applied a mixed methodology. Four main
aims emerged from the content of papers: (1) to evaluate resident and medical student experiences
in Balint groups, (2) to improve communication skills and reduce burnout level, (3) to assess the
Balint group’s effects on empathy, and (4) to explore the contexts and triggers of cases presented
in Balint groups.
CONCLUSION: Our results help us to the achievement of a better planning and design of an efficient
Balint group in medical education. The findings enable the policymakers to make better decisions
on the topic. Balint groups may guide medical students (residents) to become more patient centered
by improving their communication skills and empathic abilities and reducing the level of burnout.

Abstract INTRODUCTION: Recently, medical education has made significant progress, and medical teachers
are trying to find methods that have most impressive effects on learning. One of the useful learning
methods is student active participation. One of the helpful teaching aids in this method is mobile
technology. The present study aimed to determine the effect of sending educational questions through
short message service (SMS) on academic achievement and satisfaction of medical students and
compare that with lecture teaching.
SUBJECTS AND METHODS: In an semi‑experimental, two chapters of urology reference book,
Smiths General Urology 17th edition, were taught to 47 medical students of Isfahan University of
Medical Sciences in urology course in 2013 academic year. Kidney tumors chapter was educated
by sending questions through SMS, and bladder tumors part was taught in a lecture session. For
each method, pretest and posttest were held, each consisting of thirty multiple choice questions.
To examine the knowledge retention, a test session was held on the same terms for each chapter,
1 month later. At the end, survey forms were distributed to assess student’s satisfaction with SMS
learning method. Data were analyzed through using SPSS 20.
RESULTS: The findings demonstrated a statistically significant difference between the two learning
methods in the medication test scores. Evaluation of the satisfaction showed 78.72% of participants
were not satisfied.
CONCLUSIONS: The results of the study showed that distance learning through SMS in medical
students could lead to increase knowledge, however, it was not effective on their satisfaction.

Abstract Context: General practitioners should be competent to be accountable for patients’ needs,
but they do not acquire core competencies during education in medical schools. Aims: This
study was aimed at determine the most usual obstetric and gynecological as well as pediatric
diseases in rural and urban care centers in Isfahan province. Settings and Design: This is a
cross‑sectional descriptive study which was done in Isfahan province in 2011. Sixty‑four physicians
(general practitioners) in rural and urban health care centers in Isfahan province participated in
this study. Subjects and Methods: Participants completed valid and reliable questionnaires for
gynecological/obstetric and pediatric diseases. These questionnaires included some demographic
data and diseases of each category (according to general medicine curriculum). Scales 1‑5 for
each disease referral times was determined respectively as: Rare, sometimes, weekly to monthly,
daily to weekly and daily. Statistical Analysis Used: The data were descriptively analyzed by
SPSS 11.5(SPSS Inc. in Chicago). Results: Nearly 43.7% of participants were male. The mean
age of participants was 39.0 ± 7.0 and their mean working experience was 11.3 ± 5.9 years. The
highest referral times’ score in rural and urban care centers in gynecological and obstetric group
was vaginal discharge; in pediatrics, it was the common cold. Conclusions: In this study, the
extent to which general practitioners encountered different gynecological/obstetric and pediatric
diseases in rural and urban care centers in Isfahan province was determined. Although, these
data are useful for decision makers to establish medical core curriculum, other factors such as
seasonal load of diseases should also be observed to determine the differences between rural
and urban care centers in most usual diseases of women and children.

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.