Journal of Education and Health Promotion

Abstract BACKGROUND: Improving the quality of clinical education requires continuous review of the current
situation, identifying strengths, and correcting weaknesses. This study aimed to investigate the
association between academic motivation with quality of clinical education, academic achievement,
and burnout.
MATERIALS AND METHODS: This cross‑sectional study was done in 2020 on all of the 140 internship
students of Shahrekord University of Medical Sciences, using the consensus method. The data
collection tools included standard questionnaires such as Herman’s Academic Motivation, Clinical
Education Quality, Maslach Modified Academic Burnout, Pham and Taylor Academic Achievement,
Satisfaction of Educational Welfare Facilities. Data were analyzed using SPSS (ver. 22) software
and descriptive statistics (mean, standard deviation, frequency and percentage of frequency),
Spearman rank, correlation coefficient and Mann–Whitney and Kruskal–Wallis statistical tests.
P < 0.05 is considered statistically significant.
FINDINGS: The mean ± SD of age was 25.68±2.03. 86 (61.4%) of the internship were female
and 87 (62.1%) were single. Mean± SD of academic motivation and quality of clinical education
were 81.51± 8.73 and 28/99± 11/52 respectively. Also, the Mean± SD of academic achievement
and academic burnouts were 147/61± 14/94 and 42/37± 10/42 respectively.
RESULTS: Academic motivation had a meaningful and positive relationship with academic
achievement and satisfaction of welfare facilities but a negative correlation with academic burnout.
Also, academic achievement and academic burnout had a negative correlation but a positive
correlation was seen between the quality of clinical education and satisfaction of welfare facilities.
CONCLUSION: Considered the results, recommended improving welfare education facilities by
using up‑to‑date training aids, upgrading educational infrastructure, and employ young staff in the
education office. For improving the quality of clinical education, appropriate educational methods,
conducting developmental assessments continuously, using simulated environments, and improving
students’ motivation.

Abstract BACKGROUND: The capacity of self‑authoring one’s own beliefs, identity, and relationships is core
to many expected outcomes of future health‑care professionals. Students’ personal and professional
development for self‑authorship can be promoted by the variety of developmentally effective
“crossroads” experiences that they encounter. Identifying the characteristics of the crossroads
experiences in clinical rotations can provide a foundation for medical educators to provide an
environment that can foster self‑authorship.
MATERIALS AND METHODS: A cross‑sectional qualitative survey was conducted using a researcher
developed semi‑structured questionnaire which had three open questions and asked medical interns
to describe their internship experiences that stimulated their thinking along the self‑authorship
dimensions of identity, relationships, and ways of knowledge acquisition. Data were analyzed using
Braun and Clarkes’ thematic analysis method.
RESULTS: The survey was completed by 167 medical interns (response rate: 83%). The key features
of significant crossroads experiences and their effects were created into six themes: Experiences by
being respected and validated; experiences by involvement in patient management; experiences by
participation in interactive learning environments; experiences by participation in authentic clinical
work environments; experiences by the observation of professional behaviors; experiences through
the uniqueness of different specialties.
CONCLUSION: Authentic experiences of patient management in the real world of clinical settings with
a high interactive environment have the potential to promote interns’ self‑authorship development.
Educators can support learners by respecting and validating their capacities and by role modeling
of professional behaviors.

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: Clinical training during internship is an important part of medical education. The
maternity ward is a clinical environment in which medical students pass their obstetrics and gynecology
internship to obtain competencies in this field. The present study was conducted to explain medical
interns’ manner of learning in the maternity ward.
MATERIAL AND METHODS: The present study was conducted using a qualitative approach with
the inductive content analysis method. This study observed the maternity wards of teaching hospitals
affiliated to medical sciences universities of Isfahan and Shahrekord. Data were collected through
observation and semi‑structured individual interviews.
RESULTS: Two main categories and seven subcategories emerged from the analysis of the data.
Inadequate participation in learning opportunities included the following three subcategories: the
incongruousness of the learning opportunities with the educational goals, inadequate readiness for
participation in learning opportunities, and the overlap between learning opportunities and diminished
autonomous practice. Inadequate formal and structured education included the following four
subcategories: inadequate learning support and direction, subordinate roles and aimless presence,
the pale educational role played by the attendants and senior residents, and learning through the
support of midwifery educators.
CONCLUSION: Participation in and access to learning opportunities in the maternity ward are very
difficult for interns. Interns, therefore, need to attend the maternity ward by a structured program and
in the company of training supervisors or competent educators to obtain the required competencies
in pregnancy and childbirth.

Abstract Introduction: In this study, by using a problem‑oriented approach in the needs assessment,
identifying the defects and deficiencies in emergency health training centers has been
determined as the basis for the requirements. The main objective of the study was the
implementation of surgical emergencies integration of the five surgical groups (general surgery,
urology, orthopedics, neurosurgery, and ENT) to meet the needs and determining its efficacy.
Materials and Methods: This interventional study was conducted in three phases: (1) Phase I(design
and planning): Needs assessment, recognition of implementation barriers and providing the objectives
and training program for integrated emergencies. (2) Phase II (implementation): Justification of
the main stakeholders of the project, preparation of students’ duties in the emergency department,
preparation of on‑duty plans, supervising the implementation of the program, and reviewing the
plan in parallel with the implementation based on the problems. (3) Phase III (evaluation): Reviewing
the evidences based on the amount of efficiency of the plan and justification for its continuation. In
the first and the second phase, the data were collected through holding focus group meetings and
interviews. In the third phase, the opened‑reply and closed‑reply researcher‑made questionnaires were
used. The questionnaire face and content validity were confirmed by experts and the reliability
was assessed by calculating the Cronbach’s alpha. Results: According to the views of the
interns, assistants, teachers, and emergency personnel, the positive features of the plan included
the following: Increasing the patients’ satisfaction, reducing the patients’ stay in the Emergency
Department, increasing the speed of handling the patients, balancing the workloads of the interns,
direct training of interns by young teachers of emergency medicine, giving the direct responsibility
of the patient to the intern, practical and operational training of emergency issues, increasing the
teamwork, facing a variety of patients, practicing the role of general practitioners, role‑playing on a real
patient’s bedside, having a multilateral approach to the patient, reducing the wasting time on minor
wards, balancing the work and rest schedules of the interns, and better learning and satisfaction
of the interns. Over 60% of the participants believed the program has the following benefits: More
attention on the training plan, improving the learning of patient management, being more responsive
for the training of interns, increasing operational approach to emergency patients, being more
aware of the performed actions, and increasing  the quality and speed of services provided to patients. The mean score assigned to the whole questionnaire of investigating the viewpoints was 37.5 out of 50. The mean score of the interns’ questionnaire was significantly more than the mean score of the assistants. Discussion: The results obtained indicated that the greatest existing consensus about this plan was the positive impact on the learning of interns in the emergency setting. Thus, it will not only increase the number of patients who the interns are managing
during the internship course, but also increases the balance of their workload and they can learn and manage the emergency patients with more leisure.

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.