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: Medical education is competitive across the globe. The long duration of the medical
and paramedical courses and exposure to clinical settings potentially causes mental health issues.
The aim of this study was to estimate the prevalence of depression, anxiety and stress among
undergraduate students in a private medical college in South India.
MATERIALS AND METHODS: This cross‑sectional study was conducted among paramedical and
medical students at a private medical college hospital and research center in South India in the
year 2021. The required sample size was calculated as 783 with an expected prevalence of 53%,
95% confidence interval (CI), design effect 2.0, and non‑response of 10%. The study participants
were selected based on simple random sampling. After obtaining informed consent, the data was
collected using an email questionnaire. Standard data collection tools such as the Perceived Stress
Scale (PSS); and the Depression, Anxiety and Stress Scale ‑ 21 (DASS‑21) questionnaire were
used. The investigator computed the odds ratio (OR) and adjusted odds ratio (aOR) with a 95% CI.
RESULTS: Out of 1200 students, 1015 (85%) responded to the email questionnaire. Among them, 639
were females (63%), and 925 were paramedics (91%). Prevalence of depression, anxiety and stress
were 59%, 43% and 11%, respectively. Almost 95% of students experienced moderate‑to‑severe
stress in the last one month. Prevalence was higher among females and students of medical
courses. Students of final year of college (aOR = 2.0; 95% CI = 1.2–3.5) and students of medical
course (aOR = 1.5; 95% CI = 1.1–2.4) were independently associated with stress among the study
participants.
CONCLUSION: There is high prevalence of depression, anxiety and stress among medical college
students in south India. The final year of study and medical course were independently associated
with higher stress than others. We recommend periodic assessment of mental health status and
additional mental health care for final year students and medical students.

Abstract BACKGROUND: Since the field of health professions education (HPE) is an emerging trend in the
country, educationists face considerable challenges in their workplaces while proposing any changes
in the existing systems of academic institutions. The challenges affect the quality of work, hinder
innovation, and create a dysfunctional work environment, non‑conducive for both personal and
professional progress. The study was conducted to explore the various kinds of challenges faced
by educationists while bringing changes to the existing systems of academic institutions in Pakistan.
MATERIALS AND METHODS: A qualitative exploratory research design was used to explore the
challenges faced by health professions educationists in Pakistan during their efforts to bring about
changes in the existing systems and structures. Thirteen health professions educationists working
in various academic institutions of Pakistan were interviewed through one‑to‑one semi‑structured
interviews from March to May 2022. The data obtained were analyzed through manual thematic
analysis, and themes and subthemes were identified.
RESULTS: Four themes emerged after qualitative data analysis explaining the predominant
challenges faced by educationists. These included challenges related to faculty and staff, institutional
constraints, challenges from leadership, and stakeholders’ apprehension.
CONCLUSION: Challenges are inevitable at every workplace but the field of health professions
education in Pakistan faces significant challenges in institutions, leading to hindrance in positive
developments and innovations in the field. Educationists should be skilled at recognizing the
predominant challenges in the workplace and be equipped with strategies to manage conflicts to
achieve productive results and to promote the long‑overdue reforms in the field.

Abstract BACKGROUND: Change is a multidimensional and pervasive issue in the modern world, and
organizations are constantly changing in social, cultural, political, economic, and technological fields.
Change leadership is a model that employs a combination of leadership styles to keep the employees
and the organization prepared for learning and continuous growth. This study aims to identify the
dimensions and components of change leadership in medical sciences education to move toward
third‑generation universities through a qualitative approach.
MATERIALS AND METHODS: The present study was an applied explorative qualitative study.
Participants included the experts in the field of management and key informants in the field of change
leadership and third‑generation universities who were selected through purposive sampling. The
research tool was semi‑structured interviews aimed at the identification of dimensions and components
of the change leadership. Interview‑guided questions were about change leadership to move toward
the third‑generation universities followed by probing questions. Colaizzi content analysis technique
was used to analyze the data.
RESULTS: Data from interview transcript analysis resulted in the identification of 335 initial codes,
13 subcategories, and 3 categories or dimensions. The main categories included “change leadership
roles and specifications,” “providing a context and preparing for change,” and “change leadership
process and path.” Each of the main dimensions included several components.
CONCLUSION: The importance of leadership in the process of change is since change entails the
establishment and institutionalization of new systems and structures which is impossible without
an effective leadership style. Leaders have high expectations of their followers and inspire them
to strive toward organizational goals and facilitate the realization of the shared vision through
encouraging them. As a leadership paradigm for organization performance improvement capable
of encouraging employees and building an organizational culture in which ethical procedures are
considered behavioral norms, change leadership seeks to predict the environment changes so that
it can move in accordance with them.

Abstract BACKGROUND: The Health System Reform Plan, especially in medical education, has undoubtedly
caused changes in the university. The continuation of this project requires recognizing the challenges
confronted by those in charge of its implementation. This study aimed to explore the challenges of
the implementers of the Transformation and Innovation Plan in Medical Education in the universities
of Macroregion 5.
MATERIALS AND METHODS: The qualitative research was conducted using the content analysis
method. Semi‑structured interviews with health and medical education managers were used to
collect information. Participants were 11 educational leaders of universities who were selected by
purposeful sampling. Data collection continued until data saturation was reached. Data analysis
was performed continuously and simultaneously with data collection. The Graneheim and Lundman
methods were used to analyze the data.
RESULTS: From 11 interviews, one theme, five categories, and 12 subclasses were obtained. Five
categories include lack of proper groundwork, weak leadership, structural problems, inability to fund,
and inadequate monitoring.
CONCLUSION: Innovation and transformation in medical education are one of the critical missions
and admirable actions of the Ministry of Health in the field of education, but a review of this plan
can, in addition to identifying shortcomings and problems, pave the way for success, and progress
in future programs.

Abstract BACKGROUND: Metamotivation is a process that students use to monitor their motivational states
to reach their academic goals. To date, few studies have addressed the ways that medical students
manage their motivational states. This study aim to identify the motivational strategies of medical
students as they use the metamotivational process to monitor and control their motivational states.
MATERIALS AND METHODS: This qualitative study uses directed content analysis of the narrative
responses of 18 medical students to draft an in‑depth and semistructured interview protocol which were
conducted through WhatsApp due to social distance restrictions of COVID‑19. Data were collected,
encoded, and analyzed using deductive content analysis approach descripted by Elo and Kyngäs.
RESULTS: Seven main themes were extracted as the motivational strategies of medical students
including “regulation of value,” “regulation of situational interest,” “self‑consequating,” “environmental
structuring,” “efficacy management,” “regulation of relatedness,” and “regulation of situational
awareness.” In this study by identifying new strategies, we provide a broader framework of
metamotivational strategies in the field of the progression of learners in medical education.
CONCLUSION: Medical students use a variety of strategies to regulate their academic motivation. To
sustain and improve the motivation of medical students, identifying and strengthening metamotivational
strategies is the first step.

Abstract INTRODUCTION: With the unintended closure of classrooms following the outbreak of COVID‑19, the 
virtual education method is used as an alternative to face‑to‑face education. Virtual education is one 
of the important factors in promoting the learning of medical students and has many benefits such as 
increasing the ability of critical thinking, problem‑solving skills, and self‑directed learning. However, 
critically examining students’ perceptions of e‑learning can help improve quality and better planning.
MATERIALS AND METHODS: This research was a qualitative study. Twelve students were enrolled 
in the study based on purposive sampling. Data were collected using in‑depth semi‑structured 
interviews in 2020. All interviews were recorded and then transcribed and analyzed using a continuous 
comparison and conventional content analysis approach.
RESULTS: Data analysis revealed four main themes and ten subthemes. The main themes included 
“student concern,” “teacher barriers,” “technology weakness,” and “asynchronous virtual learning 
flexibility.”
CONCLUSION: Asynchronous e‑learning in the COVID‑19 outbreak had its advantages and 
disadvantages. By analyzing students’ perceptions in this field, some better designs and planning 
can be done to increase the quality of education.

Abstract BACKGROUND: In the recent years, the wealth creation of educational institutions has attracted an 
enormous attention in different countries. Exploring experiences of these institutes help to improve the 
wealth creation of universities. In this regard, this study was an attempt to explain the viewpoints of 
the wealth creators of medical sciences regarding wealth creation strategies and define the general 
path of wealth creation in medical sciences universities.
MATERIALS AND METHODS: This qualitative study was conducted at Iran University of Medical 
Sciences, Tehran, Iran, in 2021. Participants were the experienced knowledgeable wealth creation 
experts. Fourteen semi‑structured interviews were conducted to reach data saturation. Interview 
guided questions were about strategies and paths of wealth creation followed by probing questions. 
Data were analyzed using conventional qualitative content analysis.
RESULTS: Data analysis showed that the most important strategies were related to nine extracted 
categories of “the productions”, “contracts and relations”, revising, predicting and foresight” ‑, 
“education”, “research”, “healthcare services”, “ interdisciplinary fields between Information 
Technology (IT) and health‑care”, “ saving and maintenance”, and “altering the procedure of the 
wealth accelerator centers.” In general, wealth creation path in medical sciences includes six main 
categories.
CONCLUSIONS: The result of this study provide an opportunity for educational policy‑makers 
and authorities to improve wealth creation in medical universities. Especially, accentuated by the 
COVID‑19 pandemic, to consider the interdisciplinary fields between IT and health‑care and integrating 
technology to the various categories of medical sciences are absolute needs.

Abstract BACKGROUND: Urinary tract infections (UTIs) are more common in females than males and 
predominantly based on their unhealthy practices in their day to day lives. This study is trying to 
assess the occurrence of UTI and strategies used by female student to prevent UTI.
MATERIALS AND METHODS: A cross‑sectional descriptive study carried out in a tertiary care 
teaching institute. A total of 338 conveniently selected B. Sc. Nursing and MBBS Medical students 
were surveyed. The data were collected by using a pretested, a self‑structured questionnaire 
related to occurrence and practices to prevent UTI along with necessary demographic details. 
Descriptive (frequency, percentage, mean and standard deviation) and inferential (Chi‑square test) 
statistics was used to compute the data.
RESULTS: The result of this study shows that 10.05% female students reported of having UTI. The 
proportion was higher in nursing students (67.6%) than medical (32.4%) but did not show a significance 
difference (P = 0.61). Age, duration of hostel life, and marital status were significantly associated 
with the status of UTI (P = 0.001). To prevent UTI, students were using commercial product with 
Tea Tree Oil, soap, drinking 3–4 l water/day, increased frequency of peri‑wash during menstruation 
period, and use of Citrus Fruits. The use of western toilet was also significantly associated with 
status of UTI (P = 0.04).
CONCLUSION: The occurrence of UTI was more among nursing students. Most of the perineal 
hygienic practices by the female students were associated with occurrence of UTI; hence, it is 
necessary to emphasize on preventive practices to minimize re‑occurrence.

Abstract BACKGROUND: Ineffective health communication could cause the increase of COVID‑19 cases 
in Indonesia. Medical students can involve in efforts in health communication on social media to 
positively impact prevention behaviors during a pandemic. This study aims to identify and analyze 
medical students’ and internship doctors’ perceptions toward health communication related to 
COVID‑19 through social media.
MATERIALS AND METHODS: A mixed method with exploratory sequential used. A qualitative study 
was done using phenomenology approach through deep and semi‑structured interviewing. After data 
analysis, the draft of the instrument prepared. Items in the draft selected based on the respondents’ 
answer. Then, a quantitative cross‑sectional study was used. The data obtained from 399 medical 
students and doctors at a University in Indonesia using Google Form on October 14 to October 20, 2020 
through media social. Data were analyzed using Pearson Correlation and Chi‑square (alternative: Fisher’s 
exact test) and logistic regression analysis with P < 0.05 and 95% confidence interval, respectively.
RESULTS: Based on interview, respondents communicate health on social media because the 
condition of COVID‑19 in Indonesia is dangerous, feel vulnerable to COVID‑19, understand the 
benefits, obligations, or responsibilities as a candidate and/or medical personnel and believe they
can create content/find valid sources. Meanwhile, the perception of limited knowledge is their biggest
obstacle in conducting health communication. There were a relationship between gender (P = 0.028, 
PR = 0.657), perceived severity (P = 0.044, PR (Prevalence Ratio) =4.844 [0.725–32,354]), perceived 
susceptibility (P = 0.005, PR = 1.803 [1.182–2.750]), perceived barrier (P < 0.001, PR = 2.543 [1.908–
3.388]), and self‑efficacy (P = 0.012, PR = 1.810 [1.120–2.926]) with health communication behavior. 
The perceived barrier (P < 0.001, RR = 4.278 [2.709–6.754]) and perceived susceptibility (P = 0.004, 
PR = 2.304 [1.302–4.077]) were the most influenced behavior.
CONCLUSIONS: This study showed that perceived severity, perceived susceptibility, perceived 
barrier, and self‑efficacy are predictor factors of health communication behavior related to COVID‑19
on social media with perceptions of susceptibility and perceived barriers as the most influential
variables. It is necessary to provide communication learning on social media as effectively and 
applied directly to reduce perceived barriers and increase self‑efficacy.

Abstract BACKGROUND: Professional ethics is a set of principles and standards of human behavior that
affect individual behavior and leads to improve care that provided by medical staff. The present
study examined the knowledge and attitude of medical and nursing students toward professional
ethics in Iran.
MATERIALS AND METHODS: This descriptive‑analytic study was carried out on 176 medical and
nursing students in Bam University of Medical Science, Iran in 2019. In this study, students were
selected by census sampling. Data collected using two researcher‑made questionnaires related to
knowledge and attitude toward professional ethics. Data were analyzed in SPSS software.
RESULTS: The mean scores of knowledge among nursing and medical students were 86.56 (8.76)
and 85.10 (12.19), respectively. The mean score of attitude among nursing and medical students
was 127.06 (12.45) and 129.9 (11.88), respectively. Results of the Pearson correlation test showed a
positive and significant associated between the score of knowledge and attitude nursing and medical
students’ (P < 0.001), (r = 0.76) (r = 0.66). Among the demographics characteristics, student age
was associated to their attitude and knowledge significantly (P = 0.03).
CONCLUSION: Iranian nursing and medical students have a positive attitude and a high level of
knowledge about professional ethics. A high level of knowledge was related to the most positive
attitude.

Abstract BACKGROUND: COVID‑19 pandemic has forced medical education to undergo sudden
metamorphosis from the traditional face‑to‑face education to distance online learning. This transition
was dealt with a lot of infrastructure and technical difficulties from both teacher and learner ends,
especially in a developing country like India. This study was conducted with the aim of analyzing
students’ perspective and problems faced in the live online teaching.
MATERIALS AND METHODS: This was a prospective longitudinal study conducted on medical
students enrolled in the 1st, 2nd, and 3rd years of Bachelor of Medicine and Bachelor of Surgery
courses at a government medical college located in hilly state Uttarakhand, India. Clearance from
the institutional ethical committee was obtained. The students were invited to voluntarily participate in
online survey by filling Google Forms which was E‑mailed as well as shared in social media platform.
A total of 237 medical students participated. The first survey was conducted at the time of initiation
of online mode of teaching, during May 1–7, 2020, and second, after completion of 6 months of
regular online teaching, during November 1–7, 2020. The questionnaire comprised initial section
on demographic details and consent followed by 27 and 30 sets of statements pertaining to online
medical education experience in the first and second questionnaires, respectively. A 5‑point Likert
scale was used. Data were analyzed using IBM SPSS version 24.0. Chi‑square test was applied for
association, and P ≤ 0.05 was considered statistically significant.
RESULTS: A total of 237 students participated in the study. The response rate was 52.7%. Majority of
respondents had suitable devices (89.1%) and Internet facilities (62%) for online classes. The students
accepted the new method of teaching very well, but for practical sessions and clinics, traditional
classes were necessary. Long screen time, lack of student–teacher interaction, and interaction with
peers were major concerns of students. However, over the study period, the availability of resources,
friendliness toward technology, and inclination toward virtual classes increased.
CONCLUSIONS: The pandemic has introduced to a new normal where online teaching cannot be
ignored. Despite challenges faced during online learning, 65.5% of students preferred hybrid teaching
in future for delivering medical education. Acceptance for online education by students increased
over time in the study.

Abstract BACKGROUND AND AIM: Parasitology course is one of the basic science courses in the educational
curriculum for medical students. Since the integration of basic and clinical sciences has helped
students better understand the basic science course content, the aim of the present study was to
determine the effect of integration of basic and clinical aspects of a specific topic in a parasitology
course on medical students learning.
MATERIALS AND METHODS: A randomized controlled trial was conducted on 110 undergraduate
fifth‑semester medical students from April to July 2018. The students were randomly divided into two
groups, based on student identification number: Intervention and control groups. The topic selected
for this study from the parasitology course was “cutaneous leishmaniasis.” At the beginning of the
program, a dermatologist presented the clinical aspects of the topic to the intervention group. Then,
a parasitologist delivered a traditional lecture about the basic aspects of the topic to both groups.
The students’ scores on questions related to cutaneous leishmaniasis in the final exam were used
as a measure of learning and teaching outcomes. A questionnaire that consisted of seven items and
three open‑ended questions was used based on the objectives of the randomized controlled trial.
Statistical analysis was performed by SPSS software.
RESULTS: Based on the result of the final examination, there was no significant difference in
the learning rate of students between the intervention and control groups (P ≥ 0.05). According
to students’ comments, the teaching of clinical science alongside basic science increased the
importance of the topic and the students’ interest in basic science. Most students agreed that this
method prepares them for their clinical years.
CONCLUSION: Many medical students believe that the content of many basic science courses are
forgotten in the future. Therefore, basic science education alongside clinical science presentations
are suggested.

Abstract BACKGROUND: Kane’s validity framework examines the validity of the interpretation of a test at the
four levels of scoring, generalization, extrapolation, and implications. No model has been yet proposed
to use this framework particularly for a system of assessment. This study provided a model for the
validation of the internal medicine residents’ assessment system, based on the Kane’s framework.
MATERIALS AND METHODS: Through a five stages study, first, by reviewing the literature, the
methods used, and the study challenges, in using Kane’s framework, were extracted. Then, possible
assumptions about the design and implementation of residents’ tests and the proposed methods for
their validation at each of their four inferences of Kane’s validity were made in the form of two tables.
Subsequently, in a focus group session, the assumptions and proposed validation methods were
reviewed. In the fourth stage, the opinions of seven internal medicine professors were asked about
the results of the focus group. Finally, the assumptions and the final validation model were prepared.
RESULTS: The proposed tables were modified in the focus group. The validation table was developed
consisting of tests, used at each Miller’s pyramid level. The results were approved by five professors
of the internal medicine. The final table has five rows, respectively, as the levels of Knows and Knows
How, Shows How, Shows, Does, and the fifth one for the final scores of residents. The columns
of the table demonstrate the necessary measures for validation at the four levels of inferences of
Kane’s framework.
CONCLUSION: The proposed model ensures the validity of the internal medicine specialty residency
assessment system based on Kane’s framework, especially at the implication level.

Abstract CONTEXT: Virtual learning is not without challenges. It can cause stress, lack of motivation, and social
isolation. Due to COVID‑19 pandemic, our college shifted from face‑to‑face to virtual teaching–learning
style. the aim was to find out the barriers in virtual learning among medical students and provide
solutions to overcome them.
MATERIALS AND METHODS: This cross‑sectional study was conducted among 3rd‑ and 4th‑year
Bachelor of Medicine and Bachelor of Surgery students in 2020. Prevalidated electronic survey forms
on institutional barrier, technical barrier, and individual barrier were sent to students, 160 students
responded. SPSS version 12 was used to calculate descriptive statistics and independent t‑test.
RESULTS: The students had the highest mean score in individual barrier
(mean: 2.82 [standard deviation (SD): 0.72]) followed by institutional barrier (mean: 2.79 [SD: 0.74])
and technological barrier (mean: 2.72 [SD: 0.75]). Regarding technological barriers, 38.6% of the
students agreed difficulty in procurement of the laptop and 66.4% faced slow Internet connection.
Regarding institutional barriers, 75.9% were stressed to join one lecture to another lecture as the
lectures were continuous, 69.6% had limited opportunity to interact with lecturers, and 62.7% had
poor communication between lecturers and students. Regarding individual barriers, 74.1% of the
students were not motivated for online learning, 71.5% of the students could not learn as well as
they were in the classroom, and 58.2% disagreed taking online courses in future.
CONCLUSION: Low motivation, communication, Internet connectivity, and technical problems were
the main barriers. Smaller size class, highly motivated and well‑trained lecturers, and interactive
lectures may help in breaking the barriers of virtual learning.

Abstract BACKGROUND: Management of cancer complications requires the provision of palliative care as a
comprehensive care by the main and trained members of this method of care. The aim of the present
study was to assess the compliance of educational curricula of selected disciplines with the content
standards of cancer‑related palliative care.
MATERIALS AND METHODS: In this descriptive–comparative study, the content standards of
palliative care for nurses, physicians, and social workers were identified based on the World Health
Organization guideline and Oxford Textbook of Palliative Nursing. For this purpose, a separate
checklist was prepared for the disciplines with different dimensions. Then the face and content
validity of the checklists were checked. Finally, we examined the coordination between selected
curricula available on the website of Education Deputy of the Ministry of Health, Treatment and
Medical Education with the dimensions of the checklists.
RESULTS: All three curricula in most domains were relevant with the content standards, but there
was the biggest education need in the areas related to the dimensions of “planning and educational,”
“educating physician in palliative care,” and “considering patient preferences” in these disciplines.
CONCLUSIONS: To meet the educational needs, it is suggested to change some course topics,
hold training courses, or joint workshops.

Abstract BACKGROUND: Before the COVID-19 pandemic, medical students had reported experiencing high
rates of distress, burnout, anxiety, and depression. The psychological impact of the COVID-19 in the
general population suggested that the mental health impact was increased anxiety, depression, and
stress. There were no exceptions if medical students also experience the same psychological impact.
The aimed to this study is analyze the mental and emotional effects of the COVID-19 pandemic
among medical students.
MATERIALS AND METHODS: An observational analytic study was used with a cross-sectional
approach. Data were obtained with questionnaires distributed through social media platforms from
July 14, 2020, to July 21, 2020. This study using the Fear of COVID-19 (FCV-19) Scale and the
Depression, Anxiety, and Stress Scale-21 to assess FCV-19, anxiety, stress, and depression.
statistical analysis used IBM SPSS Statistics 24 was used to analyze the two-tailed Chi-square test,
the Mann–Whitney test, and the Kruskal–Wallis test, which were used with statistical significance
as P < 0.05 for all tests.
RESULTS: Out of 1027 samples, 44.6% had stressed, 47.8% had anxiety, and 18.6% had depression.
The gender (P = 0.000), educational stage (P = 0.000), and the comorbidity factor (P = 0.001 for
stress and anxiety, P = 0.036 for depression, and P = 0.000 for FCV-19) had a significant association
with stress, anxiety, depression, and FCV-19 in medical students. The hometown that showed zone
risk of infection only showed significant differences in FCV-19 (P = 0.026).
CONCLUSIONS: Protection and psychological support for a medical student is extremely high
importance given that COVID-19 is now a well-established pandemic and there will be other
pandemics in the future.

Abstract BACKGROUND: Videoconferencing has been used as a modality of online medical teaching
by various institutes. There is a paucity of studies reporting the perception of medical teachers
toward teaching using teleconferencing platforms. The objective of this survey was to evaluate the
perception of medical teachers toward teaching using videoconferencing platforms such as Zoom
meet, Google meet, and Google classroom during the COVID‑19 pandemic. Our hypothesis was
teaching faculty would have a positive perception and experience toward web‑based teaching
modalities.
MATERIALS AND METHODS: Medical teachers of a medical college were invited to participate
in a prospective observational cross‑sectional online survey. The faculty demographic information,
perception, experience, and satisfaction were noted. Perception data were presented as proportion
and percentage.
RESULTS: 104 out of 160 faculty members participated in the study (response rate = 65%).
61 male (58.7%) and 43 female (41.3%) faculty members participated in the study. The mean age
of the faculty members was 39.3 years ± 13 (range: 27–69 years). Laptop (n = 73 [70.2%]) was the
most commonly used electronic device by the faculty members for conducting e‑teaching sessions
followed by smartphone (n = 25 [24%]). Google meet was the most preferred videoconference tool
for online teaching. Ninety‑six faculties (92.2%) were satisfied with the e‑teaching method adopted
by the institute. Eighty‑three faculty (79.8%) perceived the e‑teaching method to be very useful and
quite useful as a modality for teaching during the lockdown period.
CONCLUSIONS: The teaching faculties had a positive perception toward digital education methods
adopted for teaching of undergraduate medical students at our institute.

Abstract BACKGROUND: The COVID‑19 pandemic led to the closure of crowded places such as universities
and replaced face‑to‑face learning with virtual education. The purpose of this qualitative study was
to investigate the challenges of virtual learning from the students’ perspectives.
MATERIALS AND METHODS: This qualitative descriptive study was conducted on students of
Sabzevar University of Medical Sciences. Purposeful sampling was performed by semi‑structured
group interviews on the Internet in the WhatsApp social network. Fifty‑two nursing, midwifery,
hygiene, and paramedical students were interviewed. Every interview was started by asking the
question “what is your experience about virtual teaching?” The data were analyzed using MAXQDA
software version 2020. According to the steps of qualitative content analysis, content analysis was
performed and the themes were extracted.
RESULTS: Fifty‑two students were interviewed in eight group sessions. Qualitative data analysis
leads to the extraction of 23 codes, 7 categories, and the 2 main themes; dissatisfaction with virtual
education with 4 categories (lack of feedback, communication channel problems, the unpreparedness
of the message receiver, and weakness in educational content) and solutions to the modification of
virtual teaching with three categories (possibility of receiving feedback, channel improvement, and
strengthening educational content) were extracted. The highest frequency of code was related to
the dissatisfaction with the uploaded contents.
CONCLUSIONS: Virtual education has created a negative experience among students for various
reasons, including the lack of distance learning infrastructure and the lack of a standard for preparing
quality content. Therefore, it is necessary for the officials of the Education Development Center to
supervise the prepared contents and improve distance learning infrastructure.

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 AIM: To assess the knowledge, attitude, practices (KAP), and barriers regarding pharmacovigilance
and adverse drug reaction (ADR) reporting among medical and dental faculties of the teaching
hospitals.
METHODOLOGY: This study was conducted for a period of 3 months among medical and dental
faculties. A self‑structured, 42‑item closed‑ended questionnaire based on pharmacovigilance and
ADR reporting was used in this study. Data were analyzed using Statistical Package for the Social
Sciences Version 21. All the items of the domains along with demographic variables were summarized
as absolute and relative frequencies. Intergroup comparison was done using Kruskal–Wallis test and
Mann–Whitney U‑test. The correlation between the domains was assessed by Spearman correlation
coefficient.
RESULTS: Among the study subjects, 272 (60.4%) were females and 178 (39.6%) were males.
The number of medical and dental faculties was 360 (80%) and 90 (20%), respectively. The mean
KAP scores for medical and dental faculties were 7.58 and 5.37, 8.78 and 6.01, and 6.91 and 6.32,
respectively. The Spearman correlation coefficient (ρ) was found to be significant for knowledge–
attitude and knowledge–practice domains. The values obtained between attitude with practice and
barrier also were significantly correlated.
CONCLUSION: Our study findings advocate that although medical faculties have better knowledge
about pharmacovigilance and ADR reporting, dentists have a positive attitude, thereby suggesting a
huge scope of progress if more emphasis is given on the need for continuous educational initiatives
and including the topic in their academic curriculum.

Abstract INTRODUCTION: To design instructions in health sciences education, it is highly relevant to heed
the working memory and the approaches for managing cognitive load. In this article, we tried to
mention the implications of cognitive load theory (CLT) for optimizing teaching-learning in health
sciences education and discussing cognitive load from the perspective of cognitive neurosciences
as brain-aware medical education.
MATERIALS AND METHODS: We searched databases of Pubmed, Proquest, SCOPUS, and ISI
Web of Science for relevant literature in September 1, 2018.
RESULTS: The 27 articles out of a total of 46 records, along with 23 papers from snowballing and
hand searching were included in this study. Main items encompassed; “Various types of cognitive
loads,” “Aim of cognitive load theory,” “Strategies to managing Cognitive Load,” “Cognitive Load Theory
in novice and experienced learners and “expertise reversal effect,” Medical and Health Sciences
Curriculums and Cognitive Load Theory,” “Challenges of Cognitive Load Theory.”
CONCLUSIONS: We discussed six important themes for CLT in health sciences education according
to the literature. Mental imagery (visualization) as one of the useful techniques to optimize germane
load was suggested, as it processes further gain access to neural circuits that are engaged in sensory,
motor, executive, and decision-making pathways in the brain.

Abstract OBJECTIVE: The aim was to explore the relationship between mental health problems (MHPs) and
health‑promoting lifestyle (HPL) in the medical students.
METHODS: This cross‑sectional study was carried out on medical students in 2017 at Semnan
University of Medical Sciences applying a stratified random sampling. The Symptom Checklist‑25
and the HPL profile scales were used. Logistic regression models were used to analysis.
RESULTS: Of the participants, 84 were male and 148 were female. The mean age was
22.69 years (±2.42). Most students (95.3%) were single and 40.1% were in the preclinical stage.
The mean MHP score was 44.14 (±13.99), and 3% were in the severe category. The mean HPL
score was 104.88  (±16.84); 95.7% and 4.3% of them had average and satisfactory lifestyles,
respectively. The MHP score of the female (P < 0.001), younger (P < 0.001), single (P = 0.045),
preclinical (P < 0.001), and who were away from home (P  =  0.009) were significantly higher.
The HPL score of female (P < 0.001), older (P = 0.041), and married students (P = 0.028) were
significantly higher. The female gender (odds ratio [OR] = 4.45, P < 0.001) and studying in the clinical
level (OR = 0.30, P < 0.001) were the most important associated factors with MHP. Adjusting for
them, there was a significant relationship between an increase in the HPL score and a decrease in
the likelihood of MHP (OR = 0.96, P < 0.001).
CONCLUSIONS: The mental health of medical students was shown to be in association with lifestyle
independent of other important determinants, including gender and academic level. It seems that
modifying the lifestyle to a healthier way can improve students’ mental health.

Abstract BACKGROUND: Special learning outcomes are considered for medical and health sciences education
which can be acquired by some interactive learning systems in the human brain. Given the importance
of this issue, based on literature, we attempted at mentioning certain practical points for medical and
health sciences educators to employ in preclinical and clinical teaching.
MATERIALS AND METHODS: We searched databases of PubMed, Proquest, Scopus, ERIC, and
ISI Web of Science for relevant literature from January 2010 to January 2019.
RESULTS: From a total of 1029 records, 30 articles along with 35 papers from snowballing and hand
searching were included in this study. The following 12 main items were encompassed: teaching
students the basic neuroscience of learning and set individual learning goals, “just right challenge”
heeding the balance between supervision and autonomy, brain‑friendly coaching, repetition with
spaced learning, visualization as a powerful learning tool, multimodal teaching, cognitive learning
and mental model, cognitive‑emotional learning, active and social learning, creativity and art, sleep,
medical faculty’s participation regarding the courses of “neuro‑education studies,” and “neuro‑myths”
were suggested for brain‑friendly medical and health sciences teaching.
CONCLUSIONS: We considered 12 practical points for brain‑aware medical and health sciences
teaching according to the recent literature on the basis of the association between education, cognitive
science, neuroscience, and psychology. Interdisciplinary research and practice regarding this issue
can improve teaching–learning quality, students’ well‑being, and ultimately patient outcomes.

Abstract BACKGROUND: Respiratory diseases are a major cause of mortality and morbidity worldwide.
A sound knowledge of management of respiratory diseases is thus very vital. The clinical exposure
of undergraduate medical students is limited to 2 weeks in pulmonary medicine. We hypothesized
that the short duration of posting can be best utilized by developing need‑based modules for bedside
teaching.
AIMS: This study aimed to determine gain in knowledge and skills of final‑year medical students
in diagnosis and management of common pulmonary diseases and assess students’ perception of
the module.
METHODS: A one‑group pretest‑posttest quasi‑experimental study design enrolled a convenience
sample of 48 final‑year medical students. Twenty‑four students were posted at a given time for the
bedside clinical posting in pulmonary medicine between August 2013 and November 2013. These
students were divided randomly into two groups of 12 students each. All students consented to be
part of the study. Two trained faculty taught in rotation. The bedside teaching module was prepared
by Delphi technique and curriculum was based on Kern’s six‑step approach. History taking, physical
examination, tuberculosis, chronic obstructive pulmonary disease, asthma, lung cancer, chest X‑rays,
and spirometry were taught. Students were administered pre‑ and post‑test questionnaires to assess
knowledge, while Objective Structured Clinical Examination assessed skills. Students’ feedback
questionnaire evaluated the teaching module. A two‑tailed paired sample t‑test assessed mean gain
in knowledge and skills. Effect size was calculated by Cohen’s d, while Cronbach’s alpha estimated
the reliability testing of perception questionnaire. Statistical analysis was performed using statistical
software package IBM SPSS version 23.
RESULTS: Mean pre‑ and posttest knowledge scores were 12.46 (8.09) and 43.17 (10.7),
respectively, P = 0.001. Mean pre‑ and posttest skills scores were 7.00 (4.76) and 24.79 (3.31),
respectively, P = 0.001, and Cohen’s d showed large effect size. Most students stated that the
module enhanced their clinical skills, helped to understand difficult material, and promoted inquiry
and thinking. Cronbach’s alpha for perception questionnaire was 0.854.
CONCLUSIONS: Structured bedside teaching module in pulmonary medicine improved the knowledge
and skills of undergraduate medical students. The contents and various teaching methodologies
were evaluated positively.