Journal of Medical Education
Volume:16 Issue: 4, Nov 2017

In current issue of the Journal of Medical Education, Afshar in the Editorial “The Role of Private Sector in Higher Education; From Quantity and Quality to Access and Social Justice” proposed the importance of justice and quality. (1) It seems that there are some differences between two types of private sector in higher education. One type of private financial support in higher education comes purely from private sector without any contribution of public sector. The second type of private finance in the higher education especially the type which has grown recently in Iranian higher education is a type of combination between public higher education and private sector the so called international branch of the university till recent years, and nowadays called selfgoverning campus of the university. (2) In this type of private contribution to public higher education those who have no or little money must pass very hard national examination to be accepted in the university, and those who can pay the tuition fee could enter to the best schools of that university without the exam (in the first year of the project) or by loose standards or lower cut off scores. Actually, this is an instance of the double standards.
One of the elements of being equitable and avoiding discrimination is to prevent undue achievement by the owners of the power such as owners of political, religious, economic, or military power, and to avoid any distinction according to race, colour, sex, language, and etc. (3) In this type of private money absorption in the higher education, while the others have no extra way to enter to the university that would lead to achievement of scientific power, the owners of the economic powers’ daughters and sons could have a special chance to achieve scientific power by the power of their parents, and there is a different criterion to enter the university based on non-scientific differences.
In such situation growing student movements against commercialism of knowledge and education which is contrary to their culture and also against fair distribution of educational opportunities is probable. (4-6) In this condition the pressure of stigma on the student with lower scores in the entrance and the other examinations is not ethically acceptable either.
The other problem of this type of private financial support in higher education is the matter of distinguishing the clear border between public sector incomes regarding the private one. Some similar studies in combining public and private healthcare services showed that it is the private sector that finally has income from the public one contrary to the presuppositions. (7)
From another view supporters of self-governing branch (previously called international branch, while it doesn’t have real international students, faculty members or staffs) could state some benefits for private contribution to public sector higher education such as taking financial resources from private to the public, preventing capital leakage of rich people in the country to abroad. More over, It is said that “it is better to spend your money to attain knowledge and degree comparing with those who spend their talents and academic knowledge and degree to attain money in an unethical way”; namely if rich persons tend to spend their money to improve their family members knowledge and to help the scientific sector of the public, it would be appreciated as a good practice and act. on the other hand, could see some talent students or graduates who committed immoral practices such as a case in which a doctor explicitly states to the laboratory or other Para clinics colleague: “how much do I get if I send you patients?” (8)
Entering best fields of best universities by the lower cut off scores comparing other similar applicant merely because of parents’ economic status could consider as an exemplary of unequal opportunity for equal ones. Helping public science sector of the society via paid tuitions may diminishes the ugliness of injustice, however public sector incomes
clearance is essential to make public benefit claims real and documented. In the other hand stigmatization of the student with lower scores after their entrance to the university also seems to be unethical.

The concept of hidden curriculum was first used by Philip Jackson in 1968, and Hafferty brought this concept to the medical education. Many of the subjects that medical students learn are attributed to this curriculum. So far several definitions have been presented for the hidden curriculum, which on the one hand made this concept richer, and on the other hand, led to confusion and ambiguity.
This paper tries to provide a clear and comprehensive definition of it.
In this study, concept analysis of McKenna method was used. Using keywords and searching in the databases, 561 English and 26 Persian references related to the concept was found, then by limiting the research scope, 125 abstracts and by finding more relevant references, 55 articles were fully studied.
After analyzing the definitions by McKenna method, the hidden curriculum is defined as follows: The hidden curriculum is a hidden, powerful, intrinsic in organizational structure and culture and sometimes contradictory message, conveyed implicitly and tacitly in the learning environment by structural and human factors and its contents includes cultural habits and customs, norms, values, belief systems, attitudes, skills, desires and behavioral and social expectations can have a positive or negative effect, unplanned, neither planners nor teachers, nor learners are aware of it. The ultimate consequence of the hidden curriculum includes reproducing the existing class structure, socialization, and familiarizing learners for transmission and joining the professional world.
Based on the concept analysis, we arrived at an analytical definition of the hidden curriculum that could be useful for further studies in this area.

In recent years, availability of class material including typed lectures, the professor’s Power Point slides, sound recordings, and even videos made a group of students feel that it is unnecessary to attend the classes. These students usually read and memorize typed lectures within two or three days prior to the exams and usually pass the tests even with low attendance rate. Thus, the question is how effective is this learning system and how long the one-night memorized lessons may last.
A group of medical students (62 out of 106 students), with their class attendance and educational achievements in the Medical Mycology and Parasitology course being recorded since two years ago, was selected and their knowledge about this course was tested by multiple choice questions (MCQ) designed based on the previous lectures.
Although the mean re-exam score of the students at the end of the externship was lower than the corresponding final score, a significant association was found between the scores of the students in these two exams (r=0.48, P=0.01). Moreover, a significant negative association was predicted between the number of absences and re-exam scores (r=-0.26, P=0.037).
As our findings show, the phenomenon of recalling the acquired lessons is preserved for a long period of time and it is associated with the students’ attendance. Many factors including generation effect (by taking notes) and cued-recall (via slide picture) might play a significant role in the better recalling of the learned information in students with good class attendance.

The primary aim of this study was to investigate whether USMLE board scores correlate with the emotional intelligence of medical students. We hypothesized that higher Step 1 scores would be associated with lower emotional intelligence.
This prospective study included medical students who self-reported their USMLE Step 1 score and completed a survey designed to measure their emotional intelligence. The survey was composed of a Grit Scale, a Hardiness-Resilience quiz, and the “Reading the Mind in the Eyes” quiz. For participants who completed all three instruments, a composite score was equal to the sum of the three scoresThis study was performed at Emory University School of Medicine in Atlanta, Georgia. Of the 85 medical students who were recruited to participate, 72 completed all aspects of this study (85% completion rate).
Pearson correlation analyses showed that grit (r=-0.105, P=0.34), hardiness-resilience (r=-0.230, P=0.04), the eye quiz (r=-0.033, P=0.79), and the composite score (r=-0.187, P=0.12) were inversely correlated with USMLE scores. Participants who scored higher than the national average had a lower mean hardiness score compared to those who scored lower than the national average (P=0.03). Those who scored at least one standard deviation above the national average had a lower mean hardiness score (P=0.05) and a lower composite score (P=0.04).
Higher USMLE Step 1 scores are associated with lower emotional intelligence, namely hardiness, in medical students.

The present teaching model for undergraduate medical students is predominantly followed by many medical schools in our sub-continent. With the intention of analyzing whether this method is appropriate for bring out a skillful future generation of doctors, we correlated the perception regarding usefulness of training parameters with the perception regarding competency to perform selective procedures among newly graduated doctors from our hospital.

We conducted a cross sectional descriptive survey research among 93 students immediately after completion of their internship during the year 2016. A set of statements were formulated regarding usefulness of training curriculum and competency to perform procedures. Students were asked to give their quantitative level of agreement on a 5-level Likert scale, depending on their perception. This data was used for a correlation analysis.

Our analysis suggested that when the training was perceived to be effective, the perception of competency to perform selective procedures increased. Hence, a satisfactory training program may lead the way to enhance student competency to perform basic procedures during and after internship.

We conclude that proper skills training before graduation will definitely have an influence in the career of young medical graduates. Besides that, the present teaching model can be tailored to meet individual learning capacities for better yielding.

Evidence-based practice the clinical decision-making process which integrates the best evidence of research with patients’ values and opinions of clinical professionals. The faculty members are the most important decision-makers in clinical, medical, and therapeutic centers, and play a significant role in the use of evidence-based medical concepts in daily activities, decision making and information transfer to residents. The purpose of this study was to evaluate the knowledge, attitudes,behaviour and decisions/outcomes of faculty members in the Surgical and Non Surgical wards of Imam Hossein Hospital, based on the evidence based practice adjusted tool (KABQ) in 2016.
This is a cross-sectional descriptive study using the convenient sampling method among 66 faculty members in the Surgical and Non Surgical departments of Imam Hossein Hospital in Tehran. Anadjusted evidence based practice questionnaire(KABQ) was used after the approval of its original designer (Dr. Johnston) and checking its reliability by calculating the Cronbach’s alpha coefficient to be 0.85. SPSS software version 23 was used for data analysis. The variables were analyzed using descriptive statistics and T-test. The statistical significance of all tests was considered at P It was found that 93.9% of the subjects believed in their ability to use evidence-based practice. A total of 97% of them made 62.22% of their decisions based on clinical research evidence. The Surgical and Non Surgical groups believed in the effectiveness of evidence-based practice in the proposed treatments with a mean of 5.48 and 6.16, respectively. However, unlike the Non Surgical group, the Surgical group believed that there was similar validity for clinical trialsand observational methods to prove the effictiveness of the treatment. It was necessary for the Surgical and Non Surgical groups to search for clinical evidences 5.76 and 10.16 times a week, respectively. Over 90% of them found clinical evidences through textbook once a week, through the original research papers every 12 days, every 24 days through the Cochrane database, and almost every 28 days through secondary research resources. The Surgical and Non Surgical groups were referred to the evidence 1.95 and 3.27 hours per week, before, or during treatment. They spent 3.47 and 4.97 hours per week searching for evidence, and 4.23 and 7.16 hours per week reading new research evidences, respectively. Over 92% of them considered the use of evidence-based practice because they believed it improved the outcomes for patients.
The results of this study showed that both the Surgical and Non Surgical faculty members of Imam Hossein Medical Center (Shahid Beheshti University of Medical Sciences) had good knowledge about evidence-based practice and had a positive attitude toward its medical effect, but they are less likely to use this approach. Thus, to enhance the skills of faculty professionals and adapt their decisions to the best available evidence, a collaborative action plan is required.

Simulation based training has shown to be of benefit in the education of medical students. However, the impact of induction based clinical simulation on surgical ability of qualified doctors remains unclear.
The aim of this study was to establish if a 60 minute teaching session integrated into an Emergency Medicine speciality induction program produces statistically significant improvements in objective and subjective suturing abilities of junior doctors commencing an Emergency Medicine rotation.
The objective suturing abilities of 16 Foundation Year Two doctors were analysed using a validated OSATs scale prior to a novel teaching intervention. The doctors then undertook an intensive hour long workshop receiving one to one feedback before undergoing repeat OSATs assessment.
Subjective ability was measured using a 5 point likert scale and self-assessed competency reporting interrupted suturing before and after the intervention. Photographs of wound closure before and after the intervention were recorded for further blinded assessment of impact of intervention. A survey regarding continued ability was repeated at four months following the intervention. The study took place on 7/12/16 during the Belfast Health and Social Care Trust Emergency Medicine induction in the Royal Victoria Hospital Belfast. The hospital is a regional level 1 trauma centre that has annual departmental attendances in excess of 200,000. All new junior doctors commencing the Emergency Medicine rotation were invited to partake in the study. All 16 agreed. The group consisted of a mixture of undergraduate and postgraduate medical doctors who all had 16 months experience working in a variety of medical or surgical jobs previously.
Following the teaching intervention objective and subjective abilities in interrupted suturing showed statistically significant improvement (P>0.005). Self-reporting of competency of independently suturing wounds improved from 50% pre intervention to 100% post intervention. At four month follow up responding participants reported continued increase in confidence and independence in interrupted suturing.
This study suggests that induction based teaching is a practical and robust means of producing lasting improvement in the subjective and objective suturing abilities of medical staff commencing Emergency Medicine placements. We would suggest that the results are also translatable to doctors starting other surgical rotations and practical induction based teaching should be considered for all new trainees.