Journal of Advances in Medical Education & Professionalism
Volume:5 Issue: 2, Apr 2017

As you know, one of the new programs of the medical universities is to familiarize the students to the medical atmosphere with the help of compassionate and experienced university professors. The program is planned and implemented under the title of mentorship, in which an experienced instructor takes the responsibility of orientation, guidance and problem solving of a number of students. The students at the time of admission face some problems, usually due to the young age, unfamiliarity with the university context, the amount of the texts, etc.; therefore, they feel somehow defenseless in this atmosphere. In this program, which was longitudinal and often causes a long-term and friendly relationship between the professor and students during the education years, these problems of students discuss with teachers (Mentor) and in this interact somewhat elevated. To do the appropriate implementation of this concept in the university, the university was required to be familiar with the concept of mentorship at the first step (1). So, the Education Development Center of Shiraz University of Medical Sciences (EDC) has implemented this issue in a series of educational fellowship workshops for the professors of postgraduate levels.In teaching this concept, the Jowhari model (Joseph Luft and Harry Ingham famous model) (2) has attracted the attention of authorities and professors of this period. In educating the concept of mentoring, the development of selfgeneralization window of the professors was considered. Because this section covers the ability of communication and flexibility in the leadership of the individuals, development of the window (area) decreases the incidence of conflicts and misunderstandings and struggles between individuals in this regard. To develop this area, there was an attempt in this period that the professors get familiar with the two methods of self-openness and feedback. This educational program was a pilot which was implemented in the country for the first time in one of the fellowship programs for the faculty members. Then, according to the results and positive feedbacks, it was applied more extensively. So far, this subject has been trained in 5 different fellowship training courses of the professors in the form of diverse topics, such as the mentorship concept in educating the students, counseling and mentoring models and evaluation and feedback principles. The results of the training shows achievement of the educational goals (85%), applicability of the educational materials (93%), and relevance of the educational environment (78%) in the universities. So, due to the newness of this concept in the country and the necessity of its performance, doing more studies on the improvement of this concept in the other professor of this university seems necessary.

Non-verbal communication skills, also called sign language or silent language, include all behaviors performed in the presence of others or perceived either consciously or unconsciously. The main aim of this review article was to determine the effect of the teachers’ non-verbal communication on success in teaching using the findings of the studies conducted on the relationship between quality of teaching and the teachers’ use of non-verbal communication and also its impact on success in teaching.
Considering the research method, i.e. a review article, we searched for all articles in this field using key words such as success in teaching, verbal communication and non-verbal communication. In this study, we did not encode the articles.
The results of this revealed that there was a strong relationship among the quality, amount and the method of using non-verbal communication by teachers while teaching. Based on the findings of the studies reviewed, it was found that the more the teachers used verbal and non-verbal communication, the more efficacious their education and the students’ academic progress were. Under non-verbal communication, some other patterns were used. For example, emotive, team work, supportive, imaginative, purposive, and balanced communication using speech, body, and pictures all have been effective in students’ learning and academic success. The teachers’ attention to the students’ non-verbal reactions and arranging the syllabus considering the students’ mood and readiness have been emphasized in the studies reviewed.
It was concluded that if this skill is practiced by teachers, it will have a positive and profound effect on the students’ mood. Non-verbal communication is highly reliable in the communication process, so if the recipient of a message is between two contradictory verbal and nonverbal messages, logic dictates that we push him toward the non-verbal message and ask him to pay more attention to non-verbal than verbal messages because non-verbal cues frequently reveal the intention of the sender of the information and reflect his/her emotional reactions. Based on the obtained results of this study, it is recommended that attention to non-verbal communication skills can make a positive change in the future of a student’s life. It seems necessary for the teachers to practice and learn effective communication skills, especially for those who always interact with a large group of students. One of the factors contributing to the success or failure of students is the quality of the relationship and how the teacher builds this relationship with students. Especially, it is more effective for students who are more responsive to human relations and communication skills. Finally, it is recommended that the teachers should improve their communication skills to have better communication with their audience. The authorities are recommended to help improve the teachers’ level of communication skills through holding training courses.

Despite the importance of curriculum analysis for internal refinement of a programme, the approach for such a step in under-described in the literature. This article describes the analysis of the medical curriculum at the Faculty of Medicine, University of Gezira (FMUG). This analysis is crucial in the era of innovative medical education since introducing new curricula and curricular changes has become a common occurrence in medical education worldwide.
The curriculum analysis was qualitatively approached using descriptive analysis and adopting Harden’s 10 Questions of curriculum development framework approach. Answering Harden’s questions reflects the fundamental curricular components and how the different aspects of a curriculum framework fit together. The key features highlighted in the curriculum-related material and literature have been presented.
The analysis of the curriculum of FMUG reveals a curriculum with interactive components. Clear structured objectives and goals reflect the faculty’s vision. The approach for needs assessment is based on a scientific ground, and the curriculum integrated contents have been set to meet national and international requirements. Adopting SPICES strategies helps FMUG and students achieve the objectives of the curriculum. Multiple motivated instructional methods are adopted, fostering coping with the programme objectives and outcomes. A wide range of assessment methods has been adopted to assess the learning outcomes of the curriculum correctly, reliably, and in alignment with the intended outcomes. The prevailing conducive educational environment of FMUG is favourable for its operation and profoundly influences the outcome of the programme. And there is a well-defined policy for curriculum management, monitoring and evaluation.
Harden’s 10 questions are satisfactorily addressed by the multi-disciplinary and well-developed FMUG curriculum. The current curriculum supports the well-written faculty missions and educational objectives. It presents a structured, conceptual framework that supports the validity of the assumption behind the curriculum. The curriculum enhances intellectual and academic pursuits and supports social accountability.

MICAP is a new notation in which the teeth are indicated by letters (I-incisor, C-canine, P-premolar, M-molar) and numbers [1,2,3] which are written superscript and subscript on the relevant letters. FDI tooth notation is a two digit system where one digit shows quadrant and the second one shows the tooth of the quadrant. This study aimed to compare the short term retention of knowledge of two notation systems (FDI two digit system and MICAP notation) by lecture method.
Undergraduate students [N=80] of three schools participated in a cross-over study. Two theory-driven classroom based lectures on MICAP notation and FDI notation were delivered separately. Data were collected using eight randomly selected permanent teeth to be written in MICAP format and FDI format at pretest (before the lecture), post-test I (immediately after lecture) and post-test II (one week after the lecture). Analysis was done by SPSS version 20.0 using repeated measures ANCOVA and independent t-test.
The results of pre-test and post-test I were similar for FDI education. Similar results were found between post-test I and post-test II for MICAP and FDI notations.
The study findings indicated that the two notations (FDI and MICAP) were equally mind cognitive. However, the sample size used in this study may not reflect the global scenario. Therefore, we suggest more studies to be performed for prospective adaptation of MICAP in dental curriculum.

Medical students should be familiar with the end of life ethical issues and its considerations. For teaching end of life care to medical students, literature is a source of excellent narratives of patients with experiences of terminally ill condition in their journey through suffering and one of the most favourite bioethics literature readings has been the death of Ivan Ilych by Tolstoy. We used this novel to show medical students end of life events and suffering and asked them to write a reflective essay on it. We aimed to find what students think about terminally ill patients and their journey to death.
In an inductive qualitative content analysis model, 350 essays, collected by homogenous sampling, were analyzed. The fourth year medical students were provided with the Death of Ivan Ilych novel to read. They were asked to write a reflection essay based on the reflective stages defined by Sandars. These essays served as the unit of analysis, each being read several times and a coding model was formed according to main topics. The related concepts in each unit were named as themes and each theme was abstracted to a code and the related codes were compared and developed as categories.
Qualitative content analysis of 350 essays of fourth year medical students revealed three major categories in students’ reflection on reading Death of Ivan Ilych as an end of life human body. These included: 1) Emotional experience, 2) Empathy and effective communication, 3) Spirituality and dignity. Analysis of essays showed that this reflection activity may help medical students have a deeper idea of the end of life situation and feelings.
This project suggests that literature can be used as an example to introduce new ethical concepts to less experienced medical trainees. The students acquired the concept of the story and reflected the major aspects of the suffering of a human being in their essays. Having used and evaluated the effect of literature on facilitating ethical insight in the teaching end of life care, we strongly recommend this method and specially the novella, Death of Ivan Ilych.

Research shows that there is a relationship between students’ perceptions of classroom and learning environment and their cognitive, affective, emotional and behavioral outcomes, so, in this study the relationship between medical students’ perception of learning environment and academic emotions was examined.
The research method used was descriptive-correlative. The statistical population consisted of medical students of Shiraz University of Medical Sciences. Stratified sampling method was used to select 342 participants. They completed self-report questionnaires of Dundee Ready Educational Environment Measure (DREEM) and Achievement Emotions Questionnaire (AEQ). All descriptive statistics, Pearson’s correlations and simultaneous multiple regression were performed using SPSS 14 software.
Simultaneous multiple regression of the students’ perceived learning environment on their academic achievement emotions showed that the perceived learning environment predicts the students’ academic emotions.
The results of this study revealed that caring for and supportive learning environment can increase the students’ positive emotions and decrease their academic negative emotions (i.e. anxiety, shame, and hopelessness). Implications of the results are discussed.

Research has asserted MCQ items using three response options (one correct answer with two distractors) is comparable to, and possibly preferable over, traditional MCQ item formats consisting of four response options (e.g., one correct answer with three distractors), or five response options (e.g., one correct answer with four distractors). Some medical educators have also adopted the practice of using 3-option responses on MCQ exams as a response to the difficulty experienced in generating additional plausible distractors. To date, however, little work has explored how 3-option responses might impact validity threats stemming from random guessing strategies, and what impact 3-option responses might have on cut-score determinations, particularly in the context of medical education classroom assessments. The purpose of this work is to further explore these critically important considerations that largely have gone ignored in the medical education literature to this point.
A cumulative binomial distribution formula was used to calculate the probability that an examinee will answer at random a given number of items correctly on any exam (of any length). By way of a demonstration, a variety of scenarios were presented to illustrate how examination length and the number of response options impact examinees’ chances of passing a given examination, and how subsequent cut-score decisions may be impacted by these factors.
As a general rule, classroom assessments containing fewer items should utilize traditional 4-option or 5-option responses, whereas assessments of greater length are afforded greater flexibility in potentially utilizing 3-option responses.
More research on items with 3-option responses is needed to better understand what value, if any, 3-option responses truly add to classroom assessments, and in what contexts potential benefits might be discernible.

In Iran, similar to most countries, medicine is a prestigious and high income profession. Moreover, traditionally “best and the brightest” candidates have been considered suitable to enter medical schools. In fact, the excellency of the applicants has been measured in a highly competitive national competition, by a multiple choice knowledge test of high school materials. Accordingly, the national exam would provide equal chances for all candidates to enter medical schools based on their knowledge excellence; in addition, the test provides an “objective” assessment, which would be supported by social accountability. Moreover, using this tool is relatively feasible among about half a million applicants per year. However, a study in 2012 showed that the national exam alone or even in combination with high school Grade Point Average (GPA) has limited predictive value for medical school exams and GPA (1). Similarly, other studies have supported inadequacy of these knowledge scores in predicting success in medical training and even practicing medicine (2, 3). In fact, being a “good doctor” is required to be competent not only in knowledge acquisition, but also in non-knowledge competencies, such as communication. Therefore, it seems that the current method of candidate selection has narrowed the definition of "excellence" by focusing on theoretical knowledge. Furthermore, this method does not examine higher levels of knowledge dimension, such as metacognition and higher cognitive processes, such as creativity. In order to achieve more equity in access to education, a quota has been defined for different geographical areas of the country (central vs. marginal provinces). This would balance the chance of acceptance in medical schools for lower scored students in remote areas competing numerous high scored applicants in big cities. In the United States, since five decades ago, a quota policy has been implemented entitled “affirmative action”, to address race diversity in medicine. Such diversity has shown to improve health care and medical practice in underserved areas (3) without any adverse effect on residency training (4). In Iran, despite of implementation of the quota policy for more than half a century for selecting medical students, it seems that advantageous population -upper and middle socioeconomic groups- have a higher chance to enter medical schools even in remote areas. Indeed, they have more resources to invest on the training required for being excellent in the national knowledge exam. Therefore, equity, which addresses social justice, would not be satisfied. Moreover, it has been shown that patients of lower socioeconomic level have limited access to care and receive less medical care compared to advantageous patients (5). It can be partially because of communication problems caused by social class differences between physician and patient (6). In poorer patient's perspective, the most important criterion to choose a physician is psychosocial aspect of the patient–physician relationship (7). In addition, physicians report less interest and comfort and more anxiety in visiting patients with low socioeconomic status (8). As a result, there is a correlation between physicians’ social class and communities they serve (9). It seems that recruiting more medical students from lower socioeconomic origin might raise awareness through the socialization process (10). Therefore, the equity in access to medical education is considered as a tool for more justice in the delivery of health care rather than a means for individual social advancement (11). In other words, if just some social groups enter medical profession, specific social groups would be underrepresented in the profession and theirhealth care needs would be undermined. In summary, it seems that meaning of excellence and various excellences, which are required to provide the best care for the population, should be revisited. Accordingly, a reliable and valid measurement tool for those excellences is required to be designed. Finally, revision of policies in selecting medical students would satisfy health care needs of all social groups.