آتوسا اسماعیلی

The goal of clinical education in general medicine program is to achieve the minimum skills expected of graduates. Clinical competency exam is designed as a tool for assessing these minimum learning essentials. Exploring the viewpoints of examinees could be a step towards improving the quality of this exam and resolving its problems. The purpose of this study was to examine the viewpoints of interns participating in the clinical competency exam.
This qualitative study employed conventional content analysis approach. Subjects included 17 interns participating in the clinical competency exam in 2016 in Isfahan University of Medical Sciences who were interviewed in four groups of 4-6 people. Interviews were transcribed and then analyzed in MAXQDA-10 software.
A total of 93 preliminary codes were extracted. Having the duplicates removed and similar codes integrated, 72 codes were extracted and classified into 4 main categories and 9 subcategories. The main categories were: “conditions of the exam administration, content of the exam, educational factors affecting the exam, and conditions of exam stations”.
It seems that educational factors affecting the exam are the major factors that influenced the clinical competency exam. Also, the objectives of the exam were not clear from the perspective of examinees which could affect the results. Since the clinical competency exam can be used as a tool to make students try more to acquire the necessary and expected skills, taking corrective measures and organized regular planning are essential in this area.

Various studies show that Log book can be also used in evaluation of medical course curriculum in clinical level in addition to evaluation of students’ achievement and their level of competencies. This article was to investigate the applicability of this new usage of Log book.

Logbooks were designed by faculty members through various sessions in clinical departments in six sections of introduction, outcomes and essentials of learning, disease exposure case reports, communication skills evaluation, procedural skills learning in the morning and at the time of shift. Logbooks were filled by students and returned.Then, frequency of observed cases by students and the fields used by the departments were calculated.

The students had not observed 5 diseases (26%) in orthopedic Dept., 6 diseases (50%) in neurology Dept., 15diseases (68%) in infectious diseases Dept. and 1 disease (6%) in toxicology Dept. But, all diseases had been observed in ENT Dept by students. Log books in Dept. of internal medicine were so incomplete that their data were not usable. Departments of orthopedics and neurology from outpatient clinics, Department of infectious diseases from hospitalization ward, Department of toxicology from emergency had the highest usage.

If students, faculty members and residents in educational departments know well about the importance and role of logbook and observe its function results, logbook can be used for evaluation of educational curriculum.

Curriculum assessment is part of educational systems. In the absence of an assessment of present situations, any intervention would be futile. This study was done to determine achievement rate of medical students in advanced clerkship (externship) courses through using logbooks. This retrospective cross-sectional descriptive study was done on medical student's logbooks between June and December 2010 in Isfahan University of Medical Sciences. The students were passing their externship courses. Random sampling was done and 30 logbooks from departments of orthopedics, ENT, neurology, anesthesiology and toxicology, infectious diseases, and internal medicine were analyzed; descriptive statistics and SPSS were used for data analysis. 180 logbook tables were analyzed. Average number of skill performances supervised once or more were found to be: 8 (out of 10) skills in anesthesiology and toxicology, 5(out of 11) skills in infectios diseases,7(out of 20)skills in internal medicine, 8 (out of 13) skills in orthopedics, 11 (out of 11) in ENT, and 10 (out of 10) in neurology. Findings showed that actual skills achievement is far from ideal in the studied departments. Therefore, interventional measures such as involving residents in instruction, more practical instructions in CSLC, using instructional films,arranging hospital shifts for interns, applying OSCEs, etc. shoud be taken.

Necessity for promotion of education quality in course of medicine forced the educational authorities including those of Isfahan school of Medicine to take actions towards promotion of education using an accreditation evaluation model in this course parallel to worldwide motion. This article emphasizes on a model by which this study was conducted and reported. This is a descriptive study conducted on seven domains of general medicine curriculum. In the model used in this study, in addition to the current condition, optimal condition was determined. If 70% of the indicators were appropriate in each domain, that domain was considered as appropriate, between 40-70% as semi appropriate and less than 40% was considered as inappropriate. The study was conducted in some steps including forming internal assessment committee, determining factors criteria and indicators, holding educational workshop, preparing data collection tool, data collection and analysis, report preparation and suggestions. In domain of mission 70%, educational planning 80%, faculty members 74%, resources 54%, top and executive management 75%, student 34%, evaluation 61% and finally overall ratio 57% of the indicators were appropriate. Domains of student, resources and evaluation need continuous programming and working. Researchers have some suggestions including taking defined strategies for selecting education managers, using modern educational policies, reinforcing tests assessment system and increasing school authority in having clinical education resources.

Using multiple choice question tests, as an objective testing method, is the most common students evaluation procedure, and it is very important to design these tests properly.This study aimed to assess clerkship tests of general medicine courses in the training group of dermatology, psychiatry, gynecology, ophthalmology and neurology of medical college of Isfahan University of Medical Sciences both quantitatively and qualitatively. This descriptive cross- sectional study was done on the latest tests of clerkship courses of general medicine including dermatology, psychiatry, gynecology, ophthalmology, and neurology in 2008. The quantitative and qualitative indexes of 15 previously held tests were extracted by using valid and reliable checklists used for determining questions with inappropriate question discrimination index, difficulty coefficient, question with 3 choices of zero, reliability coefficient, question distribution based on the announced topics, the scope of questions based on the objectives, the question types based on taxonomy. Data were analyzed through SPSS software using descriptive statistics. Among the quantitative indexes, mean of queations with inappopriate discrimination index was 24%, difficult questions 4.1%, and questions with 3 choices of zero was 12.9%. The average of questions distribution basedon the announced topics and the reliability coefficient were 98% and 77.92%, respectively. among the qualitative indexes, the highest relative frequency of questions were in the fild of signs and symptoms with 30.75 % and the first taxonomy with 59 %. Considering the importance of using standard questions (which are according to the rules for designing multiple choise question) for holding appropriate exams, continuous review of test questions and administering training courses on test questions designing, creating question banks and putting emphasis on preparing two dimensional tables for tests before giving exams are effective on improvement of the quality of the questions.