فهرست مطالب seyed kamran soltani-arabshahi

The instructor is one of the key factors in attaining educational goals in medical education, and the instructor’s competencies facilitate students’ educational achievement. The present study is an attempt to explain the experiences of faculty members and students of characteristics of competent professors who play an influential role in the academic achievement of basic medical sciences students in universities of medical sciences across the country.  

The present study is a conventional qualitative content analysis. Fifteen faculty members and students of medicine from Iranian universities of medical sciences from different regions of the country were selected using a purposive and then theoretical sampling. A semi-structured interview was used for data collection.  

In this study, four themes and nine sub-themes were extracted from interviews. The themes included “clinical knowledge”, “teaching competency”, “monitoring students’ performance”, and “cognitive-psychological arousal”. The sub-themes were “clinical knowledge’ including “Non-applied teaching of basic sciences and unfamiliarity of instructors of basic sciences with the clinic”;  “teaching competency” including “having instructional design skills, teaching based on the psychology of learning, and professional development”; “monitoring students’ performance” including “fair evaluation and valid evaluation”, and “cognitive-psychological arousal” including “student support and reinforcement”.  

The present study identified the important characteristics of the competencies of professors of basic medical sciences working in Iranian medical universities. The competency of professors is essential in promoting students’ educational achievement and training efficient and professional students in the field of medicine to render quality health services. The results of this study will assist administrators and educational policymakers in planning for the promotion of professors and medical education.

Clinical decision‑making is not only stressful to physicians, but also to patients and even their companions. Thus, managing uncertainty in clinical decision‑making is essential which requires knowing its origins. Therefore, this study aimed to understand determinants of uncertainty in clinical decision‑making from the perspective of clinical physicians.

This is a qualitative study which is done during October to November 2020. An in‑depth interview is performed with 24 specialists of clinical groups including obstetrics, surgery, internal medicine, and pediatrics, working in teaching hospitals affiliated to Iran University of Medical Sciences. All the interviews were recorded, transcribed and analyzed according to the steps suggested by Graneheim and Lundman. The interviews were analyzed through comparative method. Then, the interviewer created initial codes, categories, and key concepts and sent them to fourteen physicians for member check.

According to the participants’ view, determinants of uncertainty in clinical decision‑making consisted of three themes: individual determinants, dynamics of medical sciences, and diagnostic and instrumental constraint. Individual determinants can be related to the physician or patient. The dynamics of medical sciences could be explained in two categories: variation of medical science and complexity. Diagnostic and instrumental constraint category could be also explained in subcategories such as lack of efficient diagnostic tests and unknown etiology.

To curb uncertainty, the more accessible way is considering interventional programs with a focus on individual determinants related to physicians, such as strengthening doctor–patient relationships, and considering related mandatory retraining courses to reduce insufficient knowledge of physicians.

Learners have various processing and understanding of the environment and issues and choose different strategies for problem‑solving considering learning and studying approaches. The purpose of this study was to examine medical students’ learning approaches and their association with academic performance and problem‑solving styles.

This study was conducted using the descriptive‑correlational method. The statistical population comprised medical students of Iran University of Medical Sciences during the academic year of 2019–2020. Of them, 168 subjects were chosen based on simple random sampling and Morgan Table. Study tools include the Standard Approaches and Study Skills Inventory for Students (ASSIST) Questionnaire, which includes 18 items and a Likert five‑choice spectrum, and includes a deep, superficial, and strategic approach. Its reliability was determined by Cronbach’s alpha of 0.81. Problem‑Solving Style Questionnaire developed by Cassidy and Long was used. This instrument included 24 items and 6 components, and its reliability equaled 0.83, which was their grade point average. Data were analyzed using normality tests, paired t‑test, Pearson correlation coefficient, and regression through SPSS 16 software.

Results implied the positive and significant relationship between deep‑strategic approaches, problem‑solving styles, and academic performance of medical students (P < 0.001); furthermore, there was no significant difference between learning approaches based on gender (P > 0.001), while there was a significant difference between two groups in terms of problem‑solving styles (P < 0.001).

Because deep and strategic approaches predict academic performance and problem‑solving styles, the diagnostic assessment must be done at the beginning of the educational process to determine the type of learners’ approaches. Such an evaluation can be used to implement instructional strategies and educational designs to improve the academic performance of students

Clinical reasoning is one of the important categories in medicine and teaching it in different ways can accelerate the student's ability to approach expert professional thinking. In addition, complementary trainings, along with clinical training, can promote clinical training in pandemics and situations where contact with the patient is reduced for some reason.

This is an semi-experimental, case observation study in which the case group was trained in clinical reasoning by scenario writing method, and after the test, 2 groups were compared with KF and DTI tests. The two were identical based on their basic science test scores before the study.

In this study, 60 people in two groups of case and control (30 people in each group) were compared with DTI and KF tests. The average DTI score in the case group was 151.4±15.3 and the average score in the control group was 151.8±17.2, the scores in both the case and control groups were not significant (P-value=0.922). The KF scores were 36.3±4.5 in the control group and 30.2±8.2 in the case group, and the scores in the case group were significantly higher than the control group (P-value=0.001)

The results of the study showed that short-term scenario writing training can be effective in improving the KF score and clinical reasoning, but increasing the DTI score requires more training time.

 With the increase in the population of cancer patients and the importance of reducing the economic burden of disease, it is very important to offer solutions that can provide the services needed by this group of patients in the most appropriate way. In recent years, palliative care services have been provided in a wide range of countries for this purpose, and many studies have been conducted to assess its economic and clinical aspects. The current study aimed to systematically review economic evaluation studies that investigate the costs of end-of-life care for cancer patients.  

 Electronic search was performed in multiple databases and different resources between 2000-2021 based on inclusion and exclusion criteria. Inclusion criteria were Studies consisting of a complete EE, including CEA, CUA, and CBA regarding the EE of palliative care for patients with cancer disease, EE studies carried out by decision analysis models following the EE approach, full-text articles in the English language, and published during 2000 and 2021 and  According to our search strategy, the following articles were removed: studies conducted as a partial  EE (like those intended to evaluate the effectiveness, cost evaluation, QoL evaluation), articles with poor methodological quality based on the CHEERS checklist, non-English studies, study protocols, articles presented to a conference, and letters to the editor. The quality of the articles was evaluated using a CHEERS checklist.

 29 studies were included based on inclusion criteria. Most articles were published during the past decade. All studies were performed in high-income countries (UK= 6 studies, Canada= 5 studies). Most studies (n=7) focused on the health sector. Results of quality evaluation showed that 10 articles had excellent quality (score higher than 85%). Most studies (27 out of 29 studies) concluded that palliative medicine interventions were cost-effective and yielded positive cost-effectiveness results. 20 studies confidently concluded about the costs and benefits of providing palliative care services on cost-effectiveness and cost savings, and 2 studies made such a conclusion with uncertainty. Therefore, palliative care for cancer patients is cost-effective or cost-saving in 85% of studies.

 Although there are a wide variety of studies, characteristics, and quality of the final studies included in the present study, there are relatively favorable and stable patterns regarding the results. Palliative care is usually less expensive than comparator groups, and the cost difference is statistically significant in most cases, and this treatment is a relatively cost-effective option. However, making the right relevant decision and applying it as a dominant therapy approach in different countries requires further study in larger populations and over a longer period.

Spiritual health education is known as an important element in its implementation in the health system, which has different approaches to its implementation. Spiritual health has a positive effect on health, longevity, and recovery from physical ailments. Without spirituality education, education cannot function properly in biological, psychological, spiritual, and social dimensions or reach its maximum capacity. The present study aimed to develop the spiritual health curriculum approach based on Tyler's model in Iran between 2020 and 2021.

In this qualitative study, by using a directed content analysis method and using validated curriculum models (Tyler's model), we developed a new spiritual health curriculum approach for Iranian society. This study was done between April 2021 and February 2022.

Because the spiritual health curriculum in Iran should be based on the philosophical and social principles of Iran, a new approach to spiritual health education based on Tyler's model was developed.

Tyler's Iranian-Islamic model, which is suitable for our Iranian-Islamic culture and is valid for developing spirituality, was introduced.

Hidden curriculum is important in medical education and has numerous, long-lasting effects on medical residency. The present scoping review seeks to investigate, identify, and plot the main concepts relating to hidden curriculum and its dimensions, domains, impacts and factors in medical residency courses based on the main references and evidence.

Scoping review methodology was used to guide a search of electronic databases for relevant papers. Of the 394 abstracts initially identified, after screening of both abstracts and full-text papers, 43 studies were selected for inclusion in this review. Following abstraction of key information from each study, a content analysis was undertaken.

Eleven themes were identified from the content analysis: 1) Organizational Issues (13.77%), 2) Socio-cultural Issues (10.5%), 3) Professional Issues (13.41%), 4) CommunicationalFactors (8.7%), 5) Educational Issues (22.83%), 6) Resident Personal Characteristics (21.01%), and 7) Resident Educational Characteristics (9.78%). Among the extracted effective hidden curriculum factors, the role modeling had the highest frequency and was emphasized in the studies.

Although this study explained and identified the components, elements and also the preparation of the initial format of the hidden curriculum framework of the medical residency program, its results can reduce the negative effects of the hidden curriculum on it. More extensive and in-depth studies with different qualitative methods or mixed methods related to the hidden curriculum in different contexts and disciplines of medical residency are recommended to define characteristics of a constructive hidden curriculum of medical residency programs.

In the recent years, the accreditation of educational institutions and hospitals has attracted a lot of attention in different countries to ensure the quality of medical education. In this regard, examining the experiences of different countries will help to improve the world and local standards. This study was an attempt to explore the lived experiences of senior managers about the educational accreditation challenges and appropriate strategies to overcome these challenges.

The authors used a phenomenological approach to explore the lived experiences of the senior managers about educational accreditation of teaching hospitals affiliated to Iran University of Medical Sciences. Semi‑structured interviews were conducted to reach data saturation. For this purpose, three semi‑structured face‑to‑face interviews and six electronic interviews were conducted. Data were analyzed using the Colaizzi method.

Data analysis showed that the most important challenges of educational accreditation of teaching hospitals were related to standards and criteria, executive policies of accreditation, and educational, attitudinal, and financial infrastructures. The strategies expressed by the participants were categorized into four themes including reviewing and revising standards and criteria, planning for education, providing human and financial resources, and modifying the executive structure of accreditation.

In order to improve the quality of educational accreditation programs, it is necessary to identify and find a solution for the existing challenges by experiential support of the senior managers of teaching hospitals and the other stakeholders (e.g., faculty members and students). It also provides an opportunity for educational policy‑makers to improve the hospital’s educational accreditation program.

Empathy, quality of life, and occupational burnout are essential factors in medical sciences that affect the physicians’ and patients’ communication. Therefore, the purpose of this study was to investigate the association of these three factors among medical students.

This descriptive correlational study was conducted among medical internship students. Participants were selected by using simple random sampling. The Jefferson Empathy Questionnaire, the WHO Quality of Life Questionnaire, and the Maslach Burnout Questionnaire were used for data collection. Data were analyzed using t test, Kruskal-Wallis, analysis of variance (ANOVA), and Pearson’s correlation coefficient.

A total of 167 students completed the questionnaires. The association of empathy and occupational burnout (P = 0.005, r = -0.414) and between the quality of life and occupational burnout (P = 0.005, r = -0.446) were both significantly negative. Independent t test showed the mean score of occupational burnout was significantly higher in male students than females. It was also significantly higher in married students than single (P < 0.05). The results of the Kruskal- Wallis test showed no statistically significant difference among the quality of life of different ethnic groups (P > 0.05). One-way ANOVA showed that there was a statistically significant difference between the ethnic groups in terms of occupational burnout (P < 0.05)

The association of empathy and quality of life with occupational burnout was negative. The highest quality of life was related to older students. Among all of the studied variables, married status, ethnicity, and sex were most associated with occupational burnout where married and male students had the highest burnout.

Clinical teaching is a vital component of medical education. However, evidence indicates that clinical teaching still confronts numerous challenges, as its quantity and quality are not always desirable. The need for improvement has been emphasized in the planning, teaching, and evaluation of clinical education. Therefore, this study aims to design a customized model of effective clinical teaching for the undergraduate medical program.

A mixed-method study will be conducted in three consecutive phases. The first phase, using a grounded theory approach, explores the lived experiences of clinical teachers and undergraduate medical students concerning effective clinical education in an undergraduate medical program. In the second phase, a systematized review will be conducted on secondary data sources to fill theoretical categories and to extend the theory emerging from the qualitative phase. Finally, in the third phase, a model of clinical teaching will be developed for an undergraduate medical program.

The findings of this study will offer new insights into the clinical teaching paradigm in developing curriculum, setting policies, designing suitable undergraduate medical-clinical education programs, and developing effective teaching methods. These results will contribute to understanding the challenges of clinical education in an undergraduate medical program.

The controversial role of ethics in clinical education and its ability to draw the attention of a large audience is inevitable. The issues and challenges of the COVID-19 pandemic have transformed the clinical education environment. This study was conducted to explore the challenges and ethical requirements of medical sciences education during the COVID-19 pandemic in 2020. The study was qualitative research and the instrument was a semi-structured interview. The participants included faculty members of the basic and clinical Sciences at Iran University of Medical Sciences. After 16 rounds of interviews, theoretical saturation was achieved. Qualitative data were analysed using conventional content analysis, which resulted in 81 preliminary codes and 28 sub-categories. Finally, two themes of "ethical challenges" and "ethical requirements", and 10 categories were achieved. The sub-categories were consisted of "being patient-centred", "social accountability of curriculums", "ethical challenges of the clinical environment", "the poor performance of the clinical faculty members and students", "being justice-centred", "raising awareness", "observing clinical research ethics", "preservation and promotion of mental health", "patient confidentiality", and "respect for individuals". We hope the ethical challenges in medical education that were created due to the emergence of Covid-19 can be reduced and eliminated by defining a framework for ethical requirements.

Although theory explains the development of illness script, it does not provide answers how medical students develop scripts in their learning. To fill the knowledge gap of developing illness script in medical students and interns, this study aimed to investigate the impact of educational strategies inspired by theory in the development of illness scripts.

A total of 15 medical students and 12 interns participated in an educational intervention that included theory-driven strategies. To evaluate the impact of this intervention, clinical reasoning problem (CRP) and key features (KF) tests were used for before and after the intervention. In addition to descriptive statistics, the differences in participants’ pretest and posttest variables were tested using Wilcoxon. Significance level was set at p≤0.05 for all tests.

Interns significantly recognized more KF in the posttest. However, no significant difference was found between the pretest and posttest scores in total diagnostic accuracy (5.41±1.16 vs 4.91±1.44; p=0.111) and total correct discriminating score (0.41±0.66 vs 1.41±2.06; p=0.146). Medical students produced less total key features in the posttest, indicating that they became less elaborate in their case processing. However, no significant difference was observed in common KF score (0.4 [0.25-0.78] vs 0.9 [0.6-1]; p=0.791) and discriminative key features score (0.33 [0.16-0.33] vs 0.22 [0.11-0.44]; p=0.972) in the posttest compared to the pretest.

This study showed that theory-driven educational strategies have an impact on illness script development specifically in interns. It is recommended that this intervention would be tested on those in higher levels of expertise (ie, residents).

Medical professional identity is how an individual perceives him/herself as a doctor. Formation of professional identity includes development, advancement, and socialization through social learning of specific knowledge, skills obtained while performing professional roles, practicing, and new attitudes and values. A qualitative study was performed to examine live experience of undergraduate medical science students with regards to obtaining professional identity.

This qualitative study was performed using a conventional content analysis method. Participants were students who were studying medicine at Iran University of Medical Sciences. Sampling was done based on a purposeful sampling method. A total of 23 students took part in semi-structured interviews until data saturation was reached. The interviews were transcribed verbatim. Also, to develop themes, data were analysed using conventional content analysis.  Moreover, data management was done using MAXQDA software.

Based on data analysis, 2 main themes were as follow: meaningful medical practice” and “professional medical practice”. The first theme had 3 categories: (i) self-insight; (ii) manner; and (iii) values and beliefs. The second theme had 2 categories: (i) professionalism; and (ii) holistic view of medicine.

Certain individual characteristics and personality type were factors that affected participants’ choice of their field of study. The participants’ understanding of their profession was formed, not only by studying in the university through learning relevant knowledge, skills, and practice, but also by perceived attitude, views, and values in their profession.

Virtual education is among the important factors improving the learning of medical students. This study aimed to explain the perceptions of faculty members towards the challenges of virtual education. The present study was carried out with a qualitative approach and using a conventional content analysis method. The participants included 28 faculty members working in Medical universities in Iran who were purposefully recruited and interviewed face to face practicing semi-structured interviews. All interviews were conducted and reviewed; then, the results were extracted. For this purpose, semantic similarities were first measured and subcategories identified. Subsequently, going through the re-review, we grouped the associated subcategories into wider categories. From the analysis of the participants’ narratives, two wide categories including organizational barriers and legalethical challenges were obtained. The organizational barriers included two subcategories of defective organizational culture and disproportionate infrastructure. The legal-ethical challenges also included subcategories of neglecting intellectual property rights and ignoring ethical actual instances in the field of virtual education. Understanding the challenges to which virtual education implementation is faced leads to their elimination which, in turn, develops the application of e-learning in the field of medical sciences. These challenges can be addressed through putting the emphasis on promoting the organizational culture of medical universities, improving the infrastructures of virtual education, and considering the legal and ethical concepts specific to virtual education.

Background & Objectives: According to the government policies, universities are suggested to change their budgeting system from a programming budgeting system to the performance-based one. This study was conducted to investigate the feasibility of implementation of the performance-based budgeting system in Iran University of Medical Sciences. This cross-sectional descriptive-analytic study was conducted in 2018. The statistical population of the study was all 108 financial staff, budget experts, and accounting experts of Iran University of Medical Sciences and subsidiary colleges. A researcher-made questionnaire with dimensions of ability, discretion, and acceptance was used to collect data. Data were analyzed using Pearson's correlation coefficient by SPSS version 20 software. For implementing performance-based budgeting system, all three criteria (ability, discretion, and acceptance) were at the moderate level. There was an inverse and significant correlation between acceptance variable and age of respondents. There was also an inverse and significant relationship between motivational acceptance variable, age and work experience of respondents (P<0.05). Implementation of performance-based budgeting in Iran University of Medical Sciences requires development of the expertise and skill required to calculate the cost of services provided, standardization of the internal and external organizational procedures, and creating motivations and incentives to start and implement the performance-based budgeting process appropriately.

The demand for mobile learning in the medical sciences educational program is increasing. The present review study gathers evidence highlighted by the experimental studies on the educational effects of mobile learning for medical sciences students.
The study was carried out as a systematic literature search published from 2007 to July 2017 in the databases PubMed/ Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Knowledge (Thomson Reuters), Educationa Resources and Information Center (ERIC), EMBASE (Elsevier), Cochrane library, PsycINFO and Google Scholar. To examine quality of the articles, a tool validated by the BEME Review was employed.
Totally, 21 papers entered the study. Three main themes emerged from the content of papers: (1) improvement in student clinical competency and confidence, (2) acquisition and enhancing of students’ theoretical knowledge, and (3) students’ positive attitudes to and perception of mobile learning. Level 2B of Kirkpatrick hierarchy had been examined by all the papers and seven of them had reported two or more outcome levels, but level 4 was not reported in the papers.
Our review showed that the students of medical sciences had positive response and attitudes to mobile learning. Moreover, implementation of mobile learning in medical sciences program might lead to valuable educational benefits and improve clinical competence and confidence along with theoretical knowledge, attitudes, and perception of mobile learning. The results indicated that mobile learning strategy in medical education can positively affect learning in all three domains of Bloom’s Taxonomy.

Medical universities need more than ever competent and effective managers and leaders to face the threats and challenges of the modern world. The aim of this research was to review the studies on the components of professional development of medical education heads of departments.

This systematic review examined the studies related to the components of professional development of medical education heads of departments published in Persian and English from 1990 to 2016. The keywords “professional development, department chair, department head, program director, educational leadership, and leadership development” were used to search through the databases of Cochran Data Base of Systematic Review, Eric, Medline, PubMed, Science Direct, Sage, Wiley, Taylor & Francis, ProQuest, SID, Iran Medex, and Magiran. The initial search yielded 1065 articles. Having the articles screened and qualitatively evaluated, final synthesis was performed on 35 articles. The data analysis method was framework analysis.

Synthesis of the related articles in two categories of higher education and medical education identified the components of professional development of medical education heads of departments in six themes including managerial development, leadership development, personal development, educational development, research development, and clinical development.

The six themes derived from this systematic review can be used as an effective model for designing professional development programs for medical education heads of departments and have useful results to improve the quality of medical education.

Aims: Qualitative and quantitative improvement of medical education needs informed mangers, who have necessary skills and knowledge for educational management of the large number of students and faculties in universities of medical sciences. However many of clinical department chairs start their work without being prepared for the upcoming challenges. This study carried out to provide a pattern of professional development of medical education administrators in this level.
This qualitative study carried out through content analysis method in Tehran, Iran, and Shahid Beheshti Universities of Medical Sciences in 2016 by conducting semi-structured interviews with 20 medical education administrators. Data were collected by semi-structured interviews and field notes and then were analyzed by contract qualitative content analysis.
499 initial codes were put into 137 concept codes, and were divided in a total of 26 sub-components and 6 main dimensions. The main dimensions were educational guidance development (4 sub-components), research guidance development (3 sub-components), clinical guidance development (4 sub-components), managerial skills development (4 sub-components), leadership skills development (6 sub-components) and personal self-development (5 sub-components).
six dimensions of professional development in this research as a pattern for professional development programs of clinical department chairs in universities of medical sciences can show positive outcomes on improving the quality of medical education. Most referred codes were development of leadership skills. It shows implementing professional development courses which can affect in improving leadership skills of department chair is more important.

Behavioral, social, psychological and biological factors influence health and disease; and, to achieve professional competency, physicians should be knowledgeable about their society and its inhabitants’ behavior. This knowledge will help physicians to become competent in communication, professional behavior, self-awareness, ethical reasoning, and understanding cultural and social differences. In this regard, this research is an attempt to explore perspectives of medical faculty members on necessity of integrating Behavioral and Social Sciences (BSS) components into the medical curriculum.
In this qualitative study, data were collected by semi-structured interview and observation of participants who were recruited from educational departments of faculty of medicine of Iran University of Medical Sciences. 12 faculty members were interviewed individually and were ask about their experiences and perspectives on integration of BSS subject matters into medical curriculum. Data were analyzed using content analysis.
The six following themes were emerged from data analysis: “physician-patientinteraction”, “medical culture”, “facilitating behavior change”, “socio-cultural issues”, “mind-body medical experience” and “physician interaction with health care system”.
The results revealed that “physician-patient interaction” was the most prominent among the emerged themes. The participants emphasized communication, professionalism, social accountability, and socio-cultural psychological aspects.

Traditional approaches in Continuing Medical Education (CME) appear to be ineffective in any improvement of the patients’ care, reducing the medical errors, and/or altering physician's behaviors. However, they are still executed by the CME providers, and are popular among the majority of the physicians. In the present study, we have done our best to explore the parameters involved in the degree of CME programs’ effectiveness in Iran.
In this study, 31 participants, consisting of general practitionares, CME experts and providers, were recruited to participate in in-depth interviews and field observations concerning experiences with CME. Application was made of the qualitative paradigm along with the qualitative content analysis, using grounded theory data analysis methodology (constant comparative analysis).
Our analysis demonstrated that: based on participant experiences, the insufficient consistency of the training program contents with the demands of GPs, besides non-beneficiary programs for physicians in addition to non-comprehensive educational designs, created a negative attitude to the continuing education among physicians. This could be defined by unrealistic continuing education, which is the main theme here.
Impracticable continuing education has created a negative attitude toward the CME programs among physicians so much so that they consider these programs less important, resulting in attending the said programs without any specific aim: they dodge absenteeism just to get the credit points. Evidently, promoting CME programs to improve the performance of physicians requires factual needs assessment over and above adaptation of the contents to the physicians’ performance.

In this study, ambulatory care training in Firoozgar hospital was evaluated based on Iranian national standards of undergraduate medical education related to ambulatory education using Baldrige Excellence Model. Moreover, some suggestions were offered to promote education quality in the current condition of ambulatory education in Firoozgar hospital and national standards using the gap analysis method.

This descriptive analytic study was a kind of evaluation research performed using the standard check lists published by the office of undergraduate medical education council. Data were collected through surveying documents, interviewing, and observing the processes based on the Baldrige Excellence Model. After confirming the validity and reliability of the check lists, we evaluated the establishment level of the national standards of undergraduate medical education in the clinics of this hospital in the 4 following domains: educational program, evaluation, training and research resources, and faculty members. Data were analyzed according to the national standards of undergraduate medical education related to ambulatory education and the Baldrige table for scoring. Finally, the quality level of the current condition was determined as very appropriate, appropriate, medium, weak, and very weak.

In domains of educational program 62%, in evaluation 48%, in training and research resources 46%, in faculty members 68%, and in overall ratio, 56% of the standards were appropriate.

The most successful domains were educational program and faculty members, but evaluation and training and research resources domains had a medium performance. Some domains and indicators were determined as weak and their quality needed to be improved, so it is suggested to provide the necessary facilities and improvements by attending to the quality level of the national standards of ambulatory education.

The cytotoxin-associated gene (cag) pathogenicity island is reported to be a major virulence factor of Helicobacter pylori infection. It is previously reported that the cagA-positive strains are more virulent, so it can be postulated that the cagA-positive gastritis will be more severe and the serum immunoglobulin G (IgG) and A (IgA) anti-CagA antibody titer will be higher. The aim of this study was to compare the relationship between IgG and IgA anti-CagA antibody and the cagA gene expression in patients with dyspepsia. Serum samples obtained from 130 dyspeptic patients with positive H. pylori in histological and Geimsa staining were tested for serum IgG and IgA anti-CagA antibody using the enzyme-linked immunosorbent Assay. The expression of the cagA gene was determined using PCR on the biopsy samples, taken via endoscopy.
In our material, the sensitivity of IgG anti-CagA antibody in identifying patients with a proven infection with the cagA-positive strains was 97.67%, and the negative likelihood ratios was 0.06. There was not significant correlation between serum IgA anti-CagA and the expression of the cagA gene among the dyspeptic patients.
The IgG antibody titer was significantly higher in our patients with the cagA-positive H. pylori strain. However, in daily practice, the level of the IgG antibody titer cannot predict whether or not an individual carries a cagA-positive H. pylori strain, because there is a major overlap in the IgG antibody titer between the cagA-positive and cagA-negative patients.

Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners.
Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general.
The participants’ experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers’ use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME.
Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME.

Helicobacter pylori strains have two classical virulence genes, the cytotoxinassociated A (cagA) gene and the vacuolating cytotoxin A (vacA) gene, which are located in the cag pathogenicity island (cagPAI). Serum immunoglobulin G (IgG) antibodies to H. pylori, especially, the CagA antigen may be a reliable marker for selection of dyspeptic patients for upper endoscopy. Serum sample of 129 dyspeptic patients with positive H. pylori, were tested for serum IgG Anti-CagA antibody by ELISA. The presence of the cagA and vacA genotypes were determined using polymerase chain reaction (PCR) on biopsy samples taken via endoscopy. Positive serum IgG anti-CagA antibodies in patients with cagA+/vacA+ and cagA+/vacA- genotypes were 22/23 (95.6%) and 18/19 (94.7%), respectively. In addition, serum IgG anti-CagA antibodies in patients with cagA-/vacA+ and cagA-/vacA- genotypes were 22/47 46.8%) and 33/40 (82.5%), respectively. It can be concluded that the serum IgG anti-CagA antibody alone could select patients with dyspepsia following upper endoscopy. The assessment of vacuolating cytotoxin activity of H. Pylori is, therefore, not required, even when vacA gene is positive. This hypothesis needs to be studied in a large number of patients with dyspepsia.