Tehran University Medical Journal

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The present research evaluated the teaching of treatment hospitals of medical sciences universities in Tehran. The aim of research was a clinical diagnosis on particular nature of medical specialty, sub specialty fields promoting the quality of medical education and offering special services in teaching hospitals in comparison with standard measurements. An effective method in recognizing the strong and weak points of teaching and treatment services in teaching hospitals is choosing the Accreditation Model, that played a great role in this research. The steps to perform the model are as follows: 1) At the beginning, the medical education system criteria was mentioned according to model consisting of five parts: input-process-intermediate output-final input and outcome. The evaluation factors are: 1- Managing, treatment, teaching and research sections. 2- The theoretical, practical and experties of the faculty members. 3- The educational progress of assistants. 4- Resources, facilities, equipment and financial services in teaching of treatment center. 5- The ability to carryout teaching of treatment and clinical projects. 6- Patient satisfaction. 2) To determine if the variables are standard, the national and international documents (teaching standards of Cebec, Canada) were studied to compare the standards to the medical education system in medical hospitals. The viewpoints of board of directors in teaching hospitals were gathered. At last, the final model was devised according to the viewpoints and the final standard confirmed, 96.7% positive votes. 3) To determine the percentage role of evaluation factors, called the basis the investigation forms were filled by the managers of the hospitals according to interview and Delphi technique. The importance of each basis was investigated and confirmed in two stages in teaching hospitals in Tehran and all over Iran, according to the information. 4) According to the standards, many questions were constructed. The board of directors in teaching of treatment sections in every selected hospital determined the rank of each criteria on the hospital where they worked. After gathering the data by the investigator and determining the grades, the following linear-formula will be applied and the criteria to judge a teaching hospital on its credibility will be available. Y=a1x1+a2x2+... akxk. 5) Based on the data collected and the application of the linear formula, the hospitals in the study proved to comply with the accreditation standards. They were rated as satisfactory.

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Background: Adolescence (10-19 years) is one of the most challenging periods in human development. A second period of rapid growth occurs during the teen years. Not much information is available on the effect of the socio-economic status on the outcome of nutrition education in teenage girls. Objective : The purpose of this study was to determine the effect of socio- economic status on the efficacy of nutrition education in promoting the nutritional knowledge, attitude and practice in first-grade guidance school girls in Tehran.

Material & Methods: A total of 300 students were selected from 11 guidance schools by simple sampling and divided into three groups: 1- guide-book, 2- group discussion, 3- control. The knowledge and attitude data were collected using pre-test and post-test questionnaires and the personal-socioeconomic data were collected using general questionnaires. The students in group 1 were given the guide-book and required to study it at home, while group 2 students were told to discuss among themselves the contents of the guide-book. The control group was given nothing to study or to do.

Results: Nutrition education did not have a significant effect on the increase in the attitude score in the students whose grade-point average and their mother’s education level were high. (p= 0.13, p=0.29). Only mother’s education level independently from the type of education was associated with the difference of knowledge score means (p =0.07).There was interaction between nutritional education and monthly pocket- money with regard to the increase in the knowledge score (p =0.03).

Conclusion: Overall, exception of monthly pocket money, the effect of education on the nutritional knowledge and attitude was independent from other variables. Only mother’s education associate with the difference of knowledge score means.

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Background: Medical education is inherently stressful and demanding to deal with various stressors, which may cause impaired judgment, reduced concentration, lack of self-steam, increased anxiety and depression.

Materials and Methods: A cross sectional study was conducted on 250 medical students from 6 month period to graduation in medical college of Tehran university of Medical sciences in order to assess their anxiety and practice of health behaviors and also the relation between the two variables and some other related factors..

Results: The results of study show that of 6.6% medical students suffer from severe state and 4.9% from trait anxiety. The finding of this study shows that 83.3% of girls and 84.6% of boys have practicing risky health behaviors. No statistical relationships found between, anxiety and practicing health behaviors. The relation between anxiety and health satisfaction was Statistically significant mental and physical (P<0.001).

Conclusion: The information found in this research, can help medical education institute to capitalize an opportunities to help their students in preventing risky behaviors, and different stress management techniques should be taught at medical schools.

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At the middle of the 20th century, autopsy has a fundamental role in medical education in Iran, guided by the influential Oslerian philosophy “as is your pathology so is your medical practice”. Students not only attended autopsies, but also had learnt to conduct them. In contrast, today the use of autopsy in medical education is falling down to death. Although this falling is worldwide, but the situation in Iran is much worse. Rarely Iranian medical schools deal with educational autopsy and some of them are quite unfamiliar with autopsy. There are several reasons for this declining including sophisticated medical education with autopsy, community attitudes ,clinicians’ and pathologist’ reluctance, hospital concern about legal action, religious attitudes, consent from the family and funding priorities. Even with new diagnostic modalities, autopsy remains an important tool for quality and safety assurance. A systematic review of reports on autopsies from USA, European and Australian hospitals, revealed 9 to 40% (on average 23.5%) of clinically missed diagnoses and managements involving the principal or underlying cause of death. The key roles of hospital autopsies are Improving safety and quality in diagnosis and treatment, Providing benefits to families, Advancing understand-ing of disease, Allowing good programming for emerging disease and frequently seen disease, and Educating medical and allied health professionals. We have concluded that, reversing the decline of autopsies will require cooperative action at several levels of the healthcare system, particularly including clinicians and pathologists and also governmental and financial bodies and legal authorities.

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Background: The NCEP step II diet produced a desirable lipoprotein response in hypercholesterolemia. A relation between plasma concentrations of small dense LDL and cardiovascular risk factors has also been mentioned in children. This study was conducted to determine the effects of the National Cholesterol Education Program (NCEP) step 2 diets on the low density and high density lipoprotein particle size in dyslipidemic adolescents.
Methods: Forty- four dyslipidemic adolescents, aged 10-18 years, participated in this case-control study. The control group was not given a diet prescription and was simply instructed to “eat as usual”. Their eating patterns reflected the consumption of macronutrients, fruit, vegetables and dairy products, typical of what many Tehranian eat. NCEP step 2 diets was a diet with 30% of calories as total fat, less than 7% saturated fat, less than 200 mg cholesterol, less than 15% of calories as monounsaturated fat and less than 10% as polyunsaturated fat per day. Lipoprotein particle size was the major outcome variables, which was measured after 3 months of intervention. Lipoprotein particle size was estimated by nondenaturing polyacrylamide gradient gel electrophoresis using Krauss and Burke methodtion.
Results: The mean body mass index was 26.3±4.2 kg/m2. Baseline characteristics of these adolescents did not differ significantly across the NCEP step 2 and control diet groups. The NCEP diet resulted in higher reduction in total cholesterol (-13±4 vs –2±0.3 mg/dl, p<0.001), LDL (-9±2 vs 3±0.6 mg/dl, p<0.01) and higher increase in size of the LDL (1.7±0.4 vs 0.1±0.4 mg/dl, p<0.001). HDL particle size did not change significantly. The prevalence of hypercholesterolemia decreased significantly (p<0.05) in NCEP step 2 group (68% in NCEP step 2 vs 100% in the control group) after 3 months.
Conclusion: NCEP step 2 diet not only reduces the serum LDL concentration of hypercholesterolemic adolescents but also has a favorable effect on the LDL particle size distribution. The related mechanism needs to be studied in future experimental designs.

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Background: The common cold is the most prevalent sickness and an important cause of absence from job. Furthermore, it often disturbs travel, including the practice of hajj, causing the use of many inappropriate drugs by these travelers. The health belief model is a psychological model that attempts to explain and predict health behaviors. The purpose of this study was to determine the effects of zinc and health belief model based educational intervention on the behavior of hajj travelers with regard to viral upper respiratory tract infections (URTI).

Methods: This double-blinded randomized controlled trial was performed among hajj travelers in 2005. Preventive measures were randomly allocated to four groups: 1- education + zinc sulfate. 2- education + placebo. 3- zinc sulfate only 4- placebo only. Data regarding incidence and duration of URTIs, background disorders, vaccination and health behaviors for cold were gathered by questionnaire by physicians and finally analyzed by SPSS 11.5 software using chi-square, t-test and independent samples t-test.

Results: A total of 646 travelers were studied. The incidence of common cold in groups receiving zinc were significantly less than that for those receiving the placebo. (P=0.05). However, incidence was statistically the same for those who received education versus those who did not. Use of handkerchief was the most prevalent behavior and use of mask was the least prevalent behavior. Mean duration of symptoms was less in those receiving zinc and education (3.7 days) comparing to those who received placebo and education (5.6 days). 

Conclusions: This study showed that zinc consumption can decrease the incidence and duration of the common cold. Health belief model based education could promote some preventive behaviors although most people do not take advantage of them. We recommend the use of zinc by those attending hajj.

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Background: Immediately after Comprehensive Medical Basic Sciences Examination (CMBSE), the secretariat of the Medical Basic Sciences Education Council (MBSEC) proceeds to rank medical universities according to the students’ scores both in individual academic subjects such as biochemistry, English and in all subjects put together. This study believes that the method used in ranking the universities according to the students’ English scores is not a proper method and thus doesn’t provide accurate results.
Methods: Seven of the major and smaller universities were selected. The language scores of all the students admitted to the medical schools of these universities during 3 academic years of 1378 to 1381 (2426 students in all) in both CMBSE and National university Entrance Examination (NUEE) were obtained. The language scores of each students in NUEE and CMBSE were matched.
Results: A significant correlation (max. R=69%, P<0.004 to min. R=27%, P<0.045) was observed between these two grades in all universities studied. Moreover despite the secretariat’s decision to calculate the scores and rank the universities in two separate groups of major and small universities, in some CMBSEs certain smaller universities were ranked in the group of major ones and in some others vice versa.
Conclusions: This has impaired the university ranking in the subject of English language. This study proposes two different ranking methods, that eliminate the present drawback in university ranking according to their student’s English scores.

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Background: Nowadays, new methods are emerging each month for a better operation with fewer complications. Laparoscopic surgery have remarkable advantages, Compared to open, such as smaller incision, less manipulation of the digestive system, less postoperative pain, fewer wound complication and faster discharge from the hospital. Therefore it is preferred by patients and surgeons and is replacing the traditional open surgical methods. However, any operation causes significant panic for patients and lack of knowledge about the surgical method is found to cause poor surgical outcomes, such as recovery time after the surgery we evaluated the effect of preoperative education on the recovery time of laparoscopic cholecystectomy candidates. Methods: This randomized clinical control trial was performed at Imam Khomeini and Alborz Hospitals in Karaj from February 2010 till January 2011. Using randomized sampling method, 100 female candidates for laparoscopic cholecystectomy were divided into two equal groups of case and control. The case group received detailed information about operating room’s condition, surgical equipment, anesthesia method, advantages and disadvantages of laparoscopic procedures, and patient’s role in self-care at recovery, whilst the control group received no education before the surgery. The two groups were compared regarding recovery time based on Aldrete modified checklist and mean time to reach the Aldrete consciousness score of 9 and the incidence of nausea was assessed among them. Results: The analysis showed that there was a significant difference between the mean time to reach Aldrete consciousness modified checklist score of 9 between the case and control group (18.04±3.87 vs. 29.66±5.44, respectively, P<0.001), therefore the case group had shorter recovery time than the control group. 10 of the case group (20%) and 3 of the control group (6%) had nausea after recovery (P=0.037, OR=0.255 (CI 95%: 0.066-0.992)). Conclusion: Preoperative education of patients can significantly decrease the recovery time after laparoscopic cholecystectomy surgery. Therefore, it is strongly recommended to include the preoperative education in routine care of laparoscopic cholecystectomy patients for better surgical outcomes.

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Background: Education is the main mission of teaching hospitals, but the residents’ learning in acquiring new techniques does interfere in the overall treatment process of patients. Studies pertaining to the effect of anesthesia residents’ training in operating room on treatment procedures have reported conflicting results. Therefore, this study was performed to investigate the effects of anesthesia residents’ training on start time operative delays. Methods: This cohort study was done in neurosurgical operating room, Imam Khomei-ni Hospital, Tehran, Iran during 2010-2013 on a population study comprising of sec-ond year anesthesia residents. Patients were classified into three groups with 30 cases in each one according to the anesthetic team. Group I: one anesthesiologist in charge of two operating rooms and two anesthesia assistants Group II: one anesthesiologist in charge of one operating room and one assistant Group III: one anesthesiologist with-out an assistant. Patients in these groups were compared in terms of American society of anaesthesiologists (ASA) class, induction difficulties and type of surgery. Studied variables included :1) Interval between the patient lying on the bed to till anesthesia, 2) the time devoted to teaching residents, 3) time from the start of anesthesia until the start of surgery. An observer that was blinded to the type of intervention and the study design, recorded the times. Results: ASA class (P= 0.94), induction difficulties (P= 0.66) and type of surgery (spinal cord or brain operation) (P= 0.41) were not statistically different between patients in groups. Preoperative preparation time for the first group (23.5±8.1 min) was longer than the other two groups (21.5±6.2 min and 15.8±9.1 min), respectively (P= 0.001). Differences between the times from start of anesthesia to surgeries in three groups, based on ASA class and type of surgery were not significant (P> 0.05). There was no re-lationship between the times devoted to teaching residents in the first and second groups (P> 0.05). Conclusion: Anesthesia residents’ training in neurosurgery operating room may in-crease the time required for preparing for surgery, but this time expended is hardly of any significance.

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Background: Personal characteristics such as gender, ethnicity, disability, age, goals and personal expectations and academic variables such as the number of classes and grades are among the factors that could have an important role in the development of student satisfaction. Besides these factors, the relationship between emotional intelligence (EI) and academic satisfaction has received little attention. Methods: This descriptive cross-sectional study was done in Tehran University of Medical Sciences, Tehran, 2013. Cluster sampling was applied in this study. First, faculties randomly selected from Tehran University of Medical Sciences then randomly selected classes from the faculties. Self-report and Barr-On's emotional Intelligence questionnaires were used to collect data and measuring the variables of educational satisfaction. Questionnaires were completed by students. Overall reliability test using Cronbach's alpha coefficient was 0.73. The cut-off point of questionnaires was considered 70. This means that scores below 70 points showed the low level of satisfaction and scores more than 70 points were considered as a high level of satisfaction. Results: One hundred sixty eight students participated in the study. Average emotional intelligence was 3.25±0.45, the scale of consciousness 3.44±0.59, the self-control scale 3.90±0.59, scale spontaneous 3.17±0.46, Social skills 3.30±0.59, social consciousness 3.24±0.67, satisfactory academic 96.55±14.66 respectively. There was a significant relationship between self-consciousness and educational satisfaction (P=0.002) but self-control variable did not significantly correlated with educational satisfaction (P=0.249). The results showed that emotional intelligence on academic satisfaction can be explained. A change in the variance in one unit emotional intelligence was as much as five unit of the variance student satisfaction in based on standardized beta coefficient. There is a positive and direct relationship between them. Conclusion: The promotion of education satisfaction will increase indirectly possibility of job satisfaction in students in the future. Our results showed self-awareness and motivation skills in students increase their educational satisfaction.

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Background: In fact, there is no doubt that medical education should be to prepare students for those clinical problems that they may encounter in their future performance. But according to the findings of previous studies in this area, one of the important priority and basic needs in education is training health workers, including physicians. Methods: In this qualitative study focuses on the content analysis of typical (conventional content analysis) was performed. The aim of this study was to determine the needs and skills required to train neonatal subspecialists in the ability to manage vulnerable neonates problems and their families specialized in the field of comprehensive health care have driven. Based on purposive sampling, the research participants, staff and alumni of the second year and above the five-year sub-specialty in neonatology, formed by the association of neonatal diseases were chosen. Saturation as a termination criterion was applied to the collected data. Method of data collection was semi-structured interviews and focus group discussions. Reliability means the adequacy and accuracy that was measured by four methodological criteria: credibility, confirmability, transferability and dependability. All phases of study were recorded elaborately and the researchers reported all findings in the same speech research participants. Results: Respondents consider themselves some week points in neonatal medicine education; they expressed their opinions in three categories with four subcategories as follow: "competent person knowledgeable", "weakness of the curriculum", "educational challenges", "need to review the curriculum", "the need to reform medical education system in the country", and "effective strategies for teaching". Conclusion: Editing curriculum to teach coherent and comprehensive clinical skills in one hand, social support and health care for vulnerable children and families in other hand will improve care for vulnerable neonates.

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Background: To assess patient' reaction towards bedside teaching in the nephrology ward of Imam Khomeini Hospital Complex (Tehran) and to identify the factors that may influence it.

Methods: A cross-sectional study was conducted in the nephrology ward of Imam Khomeini Hospital Complex from march to September, 2014. All inpatients present on the day of the study were interviewed using a structured questionnaire.

Results: 146 patients were examined in this study that 62 patients (42.5%) were women and 84 cases (57.5%) were men. 112 (76.7%) of patients had a good feeling about the training to physicians. The behavior of students was evaluated respectful by 132 individuals (90.4% of patients). Total number of 106 individuals (72.6% of patients) had trusted to the health care team and 120 people (82.2% of patients) knew that the physicians’ behaviors are associated with the respect to their religious beliefs. Not being same sex of the examiners was important for 47 individuals (32.2% of patients). The number of 123 cases (84.2% of patients) evaluated the physicians' behavior with respect to their privacy. The number of 119 individuals (81.5% of patients) received their responses from the examiners. Statistical tests indicate a significant relationship between the respectful behavior of students with patient and good feeling about training to physicians, so that the 95.5% of people who have seen the respectful behavior of students to oneself had a good feeling about training to physicians (P˂0.001). The relationship between the presence of teacher with students and good feeling on training to physicians was significant (P=0.013). Positive feeling about practicing physicians was associated with patient age. So the age average of people who feel good about practicing physicians was significantly lower than the other people (47.2±17 versus 55.6±18 and P=0.028). Conclusion: The relationship between respectful behavior and presence of teacher with students and age and good feeling on training to physicians was significant.

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Results: The cases studied, 421 people died in Tajrish Hospital and 356 in Modarres Hospital. The highest number of deaths in both hospitals were in the internal wards (336 cases) and surgery (168 people). 45.6% of death certificates have been issued by a forensic expert. 64.8% cases correctly inserted ICD-10 code. Conclusion: Training of physicians for the importance of death certificate and how it should be completed is very important. This research showed that in the cases which the death certificates were completed by the hospital forensic medicine specialists were more useful and accurate.

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Results: Based on the obtained data, it was observed that out of the participants in the training classes, 5 cases (14.3%) had cesarean section and  and 30 cases (85.7%) had a normal delivery. 18 cases (51.4%) of the control group had the natural method and 17 cases (48.6%) were delivered by cesarean section. It was observed that there was a significant difference between the control and intervention groups in the type of delivery method, therefore, 85.7% of the intervention groups had a normal delivery (P=0.002). Conclusion: The results of this study showed that participation in childbirth preparation classes were influenced for the choice of delivery.

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Results: The pre-test scores of groups A and B were 3.48±1.197 and 3.49±1.481, respectively. The post-test scores of groups A and B were 6.97±1.504 and 10.54±1.303, respectively. Therefore, although the pre-test scores of groups A and B were not much different (P>0.05), the post-test scores of the two groups showed a significant difference (P<0.001). Students also expressed that using this educational tool has made learning hand anatomy more interesting for them. Conclusion: The results of this study showed that the proposed educational tool is effective in the field of hand anatomy education.

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Results: The challenges of teaching medical ethics from the participant's point of view are classified into three themes: 1- Hidden curriculum 2- Necessity of completing medical ethics education program 3- Executive and managerial macro factors. The results showed that medical ethics training courses are not effective for changing students' behavior and their moral decision-making. There are substantial shortcomings in the current curriculum in terms of content, format, and implementation that make it unresponsive to ethical needs and concerns. Teaching medical ethics should be turned into a longitudinal theme. The duties and missions of the Department of Medical Ethics at the university are not well understood. The Department does not act as a strong executor and supervisor of medical ethics in interaction with higher authorities to pursue the requirements of effective ethics education and to ensure the implementation of ethical codes. There is no effective mechanism for evaluating the ethical performance of activists and students and giving feedback to them. There is insufficient organizational support for students' complaints and reports about the misconduct and unethical behavior of faculty or staff.

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