Problem statement: The aim of the present study was to determine the successful medical students' viewpoints on factors significant to their academic success assessed according to the students' grade point average. In this research the students with the grade point average (GPA) A (17-20) were considered academically successful. Approach: The participants were 30 fifth year successful students (i.e. students with GPA, A) from Shiraz Medical School. The instrument used for the qualitative data gathering was interview. The subjects were arranged into 6 groups of 5 students followed by a discussion on reasons of their success. Five educated tutors coordinated the groups. Results: Categorizing of focus group data was done and 4 general factors including "personal abilities" "attitude, beliefs and motivation", "effort and perseverance" and "supportive factors" were found to be critical to the students' success. It is clear that all factors mentioned by students play an important role in their success in general. The similarities between the results of this study and those of others support the idea that all successful medical students share some common characteristics. Conclusion/Recommendations: The results of this study would help both medical school authorities and instructors to design strategies for more effective education. The results can also help other students to find out what might lead them to more success

Introduction: Medical students should be trained about the fundamental skills of evidence-based medicine (EBM) during undergraduate medical education curriculum. This article introduces an innovative model for initiation and development of a flipped classroom for teaching EBM to sixth-year undergraduate medical students in Shiraz Medical School, affiliated to Shiraz University of Medical Sciences. Methods: After conducting needs assessment and setting objectives for the program, blended leaning format and flipped classroom strategy were used. A student satisfaction measurement form was designed to evaluate the flipped classroom based on a 5-point Likert scale. The validity of the questionnaire was determined by experts, and the reliability of the questionnaire was 0.86 after a pilot study. We also used the questionnaires based on Berlin questionnaire to measure students' knowledge, attitude, and practice about the EBM course in a pre-and posttest design. The validity and reliability of the questionnaire had been approved in our previous study. Also, the result of a summative examination after finishing the course was used as a measure of course goal achievement. Results: A total of 280 medical students on their sixth year of study participated in the flipped classroom in 6 different rotations. A total of 266 (95%) students passed the course and only 14 (%5) failed. The results of posttest scores based on the EBM domains revealed that the best result was obtained in teaching clinical questions' format (patient, intervention, comparison, and outcome). The lowest posttest scores were in the domain of biostatistics. The overall quality of flipped classroom was reported well by the students. The students stated that the ability to apply knowledge and skills in managing patients were developed in this course. Discussions: In our experience, flipping classroom was a practical and essential activity to educate a large number of medical students about EBM. We acknowledge that the development of deep learning is instructors' responsibility and that implementing blended learning and flipping classroom can facilitate students' knowledge and skills about this important topic. We hope that other medical schools all over the world use the flipped classroom discussed in this article to redesign their classrooms in such a way that enables students to develop necessary skills and get involved in deep learning. This will improve the health of the society in the near future.

Background All cancer patients, except for a small fraction, seek treatment after becoming aware of the disease. That small fraction do not seek any treatment due to various reasons, and this phenomenon is unknown to us. Therefore, the present study aimed to discover the reasons for treatment refusal in cancer patients. Methods This qualitative grounded theory study was conducted on 22 participants including patients, caregivers, physicians, and nurses. Purposive theoretical sampling was employed. Data were collected through in-depth interviews. All interviews were gradually transcribed and analyzed. Data analysis was carried out through the three-step method of open, axial, and selective coding and was continued until theoretical saturation. Straussian Grounded Theory was used for data analysis. Results A total of 4 themes and 20 sub-themes were extracted in this study. The core variable extracted from the interviews was “resilience” Other related themes included encounter with cancer, fighting cancer, and coping with cancer. The findings showed that in the context of fighting cancer, patients lost their resilience through various processes and refused treatment. Conclusion Cancer patients abandon the treatment in silence, oncologists and even family members being unaware of the matter. In other words, refusal of treatment is like an iceberg and the majority of the patients who have abandoned treatment are unknown to the health system. The model obtained in this study can increase the knowledge of the process that leads patients to lose their resilience against cancer and abandon treatment, which can increase the possibility of recognizing and predicting treatment refusal for oncologists.

The article's abstract is not available.

Background All cancer patients, except for a small fraction, seek treatment after becoming aware of the disease. That small fraction do not seek any treatment due to various reasons, and this phenomenon is unknown to us. Therefore, the present study aimed to discover the reasons for treatment refusal in cancer patients. Methods This qualitative grounded theory study was conducted on 22 participants including patients, caregivers, physicians, and nurses. Purposive theoretical sampling was employed. Data were collected through in-depth interviews. All interviews were gradually transcribed and analyzed. Data analysis was carried out through the three-step method of open, axial, and selective coding and was continued until theoretical saturation. Straussian Grounded Theory was used for data analysis. Results A total of 4 themes and 20 sub-themes were extracted in this study. The core variable extracted from the interviews was "resilience" Other related themes included encounter with cancer, fighting cancer, and coping with cancer. The findings showed that in the context of fighting cancer, patients lost their tolerance through various processes and refused treatment. Conclusion Cancer patients abandon the treatment in silence, oncologists and even family members being unaware of the matter. In other words, refusal of treatment is like an iceberg and the majority of the patients who have abandoned treatment are unknown to the health system. The model obtained in this study can increase the knowledge of the process that leads patients to lose their tolerance against cancer and abandon treatment, which can increase the possibility of recognizing and predicting treatment refusal for oncologists.