The task of breaking bad news (BBN) may be improved by incorporating simulation with art-based teaching methods. The aim of the present study was to assess the effect of an integrating simulation with art-based teaching strategies, on fellows' performance regarding BBN, in Iran. The study was carried out using quasi-experimental methods, interrupted time series. The participants were selected from medical oncology fellows at two teaching hospitals of Tehran University of Medical Sciences (TUMS), Iran. Participants were trained through workshop, followed by engaging participants with different types of art-based teaching methods. In order to assess the effectiveness of the integrating model, fellows' performance was rated by two independent raters (standardized patients (SPs) and faculty members) using the BBN assessment checklist. This assessment tool measured seven different domains of BBN skill. Segmented regression was used to analyze the results of study. Performance of all oncology fellows (n = 19) was assessed for 228 time points during the study, by rating three time points before and three time points after the intervention by two raters. Based on SP ratings, fellows' performance scores in post-training showed significant level changes in three domains of BBN checklist (B = 1.126, F = 3.221, G = 2.241; p < 0.05). Similarly, the significant level change in fellows' score rated by faculty members in post-training was B = 1.091, F = 3.273, G = 1.724; p < 0.05. There was no significant change in trend of fellows' performance after the intervention. Our results showed that using an integrating simulation with art-based teaching strategies may help oncology fellows to improve their communication skills in different facets of BBN performance. Iranian Registry of Clinical Trials ID: IRCT2016011626039N1.

Universities assess their academic learning environment to improve students' learning. Students' experience in e-learning environment is different from faceto-face educational environment. So, in this study a specific valid and reliable instrument was devised for assessing perception of e-students from educational environment, that is, educational atmosphere. Firstly, we devised the primary instrument based on factors constituting educational atmosphere. Then Instrument's content and construct validity were assessed. Also, Cronbach's alpha and test-retest were used for studying the internal consistency and reliability of the instrument respectively. The final instrument named 'e-learning educational atmosphere measure' (EEAM) consisted of 40 items covering six factors, including programme effectiveness, teaching quality, ethics and professionalism, learner support, safety and convenience, and awareness of the rules, which accounted for 68.53% of variances. Content validity ratio was more than 0.51 and content validity index score of all questions was above 0.81. Test-retest reliability was 0.85 (p = 0.001) and Cronbach's alpha was 0.943. Assessing educational atmosphere in e-learning settings by EEAM could provide managers and investors with useful information to settle an effective education system by prioritising the necessary changes.

Background:Studying medicine is perceived to be stressful, and a high level of stress may have a negative effect on cognitive functioning and mental health of the students.Objectives:In this study, we assessed perceived stress and its severity, sources and determinants.Patients and Methods:In this cross-sectional study, we assessed the perceived stress and its severity, sources and demographic variables in 341 (136 males, 205 females) randomly selected medical students of Tehran university of medical sciences, Iran, in October 2013. A self-administered valid and reliable questionnaire with a possible range of scores from 0 to 56 was used to collect the data. Stress sources were determined using logistic regression analysis.Results:The overall perceived stress mean was 32.02 (SD = 5.08). Eighty-three percent of the medical students perceived stress. Students in clinical phase perceived more stress than basic sciences ones [OR 2.25, 95% CI 1.809 - 4.032]. Logistic regression analysis showed demographic (including gender and residential status), psychosocial and academic factors and the phase of study as sources of stress.Conclusions:The results of this study show that most of the medical students declared perceived stress. So, a change in medical education environment and empowering students to effectively cope with the perceived stress sources and their families to support their children is needed.

BackgroundWith the increasing popularity of e-learning programs, educational stakeholders are attempting to promote critical thinking in the virtual education system. This study aimed to explore the experiences of both the instructors and the students about critical thinking promotion within the virtual education system.MethodsThis qualitative study recruited the instructors and students from four academic disciplines provided by the Virtual School of Tehran University of Medical Sciences (Tehran, Iran). All programs were master’s degree programs and utilized a blended (combination of e-learning and face to face) training. Semistructured interviews with the participants were used to collect data.ResultsThe participants had a variety of experiences about how to promote critical thinking. These experiences were conceptualized in four main themes, namely, instructional design, educational leadership and management, local evidence, and belief systems.ConclusionThe present study clarified the factors affecting critical thinking promotion in e-learning. Not only the instructors but also the educational designers and leaders can benefit from our findings to improve the quality of virtual education programs and promote critical thinking.

Background: Because of the developments and advancements in information technology (IT), unparalleled opportunities have been provided in electronic arenas; among them, electronic learning (e-learning) systems have brought attention to the facilitation of education. Since educational environment is a factor influencing the success of educational programs, the current study aims at evaluating the factors that create the educational atmosphere in cyberspace. Methods: The current study employed a qualitative content analysis approach and a targeted sampling method. A total of 11 students and 13 faculty members were recruited by a semi-structured interview in 2015. The interviews were continued separately for both students and lecturers up to the saturation of sample size. After the interview data were qualitatively analyzed. Results: After the data analysis, 685 codes were extracted out of the qualitative data, which were reevaluated in several stages and classified into 38 subcategories. Then, 13 categories and 6 domains (The status of virtual education, learner support, teaching skills, evaluation, professionalism and professional ethics, and self-efficacy) were created. Conclusions: Since the educational environment is an inseparable part of a curriculum, the factors creating an educational atmosphere in cyberspace are critically important and necessary for the qualitative and quantitative evaluations of the curriculum and prediction of educational outcomes.

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BackgroundStudents’ perceptions of the educational environment are an important construct in assessing and enhancing the quality of medical training programs. Reliable and valid measurement, however, can be problematic – especially as instruments developed and tested in one culture are translated for use in another.Materials and methodThis study sought to explore the psychometric properties of the Postgraduate Hospital Educational Environment Measure (PHEEM) for use in an Iranian hospital training setting. We translated the instrument into Persian and ensured its content validity by back translation and expert review prior to administering it to 127 residents of Urmia University of Medical Science.ResultsOverall internal consistency of the translated measure was good (a=0.94). Principal components analysis revealed five factors accounting for 52.8% of the variance.ConclusionThe Persian version of the PHEEM appears to be a reliable and potentially valid instrument for use in Iranian medical schools and may find favor in evaluating the educational environments of residency programs nationwide.

Ethical codes and guidelines for publication had already been developed and approved by the Ministry of Health and Medical Education. →What this article adds:A set of ethical codes specific for e-contents, on which experts of the field agreed, was devised regarding copyright issues, elearning context, and target groups' needs.