This prospective study was carried out to investigate the risk factors and incidence of surgical site infection (SSI) among patients in surgical wards of five hospitals affiliated to Iran University of Medical Sciences. Data was collected in a register card filled by specially trained staff. Nine-hundred and eighteen patients admitted in surgical wards were followed 30 days postoperatively for SSI during 1 April 2003 to 30 September 2003. A total of 77 patients were identified among 918 cases included in the study, with a resulting overall SSI rate of 8.4%. The risk of SSI was increased by age older than 60 years (OR = 3.9; P < 0.0001), diabetes mellitus (OR = 4.9; P < 0.0001), smoking (OR = 3.1; P < 0.0001), obesity (OR = 4.1; P < 0.0001) and wound drain (OR = 2.2; P < 0.0001). There were significant statistical difference in duration of anaesthesia (131.6 vs. 177 min, P < 0.001) and duration of surgery (99 vs. 140.5) between patients without SSI and patients with SSI. In conclusion, identification of the risk factors for SSI will help physicians to improve patient care and may decrease mortality and morbidity and hospital care costs of surgery patients.

An EBM workshop may improve clinical teachers' abilities and skills in using EBM. However, carefully designed studies are required to evaluate the long-term effects of EBM curricula in changing behaviors, practice patterns, and patient care outcomes.

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Background: 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 physicians' behaviors. However, they are still executed by the CME providers, and are popular among the majority of the physicians. In this study, we aimed to explore the parameters involved in the degree of effectiveness of CME program in Iran. Methods: In this study, 31 participants, consisting of general practitioners, 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). Results: Based on the participants’ experiences, the insufficient consistency between the training program contents and the demands of GPs, in addition to the non-beneficiary programs for the physicians and the non-comprehensive educational designs, created a negative attitude to the continuing education among physicians. This could be defined by an unrealistic continuing education program, which is the main theme here. Conclusion: Impracticable continuing education has created a negative attitude toward the CME programs among physicians so much 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 the physicians requires factual needs assessment over and above adaptation of the contents to the physicians’ performance.

Spirituality in medical education is an abstract multifaceted concept, related to the healthcare system. As a significant dimension of health, the importance and promotion of this concept has received considerable attention all over the world. However, it is still an abstract concept and its use in different contexts leads to different perceptions, thereby causing challenges. In this regard, the study aimed to clarify the existing ambiguities of the concept of spirituality in medical education. Walker and Avant (Strategies for theory construction in nursing, Prentice Hall, Boston, 2011) concept analysis eight-step approach was used. After an extensive review of online national and international databases from 2000 to 2015, 180 articles and 3 books in English and Persian were retrieved for the purposes of the study. Analysis revealed that the defining attributes of spirituality in medical education are: teaching with all heart and soul, Life inspiring, ontological multidimensional connectedness, religious-secular spectrum, and socio-cultural intricacies. Moreover, innate wisdom, skillful treatment, transcendent education, and environmental requirements were antecedents to this concept, with the health of body and soul, intrapersonal development and elevation, and responsive treatment and education being its consequences. The defining attributes provided in this study can assist physicians, instructors, and professors to develop and implement evidence-based, health based and comprehensive education plans according to the guidelines of professional ethics and qualification of using spirituality in practice. The clarification of the noted concept facilitates further development of medical knowledge, research, and research instruments.

↑What is "already known" in this topic: • Decline in empathy, an increased suspicion, and a decline in altruism were reported by almost all the medical students. • The first step to promote clinical empathy in medical students is to identify its challenges. →What this article adds: • This qualitative study explained the challenges of promoting clinical empathy skills among medical interns. • Two main challenges extracted: Overt challenges, which are tangible and objective, and covert challenges, which affect empathy in medical students in an implied and intangible way. • Management of financial and human resources are required to resolve the challenges in promoting clinical empathy in medical students. • Also, patients and interns should also receive training on the principles of effective doctor-patient interactions.

BackgroundClinical reasoning plays a major role in the ability of doctors to make a diagnosis and reach treatment decisions. This paper describes the use of four clinical reasoning tests in the second National Medical Science Olympiad in Iran: key features (KF), script concordance (SCT), clinical reasoning problems (CRP) and comprehensive integrative puzzles (CIP). The purpose of the study was to design a multi instrument for multiple roles approach in clinical reasoning field based on the theoretical framework, KF was used to measure data gathering, CRP was used to measure hypothesis formation, SCT and CIP were used to measure hypothesis evaluation and investigating the combined use of these tests in the Olympiad. A bank of clinical reasoning test items was developed for emergency medicine by a scientific expert committee representing all the medical schools in the country. These items were pretested by a reference group and the results were analyzed to select items that could be omitted. Then 135 top-ranked medical students from 45 medical universities in Iran participated in the clinical domain of the Olympiad. The reliability of each test was calculated by Cronbach's alpha. Item difficulty and the correlation between each item and the total score were measured. The correlation between the students' final grade and each of the clinical reasoning tests was calculated, as was the correlation between final grades and another measure of knowledge, i.e., the students' grade point average.ResultsThe combined reliability for all four clinical reasoning tests was 0.91. Of the four clinical reasoning tests we compared, reliability was highest for CIP (0.91). The reliability was 0.83 for KF, 0.78 for SCT and 0.71 for CRP. Most of the tests had an acceptable item difficulty level between 0.2 and 0.8. The correlation between the score for each item and the total test score for each of the four tests was positive. The correlations between scores for each test and total score were highest for KF and CIP. The correlation between scores for each test and grade point average was low to intermediate for all four of the tests.ConclusionThe combination of these four clinical reasoning tests is a reliable evaluation tool that can be implemented to assess clinical reasoning skills in talented undergraduate medical students, however these data may not generalizable to whole medical students population. The CIP and KF tests showed the greatest potential to measure clinical reasoning skills. Grade point averages did not necessarily predict performance in the clinical domain of the national competitive examination for medical school students.

Objective: A qualitative study was conducted to explore the perception of healthcare professional students about mobile learning acceptance. Method: The study was performed using a conventional content analysis method. The subjects were the students of medical sciences in Iran University of Medical Science. Sampling was based on a purposeful sampling method. Twenty-three students took part in semi-structured interviews until data saturation was reached. Results: The main theme was “the paradox of acceptance and rejection” with three categories; (1) perceived attraction (sub-categories: learning with the excitement of entertainment, the attraction of multimedia learning environment and enthusiasm for electronic learning); (2) perceived ease (sub-categories: easy access to information anytime and anywhere and easy and effortless use); and (3) perceived conflict (sub-categories: teachers’ contradictory behavioral patterns, contradiction about value of online information, friends’ contradictory behavioral patterns, and digital gap between generations in family). Conclusion: The three categories found in the study placed the students in a dilemma of using or not using mobile learning. They had doubts about accepting mobile technology as a legitimate educational tool. Taking these factors into account and managing them can pave the way for mobile learning in the students.