The necessity of examining patients’ social behavior and teaching behavior change theories: curricular innovations induced by the COVID-19 pandemic

During the COVID-19 pandemic, despite many widespread calls for social distancing, recommendations have not been followed by some people and the high rate of non-compliance has significantly affected lives all around the world. It seems that the rate of non-compliance with the recommendations among medical students has been as high as the rest of the other youth. In the time that students are removed from clinical environments and most physician teachers are strained in providing services to patients, medical students can be trained in interdisciplinary behavior change counseling programs and they can be employed in delivering virtual consultations to the patients referred to medical centers. In this quick review, we provide an argument regarding the importance of integrating the topic of patients’ social history into the undergraduate medical curriculum and the necessity of teaching theories of behavior change to medical students. Hypotheses are proposed that focus on the importance of integrating behavioral and social sciences into the medical curriculum and to teach theories or models of behavior change to students. Health professions educators can design and implement interventions to teach hypothesized models of behavioral change to medical students and evaluate the effectiveness of those interventions. The impacts of such educational interventions on increasing people’s compliance with recommendations to improve public health can be evaluated as well

Designing Information Acquisition Tools for Assessing the Status of Outpatient Training for Medical Students

Introduction: Outpatient medical education is one of the important parts of clinical training in medical education which has been given particular attention today due to its deep relationship with the future of the physician's occupation. Lack of proper tools and standards for assessing the status of outpatient education is one of the obstacles to conducting ambulatory education assessment studies. Therefore, this study was aimed at developing instruments for assessing outpatient training of medical students during externship and internship in Clinics Affiliated to the Medical Sciences Universities. Methods: This developmental and psychometric study was conducted to develop an outpatient education assessment instrument in educational clinics. The sources used were included reputable medical education reference books, general medical education curriculum and previous studies. For standardization and calculation of reliability and validity, Cronbach's alpha coefficient and survey of specialists were used respectively. We used SPSS tools for data processing, and Pearson correlation index for inferential analysis. Results: The developed instruments included two educational status assessment questionnaires from the viewpoint of students (reliability 89%, validity 85%) and faculty members (reliability 90%,validity 85%), a patient satisfaction assessment questionnaire (reliability 90%,validity 80%), and an observational checklist for assessment of educational clinics (reliability 95%,validity 82%). Conclusion: The developed instruments in this study compared with the instruments used in previous studies simultaneously evaluates the status of outpatient education from the viewpoint of all the three involved exposures, including tutor, learner, and patient; which is the important positive point. The evaluation of educational clinics of medical universities in the future with the developed instruments in this study while providing a clear image of the status, can provide comparable information between educational centers

Design and validation of brucellosis prevention questionnaire focused on animal vaccination

Background: The inadequate awareness of livestock breeders on brucellosis transmission, as well as their improper knowledge about preventing brucellosis is considered as one of the important barriers to animal vaccination against brucellosis. The present study aimed to design and validate a brucellosis prevention questionnaire focused on animal vaccination. The valid questionnaire was used to design, implement, and evaluate an interventional training program. Method: A brucellosis prevention questionnaire (BPQ) was developed in the exploratory psychometric study. In addition, face-to-face interviews were conducted to formulate its initial items, the results of which were merged with those obtained from literature review. Further, the face, content, and construct validity of the questionnaire were assessed by co-operating livestock breeders, veterinarians, and health educationists. The impact score (IS), and content validity ratio (CVR) and index (CVI) of the items were calculated, and the construct validity of the questionnaire was evaluated through factor analysis. Furthermore, the reliability of the results related to the questionnaire was measured by using Cronbach’s alpha, intra-class correlation coefficient (ICC), and composite reliability, as well as the standard error of measurement (SEM). Results: The questionnaire was finalized with 53 items and its validity was confirmed by CVI (0.90), CVR (0.74), and IS (4.30). Additionally, the items were loaded into three constructs of awareness, attitude, and practice. Further, the predictive power of awareness, attitude, and practice was determined as 43.43, 15.81, and 15.78%, respectively. Furthermore, the fitness of the proposed model among the constructs was confirmed by the root mean square error of approximation (RMSEA) < 0.08, as well as normed chi-square (× 2/ df) < 5.0, comparative fit index (CFI) ≥ 0.90, and Tucker- Lewis index (TLI) ≥ 0.9. Conclusion: The brucellosis prevention questionnaire represented acceptable psychometric properties. The factors influencing the preventive behavior of livestock breeders can be identified by applying the questionnaire, and co-operating veterinarians and educational planners.

Application of the PRECEDE -PROCEED model in prevention of brucellosis focused on livestock vaccination process

Background This article reports the steps of an educational intervention, which is designed to change livestock breeders’ preventive behavior in terms of vaccinating their livestock against brucellosis. The study has been conducted in a rural area in a country with the second highest brucellosis prevalence in the world. Methods In a quasi-experimental study and applying PRECEDE-PROCEED model, 45 livestock breeders were trained through basket method, accompanied with constructive feedback from researchers and peers and a brief interactive lecture at the end. The livestock breeders’ awareness, attitude and practice level in the intervention group was compared with those of other 45 livestock breeders in a control group, 1 and 6 months after the intervention. According to the results of the Rose Bengal tests (RBTs), as a rapid and simple screening test, the presence or absence of Brucella antibodies in the animals’ serum was investigated. Results Immediately and 1 month after the intervention, the mean scores of knowledge, awareness and practice of livestock breeders in the intervention group were significantly higher. Six months after the intervention, the results of the RBTs were positive in more livestock in the intervention group compared to the animals in the control group. The positive result of RBT after educational intervention, in livestock whose test results were negative immediately before intervention, accompanying the results of observation indicating a good general condition of livestock was considered as a probable evidence of the success of the educational intervention. Conclusion The model-driven educational intervention could significantly increase livestock breeders’ awareness, attitude and practice regarding prevention of brucellosis and vaccination of their livestock against brucellosis; however, a period of non-continuous reinforcement and gradual reduction of the number of the reinforcements by health educator workers is recommended in order to increase the maintenance of the learnt behavior. Trial registration Conducting this study was registered at Iranian Registry of Clinical Trials (IRCT20180304038945N1). Registered 24 December 2018. The proposal was registered before enrollment of the first participant

The Causal Relationship between Interns’ Knowledge and Self-Efficacy and Their Value in Predicting the Interns’ Communication Behavior with Patients

Abstract Background: After many years of teaching, both the efficiency and efficacy of communication skills programs are under question because patients’ dissatisfaction with doctors’ communication behavior is at the top of the complaint lists. It is assumed that finding the specific role of different determinants of doctors’ communication behavior, instructional designers can plan more effective training programs. This study aims to explore the predictive value of interns’ knowledge and self-efficacy in building effective relationship with patients and determine the causal relationship between interns’ knowledge and self-efficacy about effective doctor-patient relationship. Methods: In this cross-sectional study, PRECEDE model was applied and the analyzed content from semistructured interviews with 7 interns and 14 faculty members was combined with the items from literature review. All the emerged items were categorized under eight constructs of social cognitive theory. The validity and reliability of the items of the research questionnaire were examined by 40 interns and an expert panel of 14 faculty members. The questionnaires were completed by 203 medical interns and confirmatory factor analysis (CFA) was done on the items. The data were analyzed by SPSS.21 and LISREL 8.80. Results: CFA indicated a good fit to the data. Knowledge and self-efficacy, together, explained 23 percent of the variance in interns’ communicative behavior. 53 percent of the changes in interns’ selfefficacy were attributed to the changes in interns’ knowledge. Conclusion: Improving the interns’ shared vision can increase the quality of their knowledge and instructional designs based on learning facts, and gaining insights about effective doctor-patient relationship can increase the interns’ self-efficacy and consequently improve the interns’ communication skills

Improving interns’ patient–physician communication skills: Application of self-efficacy theory, a pilot study

Aim: This quasi-experimental study explored application of the self-efficacy theory in improving self-efficacy, communication skills and patient satisfaction among medical interns. Methods: This study was conducted among 70 medical intern students. Being selected by human judgment and homogenous sampling method, participants were assigned into control and intervention groups. Participants in the invention group received an e-book, two one-on-one training sessions and feedback on their shared experiences in group discussions by peers. The Kirkpatrick model was applied to evaluate the intervention. Participants’ knowledge, self-efficacy and communication skills as well as their patients’ satisfaction were assessed. Data from self and observational assessments were compared in and between groups at different time-points. Results: Participants’ knowledge, self-efficacy and communication skills as well as their patients’ satisfaction were improved significantly in the intervention group compared to that of the control group. Correlation coefficient between interns’ self-efficacy and communication skills scores was 0.74 (P = 0.03). Conclusions: Application of self-efficacy theory could improve medical interns’ communication knowledge, self-efficacy and skills leading to patient satisfaction