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Background: Synthesis studies are used for the retrieval, review, synthesis, analysis, and integration of the findings of original studies. The purpose of this review was to shed more light on how meta-ethnography works as a method of inductive and interpretative knowledge synthesis, and on its application and implementation in medical sciences.Methods: This was a narrative review study and the statistical population included all scholarly publications on the synthesis of qualitative studies and meta-ethnography published from 1998 to 2022. The search in international and domestic databases led to the extraction of 118 books and articles. After reviewing the titles, abstracts, and full texts of these publications, we included 2 books and 8 articles in the review.Results: Meta-ethnography is used for synthesizing the knowledge obtained from qualitative studies to re-conceptualize their findings. There are seven phases in the process of meta-ethnography: Getting started; Deciding on what is of initial interest; Reading the studies; Determining how the studies are related; Translating the studies to each other; Synthesizing the translations; and expressing the synthesis. The number of studies required to perform meta-ethnography has been recently suggested to be 40. Strategies for updating meta-ethnography include repeating the previous strategy and reformulating the strategy according to a new objective, a revised review question, or new inclusion criteria.Conclusion: Noblit and Hare introduced meta-ethnography in 1988 as a qualitative research method for the synthesis of educational ethnographies. Today, it is widely used in healthcare research.

In this study, a comprehensive classification for supply chain risks in the pharmaceutical industry is presented using the Bailey’s classical strategy method and the four-stage Collier method. Initially, through the examination of texts related to the main hazard groups, supply chain elements, considering resources and functions, and categorizing upstream supply chain organizations, primary industry, and downstream supply chain organizations within the industrial and market environment, infrastructural environment, and external macro environment were modeled. In the next stage, criteria related to the security and safety of the supply chain were identified. In the final stage, a two-dimensional matrix classification for the identification of supply chain risk factors was proposed through the cross-tabulation of supply chain elements with security and safety criteria. Based on this classification and utilizing the exemplification method through a synthetic framework, a detailed list of risk factors was compiled. The aim of this study is to propose a comprehensive risk classification for pharmaceutical industries.MethodBailey’s classical strategy method has been used to develop a comprehensive classification of supply chain risks in pharmaceutical industries. In order to review the existing knowledge about supply chain risk groups, a systematic review of literature was performed. In the first stage, to find articles related to supply chain risks in the pharmaceutical industry, different combinations of related keywords have been used to search for articles in relevant databases. The selected articles were examined in three stages: extracting and classifying the main risk groups of the supply chain (the first dimension of the conceptual framework of classification), extracting and classifying criteria for a low-risk supply chain (the second dimension of the conceptual framework of classification), and applying the two-dimensional framework of classification to identify and classify risk factors of the supply chain.ResultsA total of 77 articles were selected for review. Based on the analysis of these articles, 83 risk groups were identified. These risk groups were arranged into a model including upstream supply organizations, the main industry, and downstream supply organizations, considering the relationships between supply chain’s resources, functions, and outcomes in the industry and market environment, infrastructural environment, and external macro environment. In the next step, 30 criteria for a safe and secure supply chain were identified. These criteria are divided into two general categories: criteria for the security of the internal supply chain environment (criteria of resistant supply chain resources and criteria of resilient supply chain functions) and criteria for the safety of the external supply chain environment (criteria of safety of market and industry, criteria of safety of infrastructural environment, and criteria of safety of external macro environment). In the last stage, through cross-tabulation of resource groups with resource resistance criteria, function groups with function resilience criteria, and peripheral environment elements with peripheral environment safety criteria, a model for identifying risk factors in the industrial environment was proposed. Based on this model, 372 risk factors of the supply chain of the pharmaceutical industry were identified.ConclusionIn this study, a new classification for supply chain risks of the pharmaceutical industry has been presented. The proposed classification is highly comprehensive, and the number of risk groups counted in this study is more than all the studies that have been done in this field so far. Most existing risk taxonomies are incomplete and do not follow a specific theoretical model. The classification of risk groups identified in this study has been done based on a model that considers the relationship between assets, functions, and outcomes of the supply chain. The risk groups identified in this study cover from the upstream of the supply chain to the main industry and the downstream of the supply chain. Many risk taxonomies focus on the pharmaceutical industry and do not cover the entire supply chain from raw material production to customers. In this study, cross-tabulation of resource groups with resource resistance criteria, function groups with function resilience criteria, and peripheral environment elements with peripheral safety criteria create an ideal model for identifying risk factors in the industrial environment. The classification proposed in this study can be used to evaluate the resistance and resilience of the supply chain. This model can also provide a suitable basis for identifying and evaluating risks in the supply chain environment. In addition, results of this study provide a very practical guide for choosing supply chain risk management strategies.

BackgroundThe use of research evidence in policy making is a complex and challenging process that has a long history in various fields, especially in healthcare. Different terms and concepts have been used to describe the relationship between research and policy, but they often lack clarity and consensus. To address this gap, several strategies and models have been proposed to facilitate evidence informed policy making and to identify the key factors and mechanisms involved. This study aims to critically review the existing models of evidence informed policy making (EIPM) in healthcare and to assess their strengths and limitations.MethodA systematic search and review conducted to identify and critically assess EIPM models in healthcare. We searched PubMed, Web of Science and Scopus databases as major electronic databases and applied predefined inclusion criteria to select the models. We also checked the citations of the included models to find other scholars’ perspectives. Each model was described and critiqued each model in detail and discussed their features and limitations.ResultNine models of EIPM in healthcare were identified. While models had some strengths in comprehension, flexibility and theoretical foundations, analysis also identified limitations including: presupposing rational policymaking; lacking alternatives for time-sensitive situations; not capturing policy complexity; neglecting unintended effects; limited context considerations; inadequate complexity concepts; limited collaboration guidance; and unspecified evidence adaptations.ConclusionThe reviewed models provide useful frameworks for EIPM but need further improvement to address their limitations. Concepts from sociology of knowledge, change theory and complexity science can enrich the models. Future EIPM models should better account for the complexity of research-policy relationships and provide tailored strategies based on the policy context.

Background: To date, there is still no uniformity in forecasting models for health workforce planning (HWFP). Different countries use various HWFP models, some of which are context-specific. The objective of this systematic review is to determine approaches and components of HWFP models.Methods: A systematic review of studies published in English and Persian between 2004 and 2021 was performed by searching PubMed Central, MEDLINE, Web of Science, Scopus, Eric, and Elmnet databases. Articles that assessed HWFP models, focused on health service delivery, used input-output models, and a clear formulation process were included. Articles that scored ≥20 points on the “strengthening the reporting of observational studies in epidemiology” checklist were considered of acceptable quality for inclusion.Results: Twenty articles were included for qualitative synthesis based on the inclusion and exclusion criteria. Most studies used the mixed method approach “supply and demand”, whereas target- and needs-based approaches were used less frequently. The number of components used to estimate supply, demand, needs, and targets were 42, 32, 11, and 6, respectively. In addition, several unique factors used in the various HWFP models were identified.Conclusion: Different approaches are used in HWFP models, which is indicative of the lack of consensus on this topic. High diversity in the identified factors is related to the approach used and the context in which the model is applied.

Introduction: Proper transfer of professional values is an essential part of medical education. Real-life experiences in the educational process are one of the most effective methods for achieving values and assisting students in developing their value framework. This study aimed to develop and characterize the concept of value-rich exposures in medical education to bring this concept closer to the practice.Methods: In order to perform the synthesis, according to Walker and Avant, a combination of hermeneutic phenomenological method and literature review was used. At first, researchers characterized the concept of value-rich exposures based on the lived experiences of medical students who had participated in a program based on value-rich exposures at Shahid Beheshti University of Medical Sciences in Iran. After that, the literature was reviewed using an integrative review approach. Then we looked at the similarities and differences between the results of the interviews and the literature review and chose the best word to name the themes and subthemes. Finally, to describe the concept of value-rich exposures in medical education, we created a conceptual matrix.Results: We defined the concept of value-rich exposure in medical education under five themes while implementing thesteps of Walker and Avant’s concept synthesis: probing self-inner values, value-rich program, value mentor, value-rich interactions, and value-rich environment. The elements and relationships of the themes were depicted in the form of a conceptual matrix.Conclusions: A value-rich exposure is a type of lived experience that occurs during a student’s professional life, a necessity that, with proper planning, can play an important role in shaping medical students’ professional identities.

Background The migration of health professionals from Low- and Middle-Income Countries (LMICs) to High-Income countries (HICs) is an ongoing phenomenon that has been accelerating with globalisation. While there has been growing research around the migration of physicians and nurses, there is less understanding of the motives surrounding the migration of dentists, and even less about their migration from specific countries. Objectives This qualitative study explores the migration motivations of Iranian dentists who have moved to Canada. Methods Semi-structured interviews of 18 Iranian-trained dentists in Canada were conducted to obtain information about their motives for migration. Interviews were coded and categorised into themes using qualitative thematic analysis. Results Motivations to migrate were grouped into four analytical areas: socio-political; economic; professional; and personal. An inverse relationship was identified between the strongest motives to migrate and the topics respondents were least comfortable discussing. Socio-political-related motives were predominant with respondents focusing on their dissatisfaction with the social ethos and restrictions on personal freedom within Iran. Conclusion Country-specific context is critical to fully understand health professional migration; in particular, the dynamics and interplay between socio-political, economic, and professional/personal factors within the home country. While Iranian dentists’ motives to migrate have some similarities to other health professionals who migrated from Iran, and dentists from other countries, differences need to be considered to fully understand migration patterns.

Background: Socioeconomic status (SES) is a criterion consisting of several components that encompass socioeconomic and cultural dimensions. This study aimed to design and develop a methodological guideline for calculating a single summary index (SSI) using the contributing variables of SES in a family unit.Methods: The data consisted of 18 700 urban and 19 200 rural households. Effective components of SES were extracted using two-step factor analysis and the structural equational modeling (SEM) method for both populations separately with AMOS software. Then, in order to customize and validate the weight of each component, the analytic hierarchy process (AHP) method was performed by a panel of experts. Finally, the SES index computational tool was developed as an SSI using all effective components by Excel software. Statistical analysis was done with SPSS software version 21.Results: In rural areas, the four wealth components of education, job, income, and family size were recognized as effective socioeconomic factors. Yet, in urban areas, family size was disregarded as an effective factor. In both rural and urban communities the three welfare components of appropriate nutrition, appropriate home appliance, and appropriate housing were similarly effective. The SES of rural population had a homogeneous distribution, while urban population did not follow a particular trend.Conclusion: The SES index impacts all aspects of life, especially health status. The introduced method is comprehensive and applicable to both rural and urban populations. Due to ever-changing lifestyles, constant technological advances, and socio-political changes in each society, the tool requires modification in a specific time intervals.

Background: The training and education of competent and qualified surgeons have been one of the challenges of the surgical profession. The concept of surgical competence has been affected widely due to a series of developments in the new disease emergence, various surgical techniques and the introduction of advanced tools and equipment into the operating. The development of surgical competence and achieving this goal requires accurate identification and analysis of the dimensions of competence. This study was done to explain the concept of surgical competence using the 8-step Walker and Avant approach. Methods: This study is a qualitative study that was conducted from May- October 2016 at Shahid Beheshti University of Medical Sciences. The present study is a qualitative and conceptual analysis study, which is done with Walker&Avant's eight-step approach to determine the defining characteristics of the concept of surgical competence. A systematic search was conducted between 1990 and 2020 by keywords search such as surgery, surgical, operation OR laparoscopy AND competence competency development competency proficient, proficiency, expertise, clinical, in the database like Google Scholar, PubMed, SID, Magiran, Scopus, Web of Science. Twenty articles were included in the study based on inclusion and exclusion criteria. Moreover, the defining features of the concept were extracted from it. Results: Based on the results of this study, the concept of surgical competence was defined and the four dimensions of elements, goals, components and the process of developing surgical competence were identified. Then, by clarifying the characteristics of surgical competence, a model of surgical competence development was drawn. Surgical competence development depends on the acquisition of specialized knowledge and numerous skills that are acquired through experience and deliberated practice under the supervision of others in the surgical community of practice and over time. Conclusion: Surgical competence is a set of observable and measurable skills that allows a surgeon to manage the surgical process independently pbt while maintaining the patient's safety. It includes specialized knowledge, communication skills, cognitive and technical skills, and basic surgical skills.

Introduction: Numerous factors and elements are effective in the professional development of any field of study, including the educational structure, the individual characteristics of learners, and the educational atmosphere prevalent in the educational environment. Understanding each of these factors and elements and the relationships among them can guide educational system administrators in the direction of professional development. Surgical residents’ professional development is no exception to this rule. As a consequence, the present research sought to explain and suggest a model for surgical assistant professional growth in Iranian operating rooms.Methods: The present research was a grounded theory study based on a post-positivist approach, in which data analysis was performed using Clark’s situational analysis methodology by drawing three maps, situational map, social worlds/arenas map, and positional map.Results: In the presence of human and non-human factors, cultural, political, historical, and social components, the ordered situational map demonstrated the complexity of the operating room learning environment. The social worlds/arenas map confirmed the existence of several communities of practice wherein surgical residents were present with different power roles, and the positional map showed role of the educational level in the acquisition of thecompetence in the professional development pathway. Finally, the Triple Helix model of professional development was extracted, which has three components: psychological identity, social identity, and surgical competency.Conclusion: The surgical residents’ professional development in operating rooms occurs due to the acquisition of surgicalcompetency along with the growth of individuals and socialization. As a result, all factors and components impacting the residents’ competence development process in this learning environment must be identified and their linkages clarified.

Abstract Background Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic crisis. This study aims at analysing the hospitals’ policy solutions during the economic crisis using the resilience system capacities framework. Method This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system’s six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment). Findings After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers’ competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies. Conclusion The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC.

Abstract Introduction The variety of frameworks and models to describe resilience in the health system has led researchers and policymakers to confusion and the inability to its operationalization. Therefore, the purpose of this study was to create a meta-framework using the Critical Interpretive Synthesis method. Method For this purpose, studies that provide theories, models, or frameworks for organizational or health system resilience in humanitarian or organizational crises were systematically reviewed. The search strategy was conducted in PubMed, Web of Science, Embase, and Scopus databases. MMAT quality appraisal tool was applied. Data were analysed using MAXQDA 10 and the Meta-ethnography method. Results After screening based on eligibility criteria, 43 studies were reviewed. Data analysis led to the identification of five main themes which constitute different framework dimensions. Health system resilience phases, attributes, tools, and strategies besides health system building blocks and goals are various dimensions that provide a systematic framework for health system resilience analysis. Discussion This study provides a systemic, comprehensive framework for health system resilience analysis. This meta-framework makes it possible to detect the completeness of resilience phases. It examines the system’s resilience by its achievements in intermediate objectives (resilience system attributes) and health system goals. Finally, it provides policy solutions to achieve health system resilience using tools in the form of absorptive, adaptive, and transformative strategies.

Today, changes in political and economic conditions, epidemiological and sociological developments, and the advancement of science and technology have necessitated the health and medical education systems to change. Therefore, we conducted a study entitled “Global perspectives on trends in higher education in healthcare,” to improve the quality of healthcare so that it can be used as a model for predicting future events related to medical education. This futures study applied the social, technological, economical, ecological, political, values (STEEPV) model to identify and analyze the trends that affect medical education at different levels. To collect and analyze the data, a scoping review of the articles published from the year 2000 was conducted on the World Health Organization (WHO), Web of Science, Scopus, PubMed/MEDLINE, EMBASE, Science Direct, Google Scholar, EBSCO, and Cochrane databases. The review process was performed in five stages: 1- Determining the research question, 2- Identifying relevant studies, 3- Selecting the studies, 4- Charting the data, and 5- Analyzing data. The preferred reporting item for systematic review and meta-analysis (PRISMA) statement was used in the selection and screening of articles. A total of 213 articles were included in the study for qualitative synthesis. A total of 154 trends were identified using the STEEPV model at seven levels of health behaviors and patients, diseases and health problems, healthcare system, medical education system, medical education institutions, medical curricula, and teaching and learning. Considering the results of this study, it is possible to formulate proper and efficient future scenarios for the higher health education system. Also, it will be helpful for medical education policymaking.

Introduction: Quality improvement and performance evaluation have become today's mainstream medical issues, whereas in many areas of medical care, the quality of care services is less than desirable. Objective: To determine a conceptual model for practice-based learning and improvement (PBLI) competency in medicine. Methods: This study was conducted using Walker and Avant's theoretical synthesis method. Articles related to the concept of PBLI were searched using the keywords of practice-based learning and improvement, quality improvement, core competency, medical education, practice-based learning in English, separately and combined in google, google scholar, and Pubmed databases. After identifying the theoretical blocks and variables of each block and communicating them, a visual model of PBLI was presented. After a focused search for each block, a total of 229 full papers were studied and the PBLI model was developed in six conceptual blocks. Results: The visual model that presented in this study shows the relation among six theoretical blocks of PBLI including: Block of approach to PBLI, PBLI process triggers block, gap bridging solutions, PBLI infrastructure block, PBLI sub-competencies block, PBLI academic development block. Conclusions: Nowadays, PBLI is one of the inevitable qualities of medicine that ensures the quality of medical practice, which, in addition to individual requirements, requires a series of technical, strategic, structural, and cultural infrastructures. By utilizing this capability, a physician will be able to discover the knowledge, skills, and performance gaps, and will be able to cope up with their appropriate approaches, thereby improving the quality of their medicine and the care provided and the patient's safety. It can provide satisfaction and trust in society. The model presented in this paper makes it easy to understand the relationships between the various components of this competency.

Introduction: The realization of professionalism and its desirable consequences, as the most important goal of medical education, primarily depends on identifying the process and mechanism ofthe professional identity formation, which in turn requires the accurate identification of components and structure of the concept of professional identity. Therefore, the aim of this study was tosynthesize a static structural model for professional identity, based on the results of our previous research.Methods: In this study the theory or model construction methodology was used to synthesize a static structural model of professional identity formation for medical students. In this regard, the Walker and Avant method was followed through three steps: specifying focal concepts, reviewing the literature, and organizing concepts into an integrated and efficient representation.Results: In this study, based on the analysis of 9 selected conceptual models in the field of socialization and professional identity, first the key concepts of each model were extracted and then by carefully examining these concepts and determining their relationships and reviewing related texts, dimensions and components of professional identity were determined and presented in the form of a comprehensive structural static model.Conclusion: The advantage of the proposed model over the existing models is the explicit presentation of the dimensions, constructs, and sub-constructs of the concept of professionalidentity. In addition, this model can be used as a general pattern in all non-medical professions.

The high prevalence of pediatric upper respiratory conditions combined with poor availability of specialized care for the proper diagnosis of these diseases continues to be a significant cause of morbidity and mortality worldwide. Despite advances in computer-assisted diagnosis, there are no automated triage tools that can effectively provide a first step guide for the parents or cognitive assistance for the care providers to improve the efficacy and accuracy of diagnosis in these children. We propose a new approach to designing expert systems using an integration of logical criteria and variable evoking strength to improve these tools’ diagnostic accuracy. We conducted a retrospective chart review of the electronic health records of children evaluated for several upper respiratory conditions at a large university-based health system in the United States. The diagnoses recorded in the charts were compared to the output from the tool. The accuracy rate of the tool was based on the assumption that human physicians are the gold standard of diagnosis. A total of 138 cases, ranging in age between 6 months to 18 years, were reviewed. Forty-three percent of the participants self-identified as female. The average accuracy of the tool in matching the physician diagnosis of the eight types of upper respiratory conditions that were included in this study was 75% for the first diagnosis and 84% for matching one of the top two differential diagnoses. Integration of logical diagnostic criteria and variable evoking strength into the design of expert systems can significantly improve the diagnostic accuracy of these tools.

The complexity of today's world is constantly creating new challenges for higher education institutions, and they must continually be consistent and accountable to maintain standards of excellence and compete in international education markets. Being or becoming an entrepreneurial higher education institution is a response to these challenges. There is no "unique" approach, but there are different ways in which higher education institutions behave in an entrepreneurial and creative way. The purpose of this article was to explain how universities can become more entrepreneurial by changing how they provide knowledge. This article is based on the results of a literature review in the fall and winter of 2020 and is in line with the doctoral dissertation that is currently being done in the "Virtual School, Medical Education and Management, Shahid Beheshti University of Medical Sciences." After 1989, a review of the limited, focused literature on service innovation, with an emphasis on knowledge-based service innovation, was done. Service innovation is multidimensional and interactive in nature and can be examined from both technological (information and communication technology developments) and non-technological (organizational innovations) aspects. Accordingly, knowledge-based services include services based on professional knowledge and technology knowledge. Universities need to focus on innovation in both aspects of knowledge-based services. If universities are to become entrepreneurial universities, it is important to explain the comprehensive model of entrepreneurial universities by focusing on the dimensions, concepts, opportunities, challenges, and requirements for knowledge service innovation and then apply it to medical universities to fits their needs.

Phenomenology of practice is a useful method for deeply understanding human phenomena and is fundamentally practical. Its ultimate goal is to nurture thoughtfulness and tact in the practice of professions. Pathic knowledge is a type of non-cognitive knowledge which is obtained through phenomenology of practice and can provide a lens for teachers and students to reflect on their teaching and learning experiences through their relationships, their situations, and their acts. From Van Manen’s point of view, what distinguishes practice from theory is not that practice exerts thought and concepts in the real world; rather, phenomenology of practice involves a different path of recognizing the world. It is very important in medical education due to the importance of communication and human interactions. In this letter, the author highlighted the importance of pathic knowledge in medical education as a part of professional knowledge.

Introduction: Training in operating rooms is challenging. Specifically, surgical residents often experience a stressful environment in training arenas that, in turn, might affect their ability in the acquisition of the required qualifications. This study aims at the qualitative explanation of how the surgical residents acquire the surgical skills in operating rooms.Methods: This qualitative study was conducted in 2019-2020 using the conventional content analysis method. Participants were selected using purposive sampling. Data were collected through 25 semi-structured in-depth interviews. Then, the interview transcriptions were analyzed in MaxQDA2 software using the content analysis method.Results: The data were classified into two main categories, namely challenges/obstacles and strategies for dealing with the challenges. The data in the first category were further classifiedinto four subcategories, including burnout, confusion in technique selection, unequal learning opportunities, ignorance, and responsibility misassignment. Similarly, four subcategories of establishing communication channels with chief residents and faculty members, learning by the non-surgeon pathway, covert progress in the learning path, and taking advantage of force from a position of power in the learning path were considered for the second category.Conclusion: Based on the findings of the study, surgical residents face serious challenges and obstacles in their training course. To address these challenges, the curriculum of the surgical course needs to be improved with the emphasis on the balanced responsibility assignment and enhanced human communication.

Introduction: The differentiation as a process occurs when new functions emerge in a system, and for this reason the university system is bound to diversify. With the advancement of knowledge and increase in competition, it has become a challenging issue and an inevitable necessity. This study aimed at identifying the dimensions of the differentiation of Iran’s medical sciences universities through determining a protocol of the competitive advantage and scientific strength of clinical specialty and subspatiality departments of research activities.Methods: This was a mixed-methods study; the qualitative study was carried out using a conventional content analysis method. We held a focus group discussion to develop a protocol of scientific strength and competitive advantage for mission differentiation. We used purposive sampling, in February 2019. The sessions were audio-taped. We analyzed the data by considering the verbatim transcribed document of the audio recorded discussions using conventional content analysis method for theme development. In the second stage, we implemented the proposed protocol in thefirst stage through the Scientometrics System for all 66 colleges and universities of the Ministry of Health and Medical Education.Results: The results of the first stage includes a protocol, 4 indices and two formulae for scientific strength and competitive advantage proposed by the expert participants and an executive model designed to clinical specialty and sub-specialty of the college and universities of medical sciences in the research activities. In the second stage, the scientific strength and competitive advantage was calculated for all universities of medical sciences. The results indicated that some universities, for instance, Tehran, Shahid-Beheshti, Iran, Shiraz, Isfahan, etc. had the most competitive advantages among the academic clinical specialty and sub-specialty departments.Conclusion: Besides teaching and research, universities should contribute to local socio-economic development, in the growing conviction that scientific research results and educational skillsare crucial for the economic growth of nations. The enhancement of high-quality education and excellence in teaching will be consistent and sustained in research-intensive universities. Itshould strongly promote the integration and relatedness of teaching and research as an essential characteristic of the university.

Introduction: Disciplines are areas of knowledge boundaries which are formed through the connections between philosophical assumptions and fundamental theories and this forms the artificial boundaries to acquire knowledge of natural phenomena. This study endeavored to elaborate on the nature of scientific discipline by reviewing the definitions of discipline in current scientific literature, and propose a multi-layered model. Methods: In this study Carnwell and Daly's critical review strategy was employed to synthesize a theoretical model. Keyword about the topic of the study was searched in the related databases as Google Scholar, Eric and PubMed Central until 2018. The keywords are scientific discipline, knowledge domains, scientific domains, discipline boundaries Results: A multi-layered model was reached by reviewing, synthesizing, and generalizing diversified views and descriptions presented by discipline. This model consists of 13 main layers and 37 sub-layers. Each of these layers could represent one of the areas of scientific discipline. Conclusion: Understanding the components of discipline can set the scene for elaborating the process of creating scientific disciplines and provides a useful framework in order to evaluate and develop interdisciplinary aspects.

Introduction: In the scientific literature, each author has considered "educational equity” from a different perspective and some of its specifications and indices. These indices need to be carefully examined. In this study, the initial aim was to review scientific texts and different perspectives on "educational equity" in higher education to facilitate prioritize measures that enable taking operational steps toward "educational equity." Methods: This study was conducted through Synthesis of Quantitative Literature (classified as a synthesis research). Therefore, based on the gathered scientific literature, necessary activities for reaching “educational equity” were introduced using the content analysis method and extracting, coding, and categorizing the items. Results: The required steps for moving towards “educational equity” were categorized as follows: Steps before entering higher education (including 5 basic subsets), institutional actions and interventions (four subsets), and national actions and interventions (four subsets). Conclusion: In order to achieve equity in higher education, while considering the initial and institutional measures, additional measures need to be taken to achieve "educational equity". These include measures that should be considered at the national level to anticipate the needs of the "labor market" by adopting appropriate policies, so that graduates can apply their skills in the community.

Introduction: Clinical reasoning is a vital aspect of physiciancompetence. It has been the subject of academic research fordecades, and various models of clinical reasoning have beenproposed. The aim of the present study was to develop a theoreticalmodel of clinical reasoning.Methods: To conduct our study, we applied the process of theorysynthesis in accordance with the Walker and Avant’s approach.First, we considered clinical reasoning as a focal concept of ourstudy. Second, a search was carried out for the period 1984–2018, using the PubMed, Google Scholar, PsycINFO, ERIC,ScienceDirect and Web of Science databases to review theliterature to identify factors related to the clinical reasoning andthe nature of their relationships. Third, we organized clinicalreasoning into an integrated and efficient representation of theclinical reasoning.Results: According to this study clinical reasoning is the iterativeprocess of intermediation between the recalled clinical knowledgeand the patient’s represented problem in the clinicians’ activememory. We analogize the process of clinical reasoning to theprocess of closure of a cognitive zipper. The recalled knowledgein clinician’s memory resembles to one side of zippers teeth andthe evolving representation of the patient’s problem resemblesthe other side of zippers teeth. So, the results of this study arepresented in three models: [1] multi-layer knowledge structuremodel, [2] problem representation model and [3] cognitive zippermodel of diagnostic reasoning. Conclusion: We propose a developmental model of clinicalreasoning. Several studies have tried to present models andtheories to clarify clinical reasoning, but it seems that thesetheories and models could only explain part of this complexprocess and not the whole process. Cognitive zipper model, dueto its developmental structure, can illustrate the clinical reasoningprocess in more details than other models do.

BACKGROUND: Although the importance of health promotion and empowerment of the community has been recognized for many years, there are still many barriers to adopting health promotion in the world. One of the solutions is socially accountable medical education and community engagement. OBJECTIVE: This study aimed to compare the medical programs of five medical schools that practiced community-engaged medical education to medical education in Iran. MATERIALS AND METHODS: This comparative study has been performed in 2022 by the four-stage Bereday method, including description (the educational programs of the selected medical schools were examined), interpretation (a validated checklist was prepared according to community-based strategies), proximity (similar and different information was identified), and comparison (solutions were recommended to improve health promotion and community engagement in Iran's medical education program. The purposive sampling method was used to select five universities. RESULTS: Although successful initiatives have been attempted to integrate public health promotion and community orientation into the Iranian curriculum, they do not appear to be sufficient in comparison to leading countries. The main distinction is that the community is actively engaged in all stages of curriculum design, implementation, and evaluation. CONCLUSIONS: Although Iran's medical education program has a long way to go in terms of social accountability, by including more community-oriented initiatives into the curriculum, health needs of the community can be met and physician shortages in poor areas can be alleviated. It is recommended to implement modern teaching methods, to recruit diverse faculty and community members, and to increase the community placement in medical education.

Abstract Background: Close contact tracing is an essential measure that countries are applying to combat the epidemic of COVID-19. The purpose of contact tracing is to rapidly identify potentially infected individuals and prevent further spread of the disease. In this study, based on the factors affecting the COVID-19 transmission, a scoring protocol is provided for close contact tracing. Methods: First, the factors affecting the COVID-19 transmission in close contacts were identified by a rapid review of the literature. Data were gathered by searching the Embase, PubMed, Google Scholar, and Scopus databases. Then, by formulating and scoring the identified factors with two sessions of the expert panel, close contact transmission risk score determined, and a protocol for contacts tracing was designed. Results: Close contact transmission risk depends on the contact environment characteristics, the infectivity (virus shedding) of the sentinel case, and contact characteristics. Based on these factors, the close contact transmission risk score and contact tracing protocol were prepared. Conclusion: The close contact transmission risk scores will provide the ability to contact classifications and developing specific tracing strategies for them. Given that there are not any specific treatments for COVID-19 and lack of universal vaccination, applying nonpharmaceutical measures such as contact tracing along with physical distancing is very crucial. Therefore, we recommended this model to the evaluation of exposure risk and contact tracing.

Values ​​predispose people to make the right and especially ethical decisions, and are important for good performance in medical sciences. Students’ lived experiences and the value-rich exposures during their education are some effective means of achieving professional values that help them build their own value frameworks. In this phenomenology of practice study, we aimed to explore and describe the lived experiences of a sample of medical students in Shahid Beheshti University of Medical Sciences regarding their value-rich exposures. In-depth interviews, students’ written stories, recorded video interviews related to past trips and photographs were used to collect data. The data was analyzed based on Van Manen’s thematic analysis method. Five themes emerged from the data: “in the shadow of a supportive mentor”, “a well-orchestrated, value-rich program”, “human interactions in a value system”, “acquiring values in a real-life environment”, “and seeking values in oneself”. Our study identified different dimensions of value-rich exposure based on the lived experiences of medical students and pointed out some issues that medical education planners can consider to improve the quality of value-based education for medical students.

Introduction: Hidden curriculum plays a main role in professionallearning, formation of professional identity, socialization,moral development and learning values, attitudes, beliefs, andknowledge in learners, so it needs to be managed. Althoughthe majority of the theorists believe in the existence of a hiddencurriculum and its greater effect and sustainability compared tothe formal curriculum; none has proposed a comprehensive modelor approach for its management. This study aimed to design ahidden curriculum management model in medical education.Methods: In this study, the authors used the theory or modelconstruction methodology to synthesize a hidden curriculummanagement model in medical education. According to Walkerand Avant; this methodology includes the following three stepsfor synthesizing the model: specifying focal concepts, reviewingthe literature, and organizing concepts into an integrated andefficient representation. Results: The results of the study showed that numerous factorsaffected the hidden curriculum including environmental factors(professional, organizational), human factors (teachers, peers andstaff), and formal curriculum and learner’s influenceability filterwhich bear important messages for learners, staff and teachers. Tomanage the hidden curriculum, in addition to the above factors,it is necessary to manage knowledge and the learners’ learning inan educational institution.Conclusion: This study revealed that to achieve the desiredperformance in students, the formal curriculum reform is notsufficient. Moreover, other factors such as environmental factors,human factors, learner’s influenceability filter, and knowledgemanagement should also be taken into account. The hiddencurriculum management model can be used for training andeducating the staff and students with the desired performance inany educational institution.

Introduction: The values of individuals that orient their preferences and behaviors are not the same; this can lead to disagreements and be the basis of value conflicts. The present study aimed to analyze the value conflict resolution experiences and how to deal with the value conflicts among the faculty members. Methods: In this qualitative study, a semi-structured interview was carried out with purposeful and then snowball sampling with 11 teachers from Kashan University of Medical Sciences for data saturation. Then, the content of the interviews were analyzed by Grahamman 2004 content analysis. Results: The research participants included 6 males and 5 females who were specialists, Ph.D and Masters Degree graduates with a working experience of 3.5 years to 29 years. The final model derived from the value conflict resolution experience was in the form of 5 themes and main categories: 1. Components of the experiences of organizational value conflicts 2. Experiences of value conflicts with learners 3. Ranking of values in the instructors 4. The components of the type of conflict of value 5. Value conflict solving styles. Conclusion: Based on the results of the study, the components and styles used to solve the value conflicts that were experienced by the teachers of Kashan University of Medical Sciences can serve as a model for teaching and empowering professors as well as adopting effective strategies for dealing with value conflicts and management. Contradictions are used in educational settings.

Abstract Objective The socioeconomic status (SES) is as a symbol of social determinants of health which has a dominant influence on population health. The purpose of this study was collecting, weighing, and determining the most relevant SES measurement items in Iran. Results The SES health studies conducted in Iran was searched from 2007 to 2017. First, the SES items were categorized. Then, each item was weighed based on its reliability and generalizability. Finally, the necessity of items was determined, weighed, and ranked. This is the two-round Delphi technique. After weighing 57 SES items, 37 items were selected with ≥ 1 weight and classified in 7 categories. According to the Delphi evaluation, 15 items were identified ≥ 3.5 for measuring SES of Iranian households: household size, head of household education, head of household job, household monthly income, type of school that children attend, house ownership, local value of residence, number of rooms in the house, house area, personal computer/laptop, smart cell phone, 3D TV, dishwasher, microwave, and car ownership. The SES items for the present society are categorized in 7 domains. The items collected in this study have the most comprehension of all studies related to income, life facilities, and assets.

Background: Achieving and improving professional confidence (PC) is an ongoing process from the studentship period to independent professional career. This study aimed to assess PC and compare it between nursing students (NS) and clinical nurses (CN). Materials and Methods: This cross-sectional study was conducted in a medical sciences university in an urban area of Iran in 2015. Nursing students (NS = 230) and clinical nurses (CN = 192) participated in this study. Data were collected through the nurses professional confidence scale (NPCS), consisting of 35 questions on PC. A six-point Likert scale was used for “never” to “always” corresponding to the score of 1–6. The analysis of variance, Pearson correlation, and Backward Multiple linear regressions were used for data analysis. Results: The mean (SD) standardized scores of PC in the NS and CN were 64.59 (11.06) and 73.63 (10.05). LSD test showed that the PC score of CN with work experience of 10–20 years was significantly higher than those with less than 10 years (mean difference = -4.25, p = 0.019). Also, the mean scores of PC in the NS in the fourth and fifth academic semesters (mean difference = 12.25, p < 0.001) were higher than that in the students in the third academic semester (mean difference = 10.09, p < 0.001). Conclusions: CN experiences a higher level of PC during the middle years of work, and NS in their middle years of studying. Creating a supportive environment for learning and working can help them to maintain PC.

Exposing medical students to real-world situations and clinical practice experiences during their education years can help them build their professional value frameworks. The COVID-19 pandemic is one of the most challenging conditions that medical students have experienced; however, this pandemic have provided value-rich opportunities assisting in development and enhancement of their professional identity. This commentary aimed to emphasize the importance of medical students’ exposure to clinical practice during the pandemic and the potential that such encounters provide for internalizing values.

Background: One of the critical needs of governmental agencies and educational institutions is meeting community needs. Organizations and governmental systems that rely on social capital are considered inefficient and vulnerable if they are unable to meet the needs of society. Thus, accountability is a critical pillar of government management that leads to effective actions and better service delivery. Methods: Critical review methodology was used in the first phase to review texts and documents available in the field of social accountability and to collect items used to develop the social accountability assessment tool. The Delphi method was then used to finalize and approve the model and assessment tool. University processes were investigated and evaluated based on the social accountability tool in the second phase. Result: In all, 422 university processes were investigated and evaluated to determine their accountability in different fields. The mean score of the evaluated processes was 11.9 out of 100. Conclusion: The results show that social accountability is a relatively new topic that has received considerable attention in medical education in Iran. Given the relative newness of this topic, these results could be expected; social accountability should try and be expected to improve in the coming years.

Background: The outbreak of 2019 novel coronavirus (2019-nCoV) caused a pandemic in most countries, and how to face the pandemic is a major issue that needs to be addressed worldwide. Objectives: The current study aimed at determining the competitive advantage and scientific strength of medical sciences universities to face this pandemic. Methods: A mixed-methods was employed to conduct the current study from May to April 2020 in three steps: a) identifying the academic departments with the most exposure to this pandemic; b) designing the protocol to calculate the scientific strength and competitive advantage, c) allocating the mission to academic departments. Result: The scientific strength and competitive advantage were calculated for clinical and non-clinical departments in all medical sciences universities. The obtained results indicated that some universities, for instance, Tehran, Shahid Beheshti, Iran, Isfahan, Mazandaran, Shiraz, Kerman, and Mashhad, had the most competitive advantage that would increase their responsibility to face this pandemic. Conclusion: Policy-makers that clearly identify the mission and objectives of their institutions and define the relevant tasks may have better performance based on the capacities and abilities of the medical sciences universities.

We report two brothers with severe global cognitive and motor delay, cortical visual impairment and sick sinus syndrome who were born to consanguineous parents. Standard genetic evaluations did not reveal the cause of their mental retardation. As expected, chromosomal microarray (CMA) revealed extensive regions of homozygosity. Exome sequencing revealed that both affected boys were homozygous for a nonsense mutation in the G-protein β5 (GNB5) gene (NM_016194.3:c.1032C > G; Tyr344Ter), and that the parents were carriers of this mutation. No other DNA variants that were explanatory for the sick sinus or the developmental delay/intellectual disability were identified, and no other clinical parameters are likely to have contributed to this unusual combination of phenotypes. The neurologic features of our patients are more severe than those of most of the other patients previously reported with GNB5 variants, probably because of the homozygous, complete loss-of-function (nonsense/stop-gain) nature of their variant, and their clinical course has been monitored for longer duration.

The hidden curriculum is considered to be between the designed and experienced curricula. One of the challenges that medical educators face is to understand what students learn in real clinical settings. The aim of the present study was to answer this question: What is hidden in hidden medical curriculum? This study was a qualitative content analysis. Participants were selected through purposive sampling. Data collection was performed through unstructured interviews and continued until data saturation. Data were analyzed simultaneously with data collection using MAXQDA10 software. Data validity was confirmed based on the proposed Lincoln and Guba criteria. The main theme that emerged in this study was implicit learning. Professional ethics, spiritual, social and cultural issues, and clinical skills are the five major themes that were presented in this study. These themes and their subthemes are transferred during an implicit learning experience in hidden curriculum. Since a wide range of issues are mostly transferred by hidden curriculum, it is essential to have a dynamic approach to educational environments. This is especially important in clinical settings, as the process of learning is constantly happening in the backyard.

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BACKGROUND: The capacity of self-authoring one's own beliefs, identity, and relationships is core to many expected outcomes of future health-care professionals. Students' personal and professional development for self-authorship can be promoted by the variety of developmentally effective “crossroads” experiences that they encounter. Identifying the characteristics of the crossroads experiences in clinical rotations can provide a foundation for medical educators to provide an environment that can foster self-authorship. MATERIALS AND METHODS: A cross-sectional qualitative survey was conducted using a researcher developed semi-structured questionnaire which had three open questions and asked medical interns to describe their internship experiences that stimulated their thinking along the self-authorship dimensions of identity, relationships, and ways of knowledge acquisition. Data were analyzed using Braun and Clarkes' thematic analysis method. RESULTS: The survey was completed by 167 medical interns (response rate: 83%). The key features of significant crossroads experiences and their effects were created into six themes: Experiences by being respected and validated; experiences by involvement in patient management; experiences by participation in interactive learning environments; experiences by participation in authentic clinical work environments; experiences by the observation of professional behaviors; experiences through the uniqueness of different specialties. CONCLUSION: Authentic experiences of patient management in the real world of clinical settings with a high interactive environment have the potential to promote interns' self-authorship development. Educators can support learners by respecting and validating their capacities and by role modeling of professional behaviors.

Background: The value framework governing the health system can guide the policymaking. This study presents a set of values governing the health policies for adopting policies that are in harmony with the ideology of Iran. Methods: This study was conducted in two phases. In the first phase, using the qualitative approach, Shams et al. framework was adopted to identify values. Identification of health-related national documents (nine documents) was performed purposefully. In the next phase, semi-structured interviews on individual experts in the health system were carried out. The key question was “What values and principles govern the health policy system?” Participants included 15 individuals. Both phases were analyzed based on qualitative content analysis. Results: In this study, a taxonomy of values governing policymaking is presented. Results show that equity in different dimensions, comprehensive health and a healthy human being, pioneering in health in the region, and accountability are the most important terminal vaqlues. Individual responsibility, government responsibility for health, endogenous and extrinsic economics, fair access, transparency, efficiency, quality and integrity in the supply, development and fair allocation of public health resources, and professional commitment are the most important instrumental values in Iran. Participants believed that, despite the many higher-order documents available, the health system policymaking was not based on a predetermined value. Conclusions: It is not enough to provide a set of values in upstream documents for implementation. It is necessary to specify the relative weight of the reference values in policymaking and their relation to each other in order to apply them in policymaking.

Background The development of professionalism is one of the fundamental goals of educational systems, especially in medical sciences. Medical students, in addition to acquiring clinical knowledge and skills, should somehow benefit from moral values and professionalism in order to practice in a professional manner. The development of professional ethics is heavily influenced by the hidden curriculum affected by changes in the educational system. The health reform plan is launched in Iran in recent years. Objectives The current study aimed at qualitatively explaining the effects of changes to the educational system on the development of the professionalism in medical residents. Methods The current qualitative study was performed by the content analysis method. A total of 26 interviews were conducted with 12 prominent professors of medical education, 13 third-year internal medicine residents, as well as a focus group including 10 residents. The purposive sampling method with maximum diversity was used in the current study and continued until data saturation. Data were analyzed using the content analysis method. The Lincoln and Guba criteria were used to increase the credibility of the findings. Results The most important finding of the current study was the challenge of developing professionalism due to environmental changes. The main theme included the challenges of professionalism development in the existing educational system, changes related to the sociocultural environment of the community, changes related to health reform plan, and the shift from training to health services and promtion of faculty member. Conclusions Changes and interventions in the health care services sector, such as the health reform plan, greatly affect the development of professionalism in medical residents. The plans that affect the health system, a special attention should be paid to the education section and the educational documents should be prepared initially and implemented simultaneously.

Professional socialization is defined as a process through which a person becomes a legitimate member of a professional society. This will have a great impact on an individual’s professional conduct and morality. The aim of this study was to clarify this concept and reduce the ambiguities around it. This was a qualitative research through which the concept of professional socialization was analyzed using Walker and Avant’s eight-step approach. The review of literature for this concept was done using electronic database without any time limitation. The overall search produced about 780 articles, and after reviewing these articles, 21 were selected purposefully. Based on concept analysis, we propose the following analytical definition: Professional socialization is a nonlinear, continuous, interactive, transformative, personal, psychosocial and self-reinforcing process that is formed through internalization of the specific culture of a professional community, and can be affected by individual, organizational and interactional factors. This definition is in accordance with the interactionism perspective. Existence of a particular profession and getting involved in a community of practice are the antecedents of this process, and formation of professional identity and professional development are its consequences. A case model, as well as borderline and related cases, has been introduced for this concept. The results of this study can be used to design useful educational interventions to conduct and facilitate the process.

Introduction: Nowadays, competency based education has been highly regarded by the experts in the field of medical education and most of the curriculums has changed accordingly. Despite the importance of the subject and the use of this term in educational literature, there is no consensus on its practical and theoretical definition. Therefore, due to the lack of transparency of the concept and the fact that there is no definite distinction between this concept and similar concepts and its adjacency, this study was conducted with the aim of presenting the analytical definition of "competency” through the McKenna approach. Methods: This concept analysis was performed by implementing McKenna’s nine-step approach. After extensive search in scientific databases with Specific strategies, 52 documents were studied and the defining attributes of the concept extracted and then analytical definition were presented. Results:Based on the literature review, four conceptual areas including: competency goals, competency components, competency characteristics and competency development were extracted. Model, contrary, related, invented, and illegitimate cases are presented and Empirical indicators were also determined. Conclusion:Based on the findings of the study, the definition of “competency”is the ability to perform an activity that is include of knowledge (applied codified knowledge and tacit knowledge), skills(technical and cognitive) and perceptual ability, This ability is habitual,endurable, task-relevant, observable and measurable, independent, knowledge-based, and context dependent and is considered as the main part of the job; Explaining competencies leads to the establishment of excellent performance criteria and It is a framework for performance-based learning for the relatedjob. It can be the basis for providing a certificate of competency and strengthening social accountability too. Competencies are developed through supervised teaching and training as well as reflective authentic experience.

Introduction: Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings Methods: A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized Results: Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. Conclusion: A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed.

Introduction: Governments and professional organizations have called for new partnerships between health care providers and academics to improve clinical education for the benefit of both students and patients. To develop a substantive grounded theory on the process of forming academic-service partnerships in implementing clinical education, from the perspective of academic and clinical nursing staff members and managers working in Iranian settings. Methods: The participants included 15 hospital nurses, nurse managers, nurse educators, and educational managers from two central universities and clinical settings from 2009 to 2012. Data were collected through 30 in-depth, semi-structure interviews with the individual participants and then analyzed using the methodology of Strauss and Corbin’s grounded theory. Results: Utilizing “balancing power” as the core variable enabled us to integrate the concepts concerning the partnership processes between clinical and educational institutes. Three distinct and significant categories emerged to explain the process of partnership: 1) divergence, 2) conflict between educational and caring functions, and 3) creation of balance between educational and caring functions. Conclusions: In implementing clinical education, partnerships have been formed within a challenging context in Iran. Conflict between clinical and educational functions was the main concern of both sides of the partnership in forming a collaborative relationship, with our findings emphasizing the importance of nursing educators’ role in the establishment of partnership programs.

Introduction: Considering the pervasiveness of social accountable medical education concept around the world and the growing trend of literature in this regard as well as various interpretations made about this concept, we found it necessary to analyze the concept of social accountable medical education. Methods: In this study, the modified version of McKenna’s approach to concept analysis was used to determine the concept, explain structures and substructures and determine the border concepts neighboring and against social accountability in medical education. Results: By studying the selected sources, the components of the concept were obtained to identify it and express an analytic definition of social accountability in medical education system. Then, a model case with all attributes of the given concept and the contrary and related concepts were mentioned to determine the boundary between the main concept and auxiliary ones. Conclusion: According to the results of this study in the field of social accountability, the detailed and transparent analytical definition of social accountable medical education can be used in future studies as well as the function and evaluation of medical education system.

Introduction: Literature review suggests that there is no consensus among experts on the definition, implementation, training and assessment methods of practice-based learning and improvement (PBLI). Therefore, the purpose of this study was to elaborate on this concept and provide an analytical definition. Methods: This study was conducted based on Walker and Avant’s concept analysis approach in eight stages: selecting a concept, determining the aims of analysis, identifying all uses of the concept, determining the defining attributes, providing a model case, providing borderline, related, contrary, invented, and illegitimate cases, identifying antecedents and consequences, and defining empirical referents. An extensive search in scientific databases was carried out based on predetermined strategies, and 120 documents were reviewed. Accordingly, the defining attributes of the concept were extracted and its analytical definition was presented. Results: PBLI is a complicated, context and vocation-dependent competency which comprises a set of individual competencies that learners should acquire it during their academic education and actualize it through playing professional roles. However, its realization requires antecedents and if happened it could lead to clinical excellence. Conclusion: As a meta-competency, PBLI plays an important role in improving the quality of clinical services and by elaborating on the concept, this study facilitates planning and operationalization of this concept while distinguishing it from closely related concepts.

For downloading the full-text of this article please click here. Background and Objective: Developing the education of medical sciences is one of the main objectives of the Ministry of Health and Medical Education. The first step toward creating value-based educational programs in the country is to clarify the concept of value in medical education, which is addressed in this study. Method: Through critical interpretive synthesis, document analysis was performed to clarify the concept of value in medical education; then, the related literature on ‘value’ was investigated. From among 800 articles, 70 articles were selected by purposive sampling. A well-reasoned synthesis of the contradictory findings in different studies was conducted. As the next step, critical analysis on the documents was carried out so that the concept of value along with new concepts and their relationships, the philosophy, and the place of values in medical education of Iran were recreated. All the ethical issues were observed. Moreover, the authors did not report conflict of interest. Results: Values are created as a system within each individual, forming the basis of judgment and decision making. Values shape attitudes and guide our behavior. Furthermore, beliefs affect our scientific approaches. Scientific evidence that has been provided is not devoid of the scholars and researchers’ values. In our Islamic society, the basic assumptions shape our beliefs and values; then, these values determine our direction and behavioral patterns so that we do not get out of the circle of morality. Conclusion: In our country, in many areas including medical education, those programs that guarantee the achievement of values are needed. To foster the values in this field, the first step is paving the way for understanding and internalization of values along with the development of teaching procedures to gain value-based experiences. For downloading the full-text of this article please click here.

BACKGROUND AND OBJECTIVE: The development and innovation program in medical education is a strategic program in order to fulfill the objectives of the developmental programs of the health system. Since the medical faculty members have an important role in promoting public health, this study aimed to identify strategies for growth and development of faculty members of medical universities at northern part of Iran based on the evolution and innovation program of medical education in the form of grounded theory. METHODS: This qualitative study was conducted using Grounded Theory Approach during 2015-2016. The study population included 22 faculty members of medical universities at the northern part of Iran. Sampling was performed by targeted method on those who were responsible in university or college. They were asked about the strategies for faculty development based on the development and innovation program in medical education. FINDINGS: The results of collected data were classified into two main themes: Health ministry strategies (institutionalization of accountable and justice-centered education), and academic strategies (supporting the medical education development centers) and 9 sub-themes. CONCLUSION: Considering the results of the study, it is recommended to Education policy makers to design and provide a more accurate and systematic programs in order to achieve development and growth of their faculty members according to the evolution and innovation program in medical education; so, the effectiveness and efficiency of faculty members and consequently the higher education system will be improved.

Background: After the Islamic revolution in Iran, university admission multiplied greatly in a short time. In addition to considering the policy that guides the action plan to expand higher education (HE), we need to design strategic planning in this area for sustainable development.The main objective of this study was to create a model for how to develop HE in different geographic places in our country. Methods: According to the policy of HE development, we designed this study in the Ministry of Health and Medical Education (MOHME) to find out how to foster the development of HE in different geographic places in our country. For developing a HE geographic expansion model (HEGEM) appropriate to our country, Hugh McKenna’s qualitative concept analysis was designed and performed over 2 years. First, the problems were detected, and then conceptually clarified and analyzed. After that, we compared our primary model components, which were obtained at the end of the analysis, with the experiences of different countries, and then revised our model. Then, in order for the extracted preliminary policy draft of HEGEM to be applicable in the country, an expert panels’ group discussions and policy survey were implemented by 8 experts in policy making and HE program administrations. Lincoln and Guba eligibility criteria were considered. Results: Eight themes were extracted that greatly affected HEGEM in health systems and medical education in Iran including massification of HE, capacity for self-actualization in HE,types of division in HE, the appropriate number of HE institutions, size of HE centers, access to elite universities and avoidance of migration within the country, decentralization of HE and development of spatial planning for the public health network. The policy operational model of HEGEM was finalized and presented as a practical package for implementation in the whole country. Conclusion: For promotion of community health and improvement of the national and international position of Iran’s medical universities and HE centers, policymakers should consider the diverse factors that influence HE expansion in our developed model.

Background: In the current study, we aimed to explain the concept of stewardship by employing a critical review perspective and, finally, to develop a model. Methods: Critical review method and Carnwell and Daly approach and using particular keywords related to stewardship, and searching databases were used. In the initial search, until 2018, 1050 studies were obtained, which using targeted sampling method, 32 studies were finally selected. Then, selected studies were criticized and finally, and the conceptual model of stewardship was designed and explained. Results: After reviewing and criticizing; the concept and aspects of the model were categorized in the sub-tasks of knowledge-generation, strategic framework, evidence-based policy-making, system design, resource allocation, capacity building, enforcement/alignment, that through operation leads to achieving goals. Final model was categorized into three effective levels. Conclusion: Some studies mentioned the governance and stewardship as same concepts, while our results showed that policy-making, governance and leadership, and many other concepts, can be categorized as a part of stewardship.

Background: Values are at the heart of discussions related to policy-making and any kind of reforms in health systems. Despite wide recognition of its importance, the concept of value is still vague and the policy-making processes remain astray with respect to values. This study aims to provide a model of value-based policy-making and to explain the concept value and how it affects policy-making. Methods: The main question of the current study is to explain the concept of value-based policy-making and developing a model, based on the explained concept. In this line, critical review method and Carnwell and Daly approach and using particular keywords related to stewardship, and searching databases were used. In the initial search, 739 studies were obtained, of which using targeted sampling method, 11 studies were finally selected. Then, in order to design and explain different aspects of the value concept in the health system and to develop a model, selected studies were criticized, and finally, the conceptual model of value is designed and explained. Results: The concept of value and its effects, dimensions and its relation to principles, evidence and criteria were determined at different stages of the policy-making process. It was also revealed that value-based policy-making in a health system is contingent upon the realization of terminal values. Conclusions: In the process of selecting the best policy option, it is necessary to identify the relationship between terminal, instrumental, criterion, and evidence to avoid deviating from the reference value framework in any country and to avoid blindly imitating other experiences in other countries.

BACKGROUND: In 1985, the Iranian parliament approved the integration of Medical Education and Health Services and the establishment of the Ministry of Health and Medical Education, which has since been the policymaker of Health Higher Education in Iran. The policies are not based on a codified framework and many were abolished at some point. Some critical issues are not addressed and some activities overlap. The purpose of the present study was to identify the content themes of core policies in the Iranian Health Higher Education system and provide a detailed policy orientation taxonomy. MATERIALS AND METHODS: This qualitative study was conducted in 2019 using the thematic content analysis of documents relevant to Higher Education and Health Higher Education, including upstream documents, and documents and enactments of the Deputy Minister of Education and its policy centers. RESULTS: From 586 policy documents, six main themes or six core policy orientations in the Health Higher Education System were identified, including Development of Medical Education System Policies; Ensuring the Alignment of Operations with Policies; Policies Related to Medical Education Development; Value-orientation; Networking and Development of Medical Education System Interactions; and the Development of Research, Management, and Translation of Medical Education knowledge. CONCLUSION: Developing a taxonomy of Health Higher Education policy orientations helps policymakers identify the neglected and overstressed areas. It can provide education policymakers with categorized and comprehensive information to quickly access accurate information, make informed decisions, avoid mistakes, and increase productivity.