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Background: Burnout syndrome (BOS) is a common occupational disease amongst medical physicians; especially anesthesiologists. BOS is known to result in increased expenditure of the healthcare system and decreased patient satisfaction. In order to substitute for good conduct by its medical staff, Tehran University of Medical University established its own guidelines on professionalism as a substitute for professional conduct amongst its personnel. Learning and practicing professionalism is not only a requirement to be competent as a specialist, but also it results in increasing healthcare quality and patient satisfaction. There is a lack of studies on the relationship between BOS and professionalism. Determination of the relationships between professionalism and BOS among TUMS anesthesiology residents. Methods: In this cross-sectional study all anesthesiology residents completed three forms (demographic checklist, Maslach Burnout Inventory (MBI), and professionalism self-conduct). The results were primarily analyzed using STATA 14.0 and relationships were established via linear and binary regression. Results: About 44 percent of residents met criteria for BOS. The risk of developing BOS was significantly higher for residents who adhered to the principles of respect and altruism and for residents training in one of our surveyed hospitals; whereas the risk of developing BOS would be reduced by increasing age and adherence to the principles of justice Burnout subscales scores concerning emotional exhaustion and personal accomplishment were significantly related with higher self-reported scores of altruism and honesty-integrity respectively. Conclusion: The chances of developing BOS could be enhanced by inadequate practice in the field of professional ethics. Therefor the importance of learning and competent practice of professionalism must be acknowledged. Age and professional climate were the most important demographic variables related to BOS in anesthesiology residents.

Abstract Introduction Although paying more attention to sex education in patients with severe mental illness is recommended in the literature, the role of families has not been specifically clarified. Aim This study aims to explore family knowledge about sexual health in patients with severe mental illness in Iran. Methods We conducted a total number of 21 interviews with 4 patients, 5 families, 7 psychiatrists, 1 general practitioner, 2 nurses, and 2 psychologists through purposive sampling. The text was analyzed using conventional qualitative content analysis. Results The family knowledge about patients’ sexual health is described in three subcategories: ‘informal sources for knowledge acquisition’, ‘common myths, and ‘inappropriate reaction to the patients’ needs”. Conclusions Family sex education should be integrated into a comprehensive rehabilitation program to promote sexual health in patients with severe mental illness. Family members should be aware of the necessity of accurate information about patients’ sexual concerns.

Background: Patients with severe mental illnesses are more prone to experience sexual health problems. Herein, we developed a "Safe Sex Knowledge and Behavior Questionnaire for Patients with Severe Mental Illnesses"(SSKBQ-SMI). Methods: The present study was conducted in the form of methodological research in 4 stages. In the first stage, items of the questionnaire were selected and the item pool was formed by using similar studies and experts' opinions. During the next steps, the psychometric properties of the questionnaire were assessed using content validity, face validity, reliability and construct validity. The content validity was tested using the Content Validity Index and Content Validity Ratio. The charts of content validity were given to 13 specialists expert in sexual health including psychiatrists, clinical psychologists, gynecologists, urologists, and infectious disease specialists. The reliability was tested by using the test-retest method in 70 patients with two-week intervals. The construct validity was tested using exploratory factor analysis in 265 patients. The internal consistency was calculated by using Cronbach's alpha index. Results: After determining the content and face validity, a tool was obtained with 16 True/False items in the knowledge section (with one score for each correct answer and the total score range from 0 to 16) and 16 five-point Likert scale items in the behavior section (with each question score range from 0 to 3 and the total behavior score range from 0 to 48, the lower score defined safer behavior). The correlation coefficient of the scale scores in the test-retest method was calculated to be 0.880 (P

Sexual addiction is a growing disorder which is accompanied with many personal and social consequences. The current fundamental study aims to investigate and discover the factors affecting the development of sexual addiction, with a qualitative view at the experience, thoughts and feelings of patients with sex addiction. Using a qualitative method, 13 patients with sex addiction (10 male and 3 female) aged 21–50 were selected by purposeful sampling and interviewed in 2019 in Tehran with a semi-structured interview. Then, the data was analyzed by using a seven-step Colaizzi method. The results were categorized into three main categories including personal issues, family inefficiency and inattentiveness of the society about sex education, and further categorized into 11 subcategories. Our findings provide invaluable insights into sex addiction for physicians and other mental health providers. Given the lack of community planning and policy regarding the sex education for teachers, parents and youth, we emphasize the responsibility of parents in teaching healthy sexual behaviors to their children and adolescents.

Objective: Patients with severe mental illness may experience cognitive deficits, impaired judgment or loss of skills. Therefore, they are prone to sexual health complications. Sex education can promote sexual health, and in many countries, it is integrated into other domains of education. The educational contents taught in western countries are not necessarily appropriate for developing countries.This study aims to address sex educational content for these patients in Iran. Methods: We have conducted twenty-three face-to-face, deep and semi-structured interviews with patients, family members, psychiatrists, general practitioners, nurses and psychologists. We used the strategy of maximum diversity in selecting the participants. Results: “Improving basic knowledge,” “decreasing the risk of unsafe sex”, “empowerment” and “persuading to ask for help” should be covered in the education. Conclusions: Sexuality is not considered a priority for these patients. It is necessary to develop a training program with simple educational content for this high-risk group. Innovation: Raising awareness and knowledge about the possible risks of social media on high-risk behaviours, developing social and behavioural skills, and encouraging patients to talk about their new challenges in sexual life is recommended. Cultural, spiritual and personal beliefs should be considered in designing the educational program.

Background: Numerous studies have addressed the impact of cognitive-behavioral therapy and treatment based on acceptance and commitment to depression. However, there is a research gap between comparing the effectiveness of cognitive-behavioral therapy and treatment based on acceptance and commitment to depression and increased sexual activity behavior of patients with sexual addiction. Aims: The aim of the present study is to compare the effectiveness of cognitive-behavioral therapy and acceptance-based therapy. Depression and hyperactive sexual behavior of patients with sexual addiction. Method: The present study was a quasi-experimental study with a pretest-posttest-follow-up design with a control group The statistical population of this study was men over 18 years of age with sexual addiction living in Tehran in 2019. Thirty patients were selected as a sample by snowball method and were randomly assigned to two experimental groups and one control group (10 patients). The tools of the present study are: Behavioral Cognitive Therapy Sessions (Location, 2014), Acceptance and Commitment Therapy Sessions (Crossbow, 2011), Beck Depression Questionnaire (Beck et al., 1961) and Sexual Increase Sexual Questionnaire (Reid et al., 2011). ). Data analysis was performed by mixed variance analysis methods with repeated measurement, multivariate analysis of variance, Bonfroni test and Toki test. Results: Cognitive-behavioral therapy and treatment based on acceptance and commitment were effective in reducing depression and increased sexual activity in these patients (P< 0/05). there was no significant difference between the two treatment methods. Conclusions: Patients who participated in cognitive-behavioral and acceptance therapy sessions based on acceptance and commitment had fewer depressive symptoms and increased sexual activity

Introduction: This study aimed to emphasize the challenges in the error reporting system as one of the professionalism codes in clinical settings in hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran. Materials and Methods: In total, 23 focused group discussion sessions were conducted with 85 faculty members, assistants, and interns, as well as 165 staff members in 2016. The participants were selected using a purposeful sampling method. Furthermore, the views of four faculty members were gathered again via emails in 2020 to ensure data accuracy. The extracted codes were managed using conventional content analysis through MAXQDA software. Results: Analysis of participants' discussions led to the identification of 105 codes, which were classified into six sub-categories and two main categories, including "barriers to reporting errors of peers " and "barriers to self-reporting errors". Conclusion: Most of the non-reporting errors are due to participant’s concerns. Such concerns are generally the result of poor system management or are merely misunderstandings; accordingly, errors' addressing only requires gaining a person's trust. The seriousness of the system in persuading people to report errors is one of the most important ways to gain a person's trust.

Background: Management-level challenges are among the factors that undermine the individuals' adherence to professional behavior in clinical settings. This study investigated glitches of the management system in clinical settings from the perspective of staff, faculty members, and medical students/residents in hospitals affiliated to Tehran University of Medical Sciences. Methods: This qualitative study was conducted in 2 parts by exploring the viewpoints of personnel and physicians. In this regard, 8 focus group discussions were performed with 85 faculty members, clinical residents, and interns. Furthermore, 15 focus group discussions were held with 165 staffs. Available sampling method was applied to collect the participants and the data were analyzed using the content analysis method. Results: A total of 22 focus-group discussions were conducted with 250 participants; Participants' age ranged from 24 to 65 years. Participants' education levels varied from diploma to postgraduate for the staff and from medical student to sub-specialist for the physicians. Finally, management-level barriers, which undermine the staffs' ability to adhere to professional behavior in clinical settings were explained with 315 codes, 12 subcategories, and 2 main categories of "macro management issues " and "hospital management issues". Conclusion: Managers are required to consider providing a proper context for enforcing the professional behavior law, selecting middle managers based on their empowerment in performing the professional behaviors, prioritizing the professional behavior in policy making, and promoting the professional behavior in an administrative system consistent with the health system. In selecting the hospital managers, authorities are recommended to consider the managers' professional behavior and power in implementing the professionalism leadership. Moreover, the possibility of conducting professional behavior should be considered in making the policies.

It appears that up until now, no comprehensive tool has been developed to assess medical students’ attitudes toward the different dimensions of professionalism. The present study aimed to develop a comprehensive quantitative tool to evaluate medical students’ attitudes toward professionalism. This study consisted of two phases: The first phase was item generation and questionnaire design based on literature review and a qualitative survey. The qualitative data were extracted from 49 semi-structured individual interviews and one focus group discussion. In the second phase, the questionnaire was developed and its face, content, and structure validity and reliability were evaluated. To measure the construct validity of the questionnaire, a cross-sectional study was conducted on 354 medical students at different academic levels at Isfahan University of Medical Sciences. The final questionnaire was loaded on five factors. The factors accounted for 43.5% of the total variance. Moreover, Cronbach's alpha was 0.84 for the total scale, and the interclass correlation coefficient was 0.77 for the test-retest reliability. The 17-item questionnaire measuring medical students’ professional attitude had acceptable validity and reliability and can be adopted in other studies on physicians’ and medical students’ professional attitudes.

This study was conducted to develop and validate an instrument to measure the medical professionalism climate in clinical settings. The item pool was developed based on the Tehran University of Medical Sciences Guideline for Professional Conduct. The items were distributed between two questionnaires, one for health-care providers and the other for patients. To assess the construct validity of the questionnaires, 350 health-care providers and 88 patients were enrolled in the study. The reliability of the questionnaires was evaluated by calculating Cronbach’s alpha and ICC. At first a 74-item pool was generated. After assessing and confirming face and content validity, 41 items remained in the final version of the scale. Exploratory factor analysis revealed the three factors of “personal behavior”, “collegiality” and “respect for patient autonomy” in a 25-item questionnaire for service providers and a single factor of “professional behavior” in a 6-item questionnaire for patients. The three factors explained 51.775% of the variance for service providers’ questionnaire and the single factor explained 63.9% of the variance for patients’ questionnaire. The findings demonstrated that from the viewpoints of patients and service providers, this instrument could be applied to assess the medical professionalism climate in hospital clinical settings.

Introduction: Despite the consensus on the role of teachers in identity formation of learners, the assessment of the professional behavior of faculty members has not been paid enough attention. Professionalism is best taught in clinical settings through role modeling of teachers. Students can observe the behavior of the physicians, this way, professionalism evaluation in practicing physicians is important. This study endeavored to develop a 360-degree tool for assessing the professional behavior of clinical attending. Methods: This study was conducted in four phases. In the first phase we designed item pool based on a review of literature and experts’ views, in the second phase, content validity and face validity of items were authnticated. In the next phase a pilot study was conducted on 40 people (20 faculty members & 20 assistants). In the versy last phase the reliability of the instrument was calculated on 18 faculty members, 10 head of departments, 16 residents and 17 nurses. Results: Based on validity and reliability assessment, item pool reduced to 18. Seven items were assigned to department heads, 6 items to colleagues, 8 items to assistants, and 5 items to nurses. It was also found that patients were able to evaluate the professional behavior of clinical members in four aspects. Conclusion: A 360 degree instrument containing five sections and 18 items was developed that can examine the professional behavior of faculty of members of school of medicine, taking into account the views of stakeholders including service providers and patients.

Professional behavior with patients and interactions with colleagues, the institution and professional bodies are influenced by many factors. The purpose of this manuscript is to clarify those personal factors affecting medical professionalism in clinical settings affiliated with Tehran University of Medical Sciences. For this purpose, a qualitative study was carried out. One hundred and eighty-two participants were recruited through purposive sampling of clinical staff, physicians, and medical students in Tehran. Data were collected through 22 focus group discussions, and conventional content analysis was used to analyze the data. The results were reported in five categories to present the participants’ views. Categories were extracted from 103 codes and consisted of 1) people's belief in professionalism, 2) personality traits, 3) problems in family, 4) mental or physical health status, and 5) communication skills. The results showed that despite the facilitator roles of some personal factors, others act as barriers to professional behaviors. In order to control their impact, it is crucial to pay attention to them at the time of student/staff selection. Strengthening support systems in the organization is also essential for decreasing the effect of family problems or physical and mental health problems.

Objective (s): Data collection is one of the important stages of research process and requires valid and reliable instruments. The aim of this article was to introduce important steps of translation and construction process of a questionnaire. Adopting an appropriate instrument for research and developing an optimal instrument needs knowledge on psychometric criteria. The present paper explains the construct validity reliability and responsiveness as the important components of psychometric properties of health related instruments. Methods: The present paper was written based on exisiting documentaries. Results: There are different methods for evaluating construct validity, which include structural validity (factor analysis), hypothesis testing, convergent and discriminant validity, and cross-cultural validity. Criterion validity is also a type of validity, which can improve the quality of an instrument if being applicable. Reliability is an essential part of psychometric evaluation, which includes internal consistency, stability, equivalency and standard error of measurement. Instrument developers have often been concerned with internal consistency and stability. Examining standard error of measurement as an important component of reliability has been ignored in the development of most instruments. Responsiveness is approved if the smallest detectable change is less than the clinical minimal important change. Furthermore, the area under the ROC curve can also be used for examining responsiveness. Floor and ceiling effects exist if more than 15% of respondents get the highest or lowest possible scores. Conclusion: Psychometric knowledge should be considered as basic requirement of translation and development of health-relate measures. This could help investigators to collect valid and reliable information when collecting the data.

Objective (s): Data collection is one of the important stages of research process and requires valid and reliable instruments. The aim of this article was to introduce important steps of translation and construction process of a questionnaire. Furthermore, the present study considers two psychometric properties evaluation including face and content validity. Methods: This is a documentary that accounts for instructions and methods in tanslating and validating a health-related questionnaire. Results: The most known procedure to translate a standard questionnaire from original language into a different language is forward-backward procedure. This includes several steps including forward translation, review and reconciliation of forward translation, back translation, back translation review, pre-testing and cognitive interviewing and providing the provisional version. Main steps for instrument development include definition of concept and its domain, explication of objectives for the measure, development of a blueprint; and construction of the measure, including administration procedures, item set, and scoring rules and procedures. Then content and face validity could be performed to provide the final version. Conclusion: Translation or development of a health-related measure and its psychometric properties should methodologically be robust and follow standard procedures.

Many studies have attempted to analyze the concept of professionalism in nursing. Prior to this study, however, there had been no experience of empowering nurses to train their peers. The context of nursing is different from other professions in the health system. In comparison to physicians, nurses’ exposure to patients is not only more frequent, but also of a kind that urges them to behave in a professional manner that differs from physicians and medical students.

BACKGROUND: Observing professional behavior in clinical settings encounters many obstacles. In this research, the effect of defects of the educational system in observing professional behavior in clinical settings of Tehran University of Medical Sciences (TUMS) has been investigated. MATERIALS AND METHODS: This qualitative content analysis study was conducted using focused group discussions in TUMS. Twenty-two focused group discussions with 182 faculty members, medical students, and clinical staff were conducted. Conventional content analysis was used to analyze the data. RESULTS: One hundred and sixty codes (90 codes from the viewpoint of clinical staff and 70 codes from the viewpoint of faculty members and medical students) were extracted. The codes are categorized into 4 categories and 17 subcategories. The categories include “educators' imperfections,” “inadequate initial training,” “lack of attention to continuous professional education,” and “lack of passion for professionalism education.” CONCLUSION: Greater efforts to empower educators, planning for the effectiveness of initial education, and motivating employees might play a role in promoting the observance of professional behavior in clinical settings. Professional behavior training should be considered at the entrance into the system. This education should be strengthened by continuing theoretical and practical training and addressed by proper supervision. It is also important to focus on attracting the attention of teachers to their own model role in observing professional behavior by others.

INTRODUCTION: Despite all efforts that have been made to promote professional behavior among medical trainees, unfortunately, reports from medical schools around the world confirm the prevalence of nonprofessional behaviors by medical students. Experts in the field of medical ethics and medical education in different countries have suggested several reasons for failing to minimize unprofessional performance among medical students. MATERIALS AND METHODS: This qualitative study aimed to promote our understanding from the challenges faced by Iranian medical students in providing professional behavior. The study was first conducted in the form of a semi-structured face-to-face interview with medical students and then completed with a focus group discussion (FGD) session. Forty-nine medical students participated in the interviews and 11 students participated in the FGD session. Qualitative conventional content analysis was used for examining the data. RESULTS: The participants classified the obstacles of professional behavior into the following three main categories: problems related to educational system, problems related to the society, and problems related to students themselves. CONCLUSION: Regarding the impact of various personal, social, and educational factors on the creation and expansion of unprofessional behaviors among medical students, it is essential to have a comprehensive approach for solving the problem.