OBJECTIVES: Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran. METHODS: This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages. RESULTS: The risk of mortality from TB was found to increase with the unemployment rate (β^=0.02), illiteracy (β^=0.04), household density per residential unit (β^=1.29), distance between the center of the county and the provincial capital (β^=0.03), and urbanization (β^=0.81). The following other risk factors for TB mortality were identified: diabetes (β^=0.02), human immunodeficiency virus infection (β^=0.04), infection with TB in the most recent 2 years (β^=0.07), injection drug use (β^=0.07), long-term corticosteroid use (β^=0.09), malignant diseases (β^=0.09), chronic kidney disease (β^=0.32), gastrectomy (β^=0.50), chronic malnutrition (β^=0.38), and a body mass index more than 10% under the ideal weight (β^=0.01). However, silicosis had no effect. CONCLUSIONS: The results of this study provide useful information on risk factors for mortality from TB.
Body Mass Index ; Cross-Sectional Studies ; Education, Medical ; Family Characteristics ; Gastrectomy ; HIV ; Humans ; Iran ; Literacy ; Malnutrition ; Models, Statistical ; Mortality ; Public Health ; Renal Insufficiency, Chronic ; Risk Factors ; Silicosis ; Statistics as Topic ; Tuberculosis ; Unemployment ; Urbanization

OBJECTIVES: Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran.METHODS: This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages.RESULTS: The risk of mortality from TB was found to increase with the unemployment rate (β^=0.02), illiteracy (β^=0.04), household density per residential unit (β^=1.29), distance between the center of the county and the provincial capital (β^=0.03), and urbanization (β^=0.81). The following other risk factors for TB mortality were identified: diabetes (β^=0.02), human immunodeficiency virus infection (β^=0.04), infection with TB in the most recent 2 years (β^=0.07), injection drug use (β^=0.07), long-term corticosteroid use (β^=0.09), malignant diseases (β^=0.09), chronic kidney disease (β^=0.32), gastrectomy (β^=0.50), chronic malnutrition (β^=0.38), and a body mass index more than 10% under the ideal weight (β^=0.01). However, silicosis had no effect.CONCLUSIONS: The results of this study provide useful information on risk factors for mortality from TB.
Body Mass Index ; Cross-Sectional Studies ; Education, Medical ; Family Characteristics ; Gastrectomy ; HIV ; Humans ; Iran ; Literacy ; Malnutrition ; Models, Statistical ; Mortality ; Public Health ; Renal Insufficiency, Chronic ; Risk Factors ; Silicosis ; Statistics as Topic ; Tuberculosis ; Unemployment ; Urbanization

PURPOSE: The purpose of this study is to find out how much influence nursing students' environmental consciousness and knowledge of medical waste have on their attitudes toward medical waste. METHODS: The subjects were 211 nursing students recruited from 2 universities. Data were collected with a structured self-report questionnaire comprising measures of environmental consciousness, and knowledge of and attitude toward medical waste. Data analysis was conducted with the SPSS/WIN 25.0 program. RESULTS: A total of 211 copies of the questionnaire were used for the final analysis, except for 9 untrusted responses out of 220 that included missing values. Those subjects' environmental consciousness who received environmental education in middle and high schools was higher (t=3.15, p=.002). The higher their grades, the better their knowledge of medical waste (F=3.40, p=.035). Those subjects’ knowledge of medical waste who received medical waste education was relatively high (t=3.14, p=.002). Those subjects with clinical practice experience had more sensitive attitudes toward medical waste (t=2.06, p=.041). Those subjects' attitudes toward Medical waste who received medical waste education at the universities were relatively high (t=2.04, p=.043). The subjects' environmental consciousness was positively correlated with their attitudes toward medical waste (r=.44, p<.001). The most influential factor in their attitudes toward medical waste is their environmental attitudes and medical waste education. CONCLUSION: The higher the nursing students' environmental consciousness, the higher their attitudes toward medical waste. It is necessary to provide environment and medical waste education for nursing students in order to strengthen their environmental consciousness and attitude toward medical waste.
Consciousness ; Education ; Humans ; Medical Waste ; Nursing ; Statistics as Topic ; Students, Nursing

Myers-Briggs Type Indicator (MBTI) is a personality type test book, which is widely used in the field of personal counseling, team organization, school education and research. This study carried out MBTI of 361 medical students in the second grade of premedical course of Keimyung University School of Medicine from 2014 to 2018, and analyzed the data to use them for the students' education. The personality type was mostly distributed to ISTJ, ISTP, ESTP and ESTJ in order among 16 types. According to preference tendency, it was found out that the introverted type was extroverted, the recognition type was intuition type, the thinking type was emotional type, and the recognition type was more distributed than the judgment type. The psychological functions were ST, SF, NF, NT. MBTI type analysis of medical students shows that it is possible to organize members in group activities to improve their ability to understand themselves and understand others in class scenes. In addition, we expect to be able to design for improvement of stress management, conflict management, and communication ability. In the career counseling scene, in addition to the MBTI data analysis, it is expected that it will be possible to recommend a major suitable for the student personality type in parallel with other psychological tests. In addition, we expect to study the preferred field of study, satisfaction with the major in the future research by continuous data accumulation and analysis.
Communication ; Counseling ; Education ; Education, Medical* ; Humans ; Intuition ; Judgment ; Personality Inventory ; Psychological Tests ; Statistics as Topic ; Students, Medical* ; Thinking ; Vocational Guidance

INTRODUCTION: Postgraduate medical education in Singapore underwent a major transition recently, from a British-style system and accreditation to a competency-based residency programme modelled after the American system. We aimed to identify the relative importance of factors influencing the choice of sponsoring institution (SI) for residency among medical students during this transition period. METHODS: A questionnaire-based cross-sectional study of Singapore undergraduate medical students across all years of study was performed in 2011. Participants rated the degree of importance of 45 factors (including research, academia and education, marketing, reputation of faculty, working conditions, posting experience and influence by peers/seniors) to their choice of SIs on a five-point Likert scale. Differences in gender and seniority were compared. RESULTS: 705 out of 1,274 students completed the survey (response rate 55.3%). The top five influencing factors were guidance by mentor (4.48 ± 0.74), reputation for good teaching (4.46 ± 0.76), personal overall experience in SI (4.41 ± 0.88), quality of mentorship and supervision (4.41 ± 0.75), and quality and quantity of teaching (4.37 ± 0.78). The five lowest-rated factors were social networking (2.91 ± 1.00), SI security (3.01 ± 1.07), open house impact (3.15 ± 0.96), advertising paraphernalia (3.17 ± 0.95) and research publications (3.21 ± 1.00). Female students attributed more importance to security and a positive working environment. Preclinical students rated research and marketing aspects more highly, while clinical students valued a positive working environment more. CONCLUSION Quality of education, mentorship, experiences during clerkship and a positive working environment were the most important factors influencing the choice of SI.
Accreditation ; Cross-Sectional Studies ; Curriculum ; Education, Medical, Graduate ; economics ; organization & administration ; Education, Medical, Undergraduate ; economics ; organization & administration ; Female ; Humans ; Internship and Residency ; Male ; Mentors ; Models, Organizational ; Schools, Medical ; Singapore ; Students, Medical ; statistics & numerical data ; Surveys and Questionnaires ; United States ; Universities

BACKGROUND: Dundee Ready Educational Environment Measure (DREEM) is a 50-item tool to assess the educational environment of medical institutions as perceived by the students. This cross-sectional study developed and validated an abridged version of the DREEM-50 with an aim to have a less resource-intensive (time, manpower), yet valid and reliable, version of DREEM-50 while also avoiding respondent fatigue. METHODS: A methodology similar to that used in the development of WHO-BREF was adopted to develop the abridged version of DREEM. Medical students (n = 418) from a private teaching hospital in Madurai, India, were divided into two groups. Group I (n = 277) participated in the development of the abridged version. This was performed by domain-wise selection of items that had the highest item-total correlation. Group II (n = 141) participated in the testing of the abridged version for construct validity, internal consistency and test-retest reliability. Confirmatory factor analysis was performed to assess the construct validity of DREEM-12. RESULTS: The abridged version had 12 items (DREEM-12) spread over all five domains in DREEM-50. DREEM-12 explained 77.4% of the variance in DREEM-50 scores. Correlation between total scores of DREEM-50 and DREEM-12 was 0.88 (p < 0.001). Confirmatory factor analysis of DREEM-12 construct was statistically significant (LR test of model vs. saturated p = 0.0006). The internal consistency of DREEM-12 was 0.83. The test-retest reliability of DREEM-12 was 0.595, p < 0.001. CONCLUSION DREEM-12 is a valid and reliable tool for use in educational research. Future research using DREEM-12 will establish its validity and reliability across different settings.
Adolescent ; Cross-Sectional Studies ; Education, Medical ; statistics & numerical data ; Female ; Humans ; India ; Male ; Psychometrics ; methods ; Reproducibility of Results ; Students, Medical ; psychology ; Young Adult

PURPOSE: The purpose of this study was to explore the experience of medical teachers in the process of adapting flipped learning method through a phenomenological approach. METHODS: Semi-structured interviews with five medical teachers from two medical colleges and one medical school were conducted in December, 2017. Data analysis was done according to Colaizzi's descriptive phenomenological methodology. RESULTS: A total of 160 unique significant statements were extracted. These statements generated 17 formulated meanings that were categorized into seven theme clusters and four theme categories. Main themes were: (1) teacher with high levels of passion and motivation; (2) hurdles of flipped learning: students were still passive, struggling in preparing for flipped learning; (3) positive changes from flipped learning: changes to classroom environment and teachers' reflection through experience; and (4) challenges of flipped learning: remaining tasks for teachers, expansion of flipped learning. CONCLUSION: Through phenomenological approach, researchers were able to elucidate categories about the experience of medical teachers when attempting flipped learning. Although medical teachers did not have the exact same idea on how flipped learning was conducted and implemented, the perception of flipped learning, or difficulties in class activities, they were still wondering how they could teach students well. This study might draw more attention to flipped learning and stimulate educational and institutional supports to improve teaching and learning in medical schools.
Education, Medical ; Humans ; Learning* ; Methods ; Motivation ; Qualitative Research ; Schools, Medical ; Statistics as Topic ; Students, Medical*

INTRODUCTION: Medical school fees are rising globally. Student debt and financial background may affect residency choices, but few studies have been conducted in Asia. This study aimed to explore the relationship between financial background, student debt and postgraduate residency choices among medical students in Singapore. METHODS: An anonymised survey of all medical students in Singapore was conducted and had a response rate of 67.9%. RESULTS: 40.5% of our study population would graduate with debt. Medical students with monthly per capita household income < SGD 1,000 were more likely to graduate with debt (unadjusted odds ratio [OR] 2.0, 95% confidence interval [CI] 1.6-2.7; p < 0.001) and feel burdened by the cost of medical education (unadjusted OR 2.8, 95% CI 2.0-3.9; p < 0.001). Students with monthly per capita household income < SGD 1,000 (unadjusted OR 1.818, 95% CI 1.338-2.470, p < 0.001; adjusted OR 1.692, 95% CI 1.202-2.381, p = 0.003) and those with debt (unadjusted OR 1.623, 95% CI 1.261-2.090, p < 0.001; adjusted OR 1.393, 95% CI 1.048-1.851, p = 0.022) were more likely to rank at least one economic factor as 'very significant' in influencing their postgraduate training choices. CONCLUSION It is concerning that despite financial aid schemes, the cost of medical education remains a burden to students from lower-income households in Singapore. Student debt and financial background may distort postgraduate career choices, creating an undue push towards high-paying specialties.
Career Choice ; Choice Behavior ; Education, Medical ; economics ; Humans ; Internship and Residency ; economics ; Odds Ratio ; Schools, Medical ; economics ; Singapore ; Social Class ; Students, Medical ; statistics & numerical data ; Surveys and Questionnaires ; Training Support

End-of-life care competencies have been perceived as important and essential, so it has been suggested that end-of-life care be studied in undergraduate medical education. However, end-of-life care curriculum has mostly focused on acquisition of knowledge and skills rather than attitudes. Therefore, we aimed to explore whether education about death affects medical students' attitudes towards care for dying patients and perception of death anxiety, meaning in life, and self-esteem. A total of 15 first- or second-year medical students were surveyed with questionnaires before and after completing a 6-week death education course. Paired data analysis showed that participants' attitudes towards caring for terminally ill patients and their caregivers improved significantly (t=−2.84, p=0.013) with an effect size of 0.73. In contrast, no significant changes were found in death anxiety, meaning in life, or self-esteem. All participants agreed that formal teaching about death and dying must be encouraged in medical schools. Our results suggest that death education may positively influence attitudes towards end-of-life care. Although replication with larger samples is necessary, this preliminary finding may support the importance of developmentally appropriate end-of-life care education in medical schools.
Anxiety ; Attitude to Death ; Caregivers ; Curriculum ; Education ; Education, Medical, Undergraduate ; Humans ; Schools, Medical ; Statistics as Topic ; Students, Medical ; Terminal Care ; Terminally Ill

PURPOSE: The aim of this study was to measure the effect of an iPad-based asynchronous curriculum on emergency medicine resident performance on the in-training exam (ITE). We hypothesized that the implementation of an asynchronous curriculum (replacing 1 hour of weekly didactic time) would result in non-inferior ITE scores compared to the historical scores of residents who had participated in the traditional 5-hour weekly didactic curriculum. METHODS: The study was a retrospective, non-inferiority study. conducted at the University of California, Irvine Emergency Medicine Residency Program. We compared ITE scores from 2012 and 2013, when there were 5 weekly hours of didactic content, with scores from 2014 and 2015, when 1 hour of conference was replaced with asynchro-nous content. Examination results were compared using a non-inferiority data analysis with a 10% margin of difference. RESULTS: Using a non-inferiority test with a 95% confidence interval, there was no difference between the 2 groups (before and after implementation of asynchronous learning), as the confidence interval for the change of the ITE was −3.5 to 2.3 points, whereas the 10% non-inferiority margin was 7.8 points. CONCLUSION: Replacing 1 hour of didactic conference with asynchronous learning showed no negative impact on resident ITE scores.
California ; Curriculum* ; Education* ; Education, Medical, Graduate ; Emergencies* ; Emergency Medicine* ; Internship and Residency ; Learning ; Retrospective Studies ; Statistics as Topic ; United States*