Student based evaluation of reform educationsystem in the medical doctorate: an Iranianmedical school experience

Introduction: To be more successful in medical education andidentifying the strengths and weaknesses of the reform educationsystem, assessment of the students' views is essential. The aim ofthis qualitative study was to identify the strengths and weaknessesof the reform system from medical students' point of view whoreported their educational experiences.Methods: A self-administered anonymous survey with ۶questions including reference (s) used in training, teachingtheoretical topics, teaching practical topics, compliance with theprerequisites of the offered lessons in each semester,proportionality between the numbers of lesson units and theallocated time for presenting the lessons and sufficient time ofstudent's self-preparation for final exams with Likert criteria wasapplied to ۱۳۴ students (۸۲ studying in reform and ۵۲ studying inold system of medical education) at the basic sciences phase ofmedical education from ۲۰۱۸-۲۰۱۹. Students were also asked anopen question as “what deficiencies did you find in youreducational experience?” The answers were recorded in writtenform without the mention of name. A coding and systematiccategorizing process was used to analyze the answers. The initialcodes were ۴۳. Then, coding treatment was done by removing theduplicate and similar codes and merging the overlapped ones.Final codes were ۳۷. Then, according to the quality ofcommunication between the codes, the researchers categorizedthe codes as primarily by combining, grouping, and organizing ofthem. Finally, secondary categorization was extracted based onthe abstract thinking of the researchers as macro (experiencesfocused on the policies of the ministry of health and medicalsciences), meso (experiences focused on the physical andeducational environment of the university), and micro(experience focused on the individual factors including teachersand students) levels. Answers to the survey and open questionwere compared between students studying in the reform and oldsystem groups by Chi-squared and Fisher exact tests.Results: The results showed that the proportion of students whoagreed with a weak compliance with the prerequisites of theoffered lessons in each semester was more significantly in reformthan old system group (۷۷.۵% vs. ۲۲.۵%, respectively) (p≤ ۰.۰۵).The proportion of students who agreed that proportionalitybetween the numbers of lesson units and the allocated time forpresenting the lessons is very good were significantly more in oldcompared to the reform group (۶۶.۷% vs. ۳۳.۳ %, respectively(p≤۰.۰۰۱). Ninety percent of medical students studying in reformbut ۹.۴% of students who studying in old system reported a weakagreement with sufficient time of student's self-preparation forfinal exams (p≤۰.۰۰۱). Primary categorization of the codesobtained from the students answeres were “disparity betweenlesson content and specified time for lesson presentation”,“limitation of educational facilities and training environment”,“teacher's objections from the student's point of view”, “problemsof the training staff”, “lack of simultaneous presentation of basicand clinical education and abundant specialized floating lessons”,“ignoring research in basic science education”, “need to monitorthe reform system”, “advisor's objections from the student's pointof view”, “mnemonic and non-functional lessons for the future ofthe profession”, “curriculum problems (non- applicable courseheadings in the basic education for a physician's future career)”,and “problems of student assessment system”. Twenty-two(۱۵.۱%) of reform and ۱ (۱.۶%) of old system students reported“disparity between lesson content and specified time for lessonpresentation” (p≤۰.۰۰۱). However, forty-three (۲۹.۵%) of reformbut ۲۹ (۴۷.۵%) of old system students reported “teacher'sobjections from the student's point of view” (p≤۰.۰۰۱). Thecomparison of thems between two groups showed that twentyeight(۱۹.۲%) of reform but ۱ (۱.۶%) of old system studentsreported their educational experinces in macro level. But ۷۰(۴۷.۹%) of reform and ۳۱ (۵۰.۸%) of old system students reportedtheir experinces in meso level. Moreover, ۴۸ (۳۲.۹%) of reformand ۲۹ (۴۷.۵%) of old system students reported thier experiencesin micro level (p≤۰.۰۱).Conclusion: We concluded that medical students studying in thereform system of the MD course have experienced deficienciesthat focuse more on the macro level of medical education.However, medical students studying in the old education systemhave experienced deficinces focused on the meso and microlevels of medical education. Therfore, successful journey ofmedical education reform is an ongoing process that needs tocomprehensively identify the perspective of medical students asthose who run this program.