Evaluation of "Office-based" Course of Intern Students at Shahid Beheshti University of Medical Sciences

Background and Purpose: "Office-based" course in General Medical Curriculum of Shahid Beheshti School of medicine (the reform program) is a four-month course that is presented in the last six months of the program for interns. Office is a major practice setting after graduation for general practitioner in Iran and for this purpose physicians' offices in health care centers have been selected. Purpose of the course is to prepare interns to work independently and they have passed all their courses and had adequate knowledge to practice but they had not enough experience of office-based practice in the community and outpatient settings. This study was designed and implemented aimed to determine the program’s weaknesses and strengths in the range of the course stakeholders ‘questions (5 major questions), and provide proposed solutions to policy-makers in order to improve and promote the program of "office- based education internship" of Shahid Beheshti School of Medicine.Methods: The assessment was conducted in 3 descriptive study and the population under study included 44 interns and 36 physician mentor in 36 health care centers which were all centers under office based education plan in Shahid Beheshti medical school from October till December of 2014.The instruments used for data collection were questionnaires (mentor physician and intern students) and a check list made by the researcher. Mentor physician questionnaire contained 23 items, student questionnaire contained 20 items and documentations review check list and evidence included contained 30 items. Twenty items were on a 4-point Likert-type (weak, less than expected, as expected as and higher than expected), 14 items on a 3-point Likert-type (none, partially, totally), 33 items on two-choice question (Yes/No) and 6 as an open question. All items had the same value. Face and content validity were checked by Scientific Committee and evaluations of Shahid Beheshti University of Medical Sciences.For checking educational achievement, a student self-assessment and mentor assessment were performed in 3status, at the beginning of the course, after 2 months and after 4 months.Results: The gap between design and implementation was at least 14.1%. More than 75% of mentors had desirable conditions in terms of scientific, educational and professional competencies from the perspective of students but mentor physicians' abilities in basic skills of practice was lower compared with educational and professional abilities. Students’ skills at the beginning of the first two months of office-based course internship was lower than expected in all areas and at the end of the 4-month course learning reached 95% to 100%. Per capita, variety and number of patients referring to teach students (90.6% of the centers) were sufficient. 66.7% of mentor physicians were interested in working as a general physician and 42.7% were interested in teaching students. 52.8% of mentor physicians did not receive any fee and 100% of the recipients were not satisfied with the amount of the fee. In 81.2% of health care centers, work and training space was appropriate and there were some difficulties about equipment.Conclusions: The results of this study showed that health centers are appropriate educational setting for general medical students' office-based course and effective on promoting their essential skills of practice. Although educational and professional competencies of about 75% of mentors was desirable but the necessity of considering mentors' training, becoming more familiar with the goals and standards of the program, as well as the promotion of knowledge at the same time with considering financial motives and job promotion can play an important role in presenting this program. The need to pay attention to provide basic facilities in the centers, as well as continuous and periodic evaluation are other recommendations of the study.