1. Background
In today’s world, the quality of education is one of challenges at the universities (1). The quality of university education is always of great importance (2). Evidence suggests that the educational systems can properly perform their duties when the quality of education is good (3). One of the responsibilities of higher education is to train expert and committed persons, since they perform a critical part in the development of any country. Therefore, the main concerns of any higher education system should be to provide appropriate services and an adequate level of quality that allows employing this valuable human capital in directing the country toward sustainable development (4). Nowadays, to assess the students’ ideas about all aspects of the education provided in educational institutions is considered as an essential factor to monitor the quality of the university (5). In the medical education system, it is essential to pay more attention to the quality of education. Otherwise, it may lead to the ineffectiveness of graduates and may have many health and medical consequences (6).
There are several models to evaluate service quality (SERVQUAL) (3-5). In SERVQUAL scale, service quality is the break between expectations and perceptions of consumers of the services presented by provider organization in reality. This instrument measures the perceptions and expectations of customers in the five dimensions and finally processes the gaps between them. These five dimensions are 1) Tangibility: appearance of the physical facilities, equipment, staff, and communication facilities; 2) Reliability: reliability in performing the service continuously, accurately, and timely; 3) Responsibility: willingness of the staffs to help clients and provide them with quick services; 4) Assurance: knowledge, attention, and proficiencies revealed by the employees that inspire confidence and trust; 5) Empathy: an effort to recognize the viewpoint of the user through personal attitudes. Due to the flexible nature of this scale for use in various services, it can be also used to assess the quality of medical education (6).
According to the requirements of the educational services to assess their quality, it was decided to use the Persian standardized SERVQUAL questionnaire sample to investigate the quality of educational services in Firoozgar Hospital affiliated to Iran University of Medical Science and Imam Reza Hospital affiliated to AJA University of Medical Sciences, Tehran, Iran. The results may enable authorities of Firoozgar and Imam Reza hospitals to realize the deficiencies in the quality of their educational services. On the other hand, the current study may motivate the officials of the two hospitals to improve the quality of educational services with the needs and the expectations of their students.
2. Methods
In the current cross sectional study, 100 students were selected by stratified random sampling method. The population consisted of all of the general practitioner (GP) students of Iran University of Medical Sciences in Firoozgar Hospital and AJA University of Medical Sciences in Imam Reza Hospital in 2016. Fifty questionnaires were distributed in each hospital, out of which 41 completed questionnaires were returned from Firoozgar hospital and 41 from Imam Reza hospital.
Data were collected by SERVQUAL form (19 items) to survey the areas of tangibility (items 1 - 4), reliability (items 5 - 7), responsibility (items 8 - 11), security (assurance) (items 12 - 15) and empathy (items 16 - 19) regarding the measurement of educational quality in terms of expectations (an ideal and required medical education) and perceptions (the actual condition of the medical education) scored based on a seven - option Likert scale (from 7 for very much to 1 for very little) (7, 8). The reliability and validity of the Persian version of the questionnaire were proved by Heidarnia et al. (9). Scores of items in each area were added. The gap was derived by subtraction of the expectations’ score from the perceptions’ score for each participant response. A negative score was considered as negative gap if the current situation was distant from the desired situation.
Data were expressed as median ± inter quartile rang (IQR) and analyzed using the Mann - Whitney or Wilcoxon tests with SPSS. P < 0.05 was considered statistically significant.
3. Results
There were no significant differences in the expectations, perceptions, and the gap between AJA and Iran universities of medical sciences (Table 1).
Table 1.Comparison of the AJA and Iran Universities of Medical Sciences in the Quality Gap of Educational Services in Each Area of SERVQUAL Questionnairea
| Expectations, Score | Perceptions, Score | Gap | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Iran | AJA | P | Iran | AJA | P | Iran | AJA | P | |
| Tangibility (4 items) | 28 ± 2 | 28 ± 2 | 0.655 | 16 ± 6 | 16 ± 9.5 | 0.956 | -11 ± 7 | -11 ± 10 | 0.944 |
| Security (4 items) | 27 ± 2 | 28 ± 2 | 0.155 | 14 ± 6 | 14 ± 14 | 0.816 | -13 ± 9 | -12 ± 16 | 0.993 |
| Responsibility (4 items) | 21 ± 1 | 21 ± 1 | 0.399 | 11 ± 6 | 12 ± 9.5 | 0.211 | -10 ± 6 | -7 ± 10 | 0.287 |
| Reliability (3 items) | 20 ± 2 | 20 ± 2 | 0.685 | 11 ± 4 | 11 ± 5 | 0.344 | -9 ± 3 | -9 ± 4 | 0.323 |
| Empathy (4 items) | 21 ± 1 | 21 ± 1 | 0.059 | 10 ± 5 | 13 ± 10 | 0.077 | -9 ± 5 | -8 ± 11.5 | 0.399 |
aData are expressed as median ± inter quartile rang (IQR) and analyzed by the Mann - Whitney test.
There were significant differences between expectations and perceptions in all five areas in both universities (Table 2).
Table 2.Comparison of the Median Scores of AJA and Iran Universities of Medical Sciences Students’ Expectations and Perceptions about the Educational Services in Each Area of Qualitya
| Iran University of Medical Sciences | AJA University of Medical Sciences | |||||
|---|---|---|---|---|---|---|
| Expectations Score | Perceptions Score | P | Expectations Score | Perceptions Score | P | |
| Tangibility | 28 ± 2 | 16 ± 6 | 0.000b | 28 ± 2 | 16 ± 9 | 0.000b |
| Security | 27 ± 2 | 14 ± 6.5 | 0.000b | 28 ± 2 | 14 ± 14 | 0.000b |
| Responsibility | 21 ± 1 | 11 ± 5.5 | 0.000b | 21 ± 1 | 12 ± 9.5 | 0.000b |
| Reliability | 20 ± 2 | 11 ± 4 | 0.000b | 20 ± 2 | 11 ± 5 | 0.000b |
| Empathy | 20 ± 3 | 10 ± 5 | 0.000b | 21 ± 1 | 13 ± 10 | 0.000b |
aData are expressed as median ± inter quartile rang (IQR) and analyzed by the Wilcoxon test.
bP ≤ 0.05
4. Discussion
Medical education is a very costly and important educational period. The current study aimed at examining the extent of the gap between expectations and perspectives among medical students in two universities. The median expectations of service quality were significantly higher than the median perceptions at both universities.
There was negative break between student expectations and perceptions in the quality of all areas of educational services. It means that quality of the delivered educational services was lower than what expected in both universities. The lowest gap score of quality was derived for empathy followed by responsibility, tangibility, and reliability, and the greatest gap was in the security. The obtained results were in agreement with those of other studies (4, 8-15). This suggested that attitudes of students towards the components of five dimensions were not positive. On the other hand, students’ expectations were not fulfilled. It means that students of Iran and AJA universities of medical sciences were dissatisfied with the quality of services provided.
The causes of failing to meet the students expectations could be explained as follows: lack of adequate educational space for students to discuss in class, failure to present the job prospects of students, lack of easy access of students to teachers when needed, lack of information for specific hours to refer to teachers to resolve the problems in the lessons, not considering the students positive feedback, unsuitable time of holding classes, mismatch of students’ tasks with their knowledge, unattractive appearance of physical facilities, and old school equipment and lack of amenities. The results regarding Iran and AJA universities of medical sciences were indicative that security (assurance) had the highest quality gap. This finding was consistent with the results of the studies by Tofighi et al., (16) Arbouni et al., (17), Chua (18), and Mahmoud et al. (19).
In all areas of quality, there were significant differences between expectations and realities in both universities. In this regard, throughout the year, university educators should have courses on effective ways of providing educational services and effective communication with students; also, use of modern educational methods, counseling skills, and student communication in the workshop program for faculty members. On the other hand, more financial resources should be allocated to improve the physical condition, spaces, and educational facilities. The difference between the expectations and the facts in the two universities may be related to the students’ academic level, the educational system, or both. It was a limitation of the current study and should be considered later.
4.1. Conclusion
The medical students’ expectations in Iran and AJA universities of medical sciences were more than their perceptions of the present situations; therefore, their expectations were not met.
