1. Background
Students are a major component of universities with a critical role in presenting as prospective highly skilled and expert workforce for the community. Academic satisfaction plays a key role as the main pillar of the educational system regarding the students’ knowledge about their future activities (1).
Evaluating educational practices in medical sciences has always been absolutely significant, given their special role in training human resources and that receiving feedbacks for enhancing educational activities is a relatively new subject. Examining the opinions of students, as the main audience of educational programs, can help develop one of the best and most successful teaching methods (2, 3). Recognizing the causes of satisfaction in students and analyzing all the factors can affect students’ academic achievements and may significantly improve the quality of services (2, 4).
General practitioners have effective role in healthcare teams in exposing and treating outpatients. As community-based doctors, they have key role for the awareness, diagnosis and treatment of common diseases in the community (5, 6). Limited number of studies has conducted on students’ satisfaction and different variables that affect satisfaction in the sociological training courses.
2. Objectives
The present study was conducted to investigate the problems and quality of educational services provided in Kermanshah University of Medical Sciences (KUMS) through examining the perspective of medical students who spend their internship at community centers.
3. Methods
The present descriptive cross-sectional study was conducted in 2016 - 2017 academic year to determine the satisfaction of medical interns who spent their community-based internship in the community-based center of Samen Al-Aemeh and the hospitals affiliated to KUMS. The study population comprised 92 medical students selected through convenience sampling. The data collection tool consisted of a researcher-made questionnaire with two sections, one associated with demographic information, facilities and other hardware resources and the other related to satisfaction with the scientific impact of the course. The questionnaire was examined in terms of four criteria, namely transparency, relevance, importance and degree of feasibility. The questionnaire validity was verified by the professors of the university. The questionnaire reliability was confirmed by the students calculating a Cronbach alpha of 90%. The items were scored on a three-point Likert scale, including good, moderate and dissatisfied levels.
4. Results
Females comprised 51% of the students, who had a mean age 25.3 ± 1.1 years. The students participating in the study had been admitted to the university in 2009 (19.5%), 2010 (70.7%) and 2012 (9.8%).
The students’ dissatisfaction in the academic evaluation of the courses was related to the disproportion between the course length and the educational goals (36.6%) and the lack of cooperation of the patients with the students’ examinations (39.5%).
Furthermore, the areas causing the students’ satisfaction included the professors’ proper accountability (96.7%), their timely and regular presence (56.9%) and providing scientific education about communication with the patient (56.9%). The indices regarding the students’ satisfaction with the general medical internship course based on community-based medicine courses were evaluated (Table 1).
Table 1.The Evaluated Indices Regarding the Satisfaction of General Medical Internship Students with Community-Based Medical Centersa
| Evaluation Domains | Good | Moderate | Dissatisfied | |
|---|---|---|---|---|
| 1. | Facilities of the dressing room pavilion | 13 | 17.4 | 69.6 |
| 2. | Access to scientific resources | 15.7 | 18.3 | 66 |
| 3. | The degree of customer collaboration with student education examinations | 39.5 | 35.2 | 25.3 |
| 4. | Appropriate course length with educational goals | 36.6 | 36.6 | 26.8 |
| 5. | Regular and timely presence of professors | 56.9 | 31.9 | 11.2 |
| 6. | Proper accountability of the professors | 96.7 | 2.2 | 1.1 |
| 7. | Scientific education of how to deal with a patient | 56.9 | 36.6 | 6.5 |
| 8. | Possibility of direct visit and obtaining a biography | 40.8 | 33.8 | 25.4 |
| 9. | Introduction of common diseases by professors | 50 | 33.3 | 16.7 |
| 10. | Sufficient number of patients (Number of those admitted) | 54.2 | 31.8 | 14 |
| 11. | Variety of educational patients (type of disease and usefulness) | 48.7 | 36.1 | 15.2 |
| 12. | Learning how to refer | 41.6 | 34.7 | 23.7 |
| 13. | Learning how to track and solve patients' problems | 43 | 34.5 | 22.5 |
| 14. | Teaching how to achieve diagnosis by professors | 45 | 46.5 | 8.5 |
| 15. | Healthcare education (vaccination, disease prevention, family health services, etc.) | 46 | 42.5 | 11.5 |
| 16. | Effects of course on students' knowledge and attitudes (garment field) | 44 | 37 | 19 |
| 17. | The effectiveness of psychiatric clinic on students’ information and attitudes | 49 | 30 | 21 |
| 18. | Influence of internal clinic on students’ knowledge and attitudes | 46 | 34.7 | 19.3 |
| 19. | Effect of skin clinic on students’ knowledge and attitudes | 45.2 | 28.8 | 26 |
| 20. | The effect of women’s clinic on students’ information and attitudes | 43.5 | 43.8 | 12.7 |
| 21. | The influence of pediatric clinic on students’ information and attitudes | 39.7 | 32.3 | 28 |
| 22. | The degree of efficiency and applicability of the entire course | 44.9 | 34.8 | 20.3 |
| 23. | The extent of the presence in the field of writing skills | 35.7 | 37.1 | 27.2 |
| 24. | Applicability of trainings for the future | 44.3 | 30 | 25.7 |
| 25. | The efficacy of community-based medical education in a 2-week fixed-duration routine | 42 | 29 | 29 |
| 26. | The interest in attending the field of medical education community in the future | 41.4 | 35.6 | 23 |
| 27. | The efficacy of community-based education in 2 - 6 days visits from sections 1 to 3 months | 39.2 | 33.3 | 27.5 |
| 28. | Overall satisfaction with the quality of education | 46 | 29 | 25 |
aValues are expressed as percentage.
5. Discussion
The present research found the professors’ proper accountability (96.7%), their timely and regular presence (56.9%) and providing scientific education about communication with the patients (56.9%) to be the areas of student satisfaction, whereas the study conducted by Eslamipour et al. in Isfahan attributed the lowest satisfaction with the lack of timely presence of professors for exchanging information with the students in the scientific environment, unclear evaluation criteria and the attitude of the professors to the patient bedside. Moreover, the results of the study conducted by Khosravi and Khadivi on the quality of health field from the perspective of the clerkships and internships of Shahrekord Medical School showed that below 50% of the internships were satisfied with planning methods, presentation of the topic and the students’ attendance (7, 8).
The present study found the students’ satisfaction with the effect of the courses offered in specialized clinics and with the effectiveness and applicability of community-based courses to be below average (44.9%). It is in line with the results of the study conducted by Khezrian et al. in Ahvaz University of Medical Sciences in 2014, and the study by Farzianpour et al. on students’ satisfaction with the quality of educational programs in internship courses in Tehran University of Medical Sciences (9, 10).
5.1. Conclusions
Given the purpose of the study, i.e. determining the problems and evaluating the quality of educational services in the community-based center from the perspective of medical students, and the efforts made by the university principals and policy makers to fulfill the goals and ensure the educational quality, it is necessary to note that the results of the present research indicate the satisfaction of nearly half of the students in most of the studied areas. Furthermore, the authorities can be argued to hold a special attitude in this area.
