Medicine Course Research Articles

111 Using Video Teleconferencing for an Effective Remote Simulation Course in Transfer Medicine

Critically ill patients require transfer within and between hospitals – a necessity amplified by ITU capacity pressures during the COVID-19 pandemic. This rising demand highlighted the need for dedicated transfer teams. Alongside establishing and expanding a cross-sector transfer team, we necessarily needed to meet growing training requirements. Transfer medicine is a core competency for intensivists, anaesthetists, ITU nurses and pre-hospital staff, with simulation recommended in the respective curricula. However, COVID-related restrictions alongside demands on staff’s time, limited opportunities for face-to-face training. We overcame these challenges by developing an online simulation-based course. Teleconferencing has previously been received favourably and rated highly for educational benefit The aim of the study was to test the efficacy of and response to remote simulation-based training in transfer medicine.Before attending the online simulation, multi-disciplinary participants completed 3 hours of interactive e-learning hosted online via the platform Rise. This incorporated case-based discussions, practical assignments and filmed presentations. Simulation utilized Zoom teleconferencing to immerse participants in clinical transfers. We used high-fidelity, pre-recorded scenarios made with a mannequin simulator and high-definition video. The participants observed the simulated transfer of critically ill patients (Example screenshot of online simulated scenario with participants observingA total of 21 multi-disciplinary participants completed training: 43% doctors and 57% nurses. 100% of respondents (18) rated the course 5/5 on the Likert scale when asked ‘how much did you enjoy the course’ and 100% would recommend the course to colleagues. All rated the course extremely relevant to their practice. Average assessment scores pre- versus post-course improved by approximately 20% (74.3% to 94.4%) (Results of pre- and post-course knowledge assessmentsWe developed an effective and well-received remote simulation transfer course to deliver training to a wide-reaching audience. Participants were enthusiastic about the innovative and interactive approach, finding the online course enjoyable and relevant to their clinical practice. Results suggest the course effectively increased learning. The flexible nature of online remote provision allows for delivery at scale, to meet a rising demand. Further evaluation will establish the extent at which this training translates to performance, such as a reduction in adverse events in transfer practice.

123 Tint: Training in Trauma Simulation Programme

Major trauma is one of the leading contributors to death for several age groups globally making it a public health concern. There are approximately 20,000 cases of major trauma per year in England and over 25% of these result in deaths This Emergency Medicine (EM) course was designed for Specialty and Associate Specialist Grade (SASG) doctors to develop leadership skills and to demonstrate technical and non-technical skills as a trauma team leader (TTL) when assessing severely injured patients. This course has a strong focus on the understanding of hospital systems and processes for the timely assessment and treatment of complex trauma patients.After a successful HEE funding bid, a simulation training course was devised to cover the main principles of trauma management and the non-technical skills required to manage a trauma patient and help up-skill the 14 SASG doctors at an urban trauma unit. Five scenarios were designed based on real patients seen in urban trauma units in London. On designing the scenarios, an understanding of the functioning of hospital systems such as requesting and administering blood products and transferring patients both within the hospital and within the trauma network, were crucial learning objectives.This course was delivered weekly from January to June 2021. Sessions involved the EM SASG doctor, two EM nurses and the members of the wider MDT expected at each trauma call, to recreate the resuscitation room environment. Each SASG doctor underwent all five trauma simulation scenarios individually as the TTL. Each scenario was followed by a focussed debrief by two EM consultants, with discussion around human factors, technical and academic aspects of trauma management. All 14 SASG doctors completed the five trauma scenarios. As a result of this training, there has been an improvement in the management of patients with higher injury severity scores in the ED based on both clinical supervision and feedback from the candidates. Given the impact on practice that this training has had, this course will be delivered to the wider trauma teams within the trust, with the EM SASG doctors continuing as TTLs.

Care For Small Babies: A DOH Policy-in-waiting

Care For Small Babies: A DOH Policy-in-waiting

Data science in undergraduate medicine: Course overview and student perspectives

BackgroundDespite the growing interest in health data science education, it is not embedded in undergraduate medical curricula and little is known about best teaching practices. This paper presents a highly innovative course in a UK university that introduces undergraduate medical students to data science. It also discusses a study on student perspectives on the learning and teaching of health data science. MethodsThe pedagogical design elements of the Data Science in Medicine course are discussed, along with its syllabus, assessment methodology and flipped classroom delivery. The course has been offered to approximately 630 students over three years. Student perspectives were investigated through three focus groups with the participation of 19 students across different study years in medicine. An experiment was conducted regarding instructor-led vs. video-based modalities of online programming labs, with the participation of 8 students. ResultsThe course has led to improved data competency among medical students and to a positive change in their opinions about data science. Motivating the course and showing relevance to clinical practice was one of the biggest challenges. Statistics was perceived by focus group participants as an essential data skill. Including data science in the medical curriculum was perceived as important by Year 1 students, while opinions varied between Year 4/5 participants. Video-based online labs were preferred over instructor-led online labs, and they were found to be more useful and enjoyable, without leading to any significant difference in academic performance. ConclusionsTeaching data science to undergraduate medicine students is highly desirable and feasible. We recommend including statistics in the curriculum and practical skill development through simple and clinically-relevant data science tasks, supported through video-based online labs. Further reporting on similar courses is needed, as well as larger-scale studies on student perspectives.

Scientific research with cancer patients during the COVID-19 pandemic: an experience report

Scientific research brings resolutions to several problems in society, supporting clinical performance in health. Work with cancer patients needs to be even more careful. During the COVID-19 pandemic, cancer patients enter the risk group for exposure to the virus, limiting the monitoring of the disease, impairing treatment. New health technologies and telemedicine have been on the rise in recent years, changing the course of medicine, research and health care. Its implementation and validation have been widely discussed in recent years, and it was greatly encouraged by the COVID-19 pandemic. To report the development, adaptations and the six-month longitudinal follow-up of 20 individuals who underwent thyroidectomy at a university hospital. The research flowchart initially persisted in evaluating symptoms and vocal fatigue in individuals undergoing thyroidectomy due to thyroid cancer at three times: pre-surgical (M1), immediate post-surgical (M2) and late post-surgical (M3) in three to six months. The individuals were submitted to videolaryngoscopy, voice recording, voice acoustic analysis and completion of self-assessment protocols along with the medical consultation. All assessments were performed on an outpatient basis at the three times described. The research began in October 2019, and was interrupted at the beginning of the pandemic. In February 2020 we obtained eight cases with the two initial assessments, and only two cases with M3. Due to the pandemic, the surgeries were suspended and the continuity of the study was impaired, requiring modifications. The initial goal was to last nine months with 30 individuals in the sample. New cases were followed up from October 2020 until May 2021 when there was a reduction in cases. At the end, all data from 20 individuals in this period of the research were collected. The completion time increased from nine months to 20 months. None of the patients were infected by COVID-19 during the research period. Therefore, the treatment of cancer patients encompasses several aspects that have been hampered by its continuity, delaying deadlines and making access difficult by COVID-19. As well as, scientific research in this population has undergone several adaptations to preserve the health of individuals, not unnecessarily exposing them to contamination with the virus. Monitoring by telemedicine proved to be effective for the initial objectives of this study, but it may limit it depending on the type of proposed intervention. Despite the existing pandemic, scientific production should not be stopped because it brings discoveries that aim to improve the health of the population.

Practice of Clinical Teaching Reform based on Health Belief Model

The purpose of this study is to study the effect of this health education mode on the practice of clinical teaching reform based on the health belief model. We made an attempt and satisfaction survey on three teaching methods of clinical medicine courses for 90 students in our school. The results show that the clinical teaching method based on the health belief model is novel, clear in thinking, focused and easy to understand and remember. At the same time, taking cases to analyze, it strengthens the training of clinical thinking, cultivates a kind of ability and stimulates learning interest. This shows that the practice of clinical teaching reform based on health belief model is basically complete and feasible, and provides a set of scientific and reasonable methods for clinical teaching in the future.

An innovative General Practice based Pharmacy Longitudinal Clerkship: using theory to characterise its development, implementation and initial evaluation

ABSTRACT Background Longitudinal Integrated Clerkships exist in undergraduate medicine courses. A pilot Pharmacy Longitudinal Clerkship (pPLC) was funded to investigate delivery of this model of clinical education for student pharmacists. Objective(s) To investigate the development, implementation and initial evaluation of a pPLC. Methods The 11-week pPLC was delivered to two students in two GP practices in Scotland. Mixed theory-based methods were used to gather information on the pPLC structures and processes required and qualitative semi-structured Theoretical Domains Framework (TDF) based interviews explored outcomes with key stakeholders. Informed written consent was obtained. Interviews were audio-recorded, transcribed verbatim and analysed thematically. University Ethics approval was granted. Results Data were generated on resources and processes required for a pPLC including funds budgeted for and actually spent on staffing, student travel/subsistence and student clinical ‘Kit Bags’, learning outcomes, curriculum and training timetable, GP Practice/University contracts. Interviews were completed with the two students, three linked GP clinical supervisors and two Regional Tutors involved. The seven themes were identified and mapped to seven TDF domains including: increased levels of student confidence, and increased student enthusiasm for a career in pharmacy, need for definition of the role of the Regional Tutor for the PLC and GP positivity towards the expected outcomes of clerkship model versus traditional placements. Conclusion Findings are limited by the small number of participants and settings, but evaluation was positive and the work garnered information on requirements for resources and processes. This will inform ‘roll out’ of the PLC.

Presentation and evaluation of a modern course in disaster medicine and humanitarian assistance for medical students

BackgroundDisaster medicine is a component of the German medical education since 2003. Nevertheless, studies have shown some inconsistencies within the implementation of the national curriculum, and limits in the number of students trained over the years. Recently, the SARS-CoV-2 pandemic and other disasters have called attention to the importance of training medical students in disaster medicine on a coordinated basis. The aim of this study is to present and evaluate the disaster medicine and humanitarian assistance course, which was developed in the University of Tübingen, Germany.MethodsThe University Clinic for Anesthesiology and Intensive Care Medicine in Tübingen expanded the existing curriculum of undergraduate disaster medicine training with fundamentals of humanitarian medicine, integrating distance learning, interactive teaching and simulation sessions in a 40 h course for third-, fourth- and fifth- year medical students.This prospective and cross-sectional study evaluates the Disaster Medicine and Humanitarian Assistance course carried out over five semesters during the period between 2018 and 2020. Three survey tools were used to assess participants’ previous experiences and interest in the field of disaster medicine, to compare the subjective and objective level of knowledge before and after training, and to evaluate the course quality.ResultsThe total number of medical students attending the five courses was n = 102 of which n = 60 females (59%) and n = 42 males (41%). One hundred two students entered the mandatory knowledge assessment, with the rate of correct answers passing from 73.27% in the pre-test to 95.23% in the post-test (t [101] = 18.939, p < .001, d = 1.88). To determine the subjective perception of knowledge data were collected from 107 observations. Twenty-five did not complete the both questionnaires. Out of a remaining sample of 82 observations, the subjective perception of knowledge increased after the course (t [81] = 24.426, p < .001, d = 2.69), alongside with the interest in engaging in the field of disaster medicine (t [81] = 7.031, p < .001, d = .78). The 93.46% of the medical students (n = 100) graded the training received with an excellent overall score (1.01 out of 6).ConclusionThe study indicates a significant increase in students’ understanding of disaster medicine using both subjective and objective measurements, as well as an increase interest in the field of disaster medicine and humanitarian assistance. Whereas former studies showed insufficient objective knowledge regarding disaster medical practices as well as subjective insecurities about their skills and knowledge to deal with disaster scenarios, the presented course seems to overcome these deficiencies preparing future physicians with the fundamentals of analysis and response to disasters. The development and successful implementation of this course is a first step towards fulfilling disaster medicine education requirements, appearing to address the deficiencies documented in previous studies. A possible adaptation with virtual reality approaches could expand access to a larger audience. Further effort must be made to develop also international training programs, which should be a mandatory component of medical schools’ curricula.

Spiralled Palliative Care Curriculum Aligned with International Guidelines Improves Self-Efficacy but Not Attitudes: Education Intervention Study.

PurposeDespite recommendations that palliative care education should be in all health professional programmes, such education is ad-hoc and variable. To reduce variability, the European Association of Palliative Care (EAPC) published a comprehensive guideline for curricula development. This study evaluates a new palliative and end-of-life care course for medical undergraduates aligned with the EAPC guidelines, focusing on knowledge, skills and attitudes.MethodsFinal-year medical students were surveyed using two validated questionnaires: Self Efficacy in Palliative Care (SEP-C) and Thanatophobia scale (TS). We compared the intervention group, that were exposed to an integrated palliative medicine course throughout the three clinical years, with a control group that were not exposed to the new educational intervention.ResultsFor self-efficacy, the intervention group had statistically significantly higher scores than the control arm. The control group had high scores compared with international data. Positive attitudes to dying patients were low and did not differ between the two groups.ConclusionA well-designed palliative and end-of-life curriculum that is aligned to EAPC guidelines increases the self-efficacy of medical students in managing palliative patients but has little effect on attitudes to dying people. This is likely to be influenced by other factors such as the need for experiential learning.

Optimization strategies for presenting a Narrative Medicine Course from the perspective of medical interns: a qualitative study

Optimization strategies for presenting a Narrative Medicine Course from the perspective of medical interns: a qualitative study

Credit achievement ability during distance learning era: the case of Statistics in Medicine course

Credit achievement ability during distance learning era: the case of Statistics in Medicine course

Employment of color Doppler echocardiographic video clips in a cardiac auscultation class with a cardiology patient simulator: discrepancy between students\u2019 satisfaction and learning

BackgroundWe have provided fourth-year medical students with a three-hour cardiac auscultation class using a cardiology patient simulator since 2010. The test results of 2010-2012 revealed that as compared with aortic stenosis murmur, students correctly identified murmurs of other valvular diseases less often. We investigated whether employment of color Doppler echocardiographic video clips would improve proficiency in identifying murmurs of aortic regurgitation and mitral regurgitation, and whether students’ favorable responses to a questionnaire were associated with improved proficiency.MethodsA total of 250 fourth-year medical students were divided into groups of 7-9 students in 2014 and 2015. Each group attended a three-hour cardiac auscultation class comprising a mini-lecture, facilitated training, two different auscultation tests (the second test being closer to clinical setting than the first) and a questionnaire. We provided each student with color Doppler echocardiographic videos of aortic regurgitation and mitral regurgitation using a tablet computer, which they freely referred to before and after listening to corresponding murmurs. The test results were compared with those in 2010-2012. The students had already completed the course of cardiovascular medicine, comprising lectures including those of physical examination, echocardiography, and valvular heart diseases, before participating in this auscultation training class.ResultsMost students indicated that the videos were useful or somewhat useful regarding aortic regurgitation (86.3%) and mitral regurgitation (85.7%). The accuracy rates were 78.4% (81.2% in 2010-2012) in aortic regurgitation and 76.0% (77.8%) in mitral regurgitation in the first test, and 83.3% (71.4%) in aortic regurgitation and 77.1% (77.6%) in mitral regurgitation in the second test, showing no significant differences as compared to 2010-2012. Overall accuracy rate of all heart sounds and murmurs in the first test and that of second/third/fourth sounds in the first and second tests were significantly lower in 2014-2015 than in 2010-2012.ConclusionsReferring to color Doppler echocardiographic video clips in the way employed in the present study, which most students regarded as useful, did not improve their proficiency in identifying the two important regurgitant murmurs, revealing a discrepancy between students’ satisfaction and learning. Video clips synchronized with their corresponding murmurs may contribute toward improving students’ proficiency.

Abstract proceedings of the best case report contest 2021. Clinical Cases in Internal Medicine: Learning Through Practice (McMaster International Review Course in Internal Medicine, May 11-June 17, 2021, virtual course).

Abstract proceedings of the best case report contest 2021. Clinical Cases in Internal Medicine: Learning Through Practice (McMaster International Review Course in Internal Medicine, May 11-June 17, 2021, virtual course).

Views of Physicians on the Persistence and Efficiency of Basic Medical Sciences Education

Introduction: In this study, it is aimed to contribute to the persistence of the basic medical sciences education given in medical faculties, how much it can be integrated into clinical science practices and to the development of education. Materials and Methods: The study was planned in a descriptive type and a questionnaire was applied to collect the data. The population of the study consisted of medical faculty graduates and there was no limitation in the selection of the sample. The level of agreement with the statements was graded from 1 to 5 with Likert-type scaling. In the study with a total of 205 participants, numbers and percentages were used for the data. Results: Of the physicians 59.5% stated that the basic medical sciences courses they took were not sufficient and permanent for their professional life, 69.74% of them stated that the course topics in basic medical sciences education are too detailed, 60.48% of them stated they could not integrate the education they received in basic medical sciences into clinical sciences, 82.91% stated that it would be more beneficial to give basic medicine and clinical medical sciences courses simultaneously, and 86.82% of them stated that the technology-adapted auxiliary course tools will increase the quality of basic medical education. Conclusion: In today's world where important developments are experienced in medical education, innovations are needed in order to train physicians in the best way. For this, it is necessary to work on a system in which basic medicine and clinical medical sciences are integrated, the course curriculum is revised and a strong technological infrastructure is provided.

Increasing Team Effectiveness through Experiential Team Training: An Explanatory Mixed-Methods Study of First-Year Veterinary Students' Team Experiences.

This article explores the impact of experiential team communication training on student team effectiveness. First-year veterinary students were concurrently enrolled in the Group Communication in Veterinary Medicine course and applied their knowledge to their authentic team experiences in the Veterinary Anatomy and Introduction to Clinical Problem Solving courses. All students completed a modified team effectiveness instrument and a team self-reflection at the end of the semester. Results show that students experienced a high level of team effectiveness. Although students experienced challenges with respect to staying on task and distributing roles and responsibilities, team coordination and communication improved over time, due in part to the team activities associated with the team training intervention. This research provides support for the impact of experiential team training to the development of team process skills and team effectiveness.

Customised study companion improves student exam performance: a retrospective study in an undergraduate medicine course

The aims of this study were to retrospectively analyse the relationship between usage of a customised learning tool and medical student performance in an examination, and to solicit student feedback on the learning tool. Learning theories and strategies have long suggested that reducing extraneous load, e.g. by reducing learner attention to multiple information sources, could enhance learning in medicine because of more effective use of cognitive load. A customised learning tool, termed “Study Companion” (Pha1SC), was developed that integrates key analgesic pharmacology contents from several major textbooks. The entire cohort of 231 pre-clinical Medical Year 3 students was offered Pha1SC during the academic year, and 82 of them (“Users”) made use of the learning tool &nbsp;to various extents. Overall, Users earned higher scores than Non-users on exam questions regardless of their relation to the contents of Pha1SC.&nbsp; However, Users were more likely to score higher in pharmacology questions than Non-users. More importantly, Users tended to fare better on the Pha1SC-related question independently, regardless of their scores on the question not related to Pha1SC.&nbsp; Findings in this study support the adoption and refinement of Pha1SC to enhance student learning outcomes in pharmacology.

Präsenzkurse unter Lockdown-Bedingungen – eine Herausforderung

HintergrundZur Aufrechterhaltung der manualmedizinischen Kurse der ÖAMM mussten während der Lockdowns 2020/2021 entsprechende Maßnahmen ergriffen werden: Dokumentation eventueller Krankheitssymptome vor Kursbeginn durch die Teilnehmer (bei deren Vorliegen Ausschluss des jeweiligen Teilnehmers), Vorweisen eines negativen Antigentests, Bildung fixer Übungspaare im Kurs und deren Trennung durch Plexiglaswände im Kursraum, verpflichtendes Tragen von FFP2/3-Masken, Abstandhalten während der Pausen.MethodeDie Teilnehmer sollten retrospektiv beurteilen, ob es innerhalb der ersten 2 Wochen nach Kursende zu Krankheitssymptomen gekommen ist. Dazu wurde ein aktives und passives Meldesystem angewandt.ErgebnisKeiner der Kursanten hat sich während der Kurse mit SARS-CoV 2 infiziert.SchlussfolgerungDie Entwicklung und Umsetzung eines entsprechenden Sicherheitskonzepts, das den gesetzlichen Maßstäben gerecht werden muss, ermöglichen auch in Zeiten eines Lockdowns einen Kursbetrieb.

From the "what" to the "how": Teaching integrative medicine-related skills to medical students during COVID-19

ObjectiveTo examine the impact of an integrative medicine (IM) course on self-perceived IM-related communication and research skills. MethodsA 3-day mandatory "hybrid" (online and in-person) IM course was held within COVID-19 restrictions for 161 pre-clerkship medical students, with workshops facilitated by mentor healthcare professionals (IM and non-IM) and student-directed tasks. Self-perceived levels of 6 IM-related skills were scored (from 1 to 5) for history-taking; communicating with patients with "alternative" health-beliefs; referral to IM consultations; assessing risks/benefits; and working with non-medical IM practitioners. Results137 students (85.1%) completed pre-/post-course questionnaires, with overall scores improving from pre-course (1.98 ± 0.92) to post-course (3.31 ± 0.63; p < 0.0001), for the entire group and student subgroups (with vs. without prior IM experience). Multivariate analysis found no association between age, gender, primary language or prior experience with IM and improvement in skill scores. ConclusionsThe IM course increased self-perceived skill levels, reflecting the course curriculum and workshops. Further research needs to explore the application of these skills during clinical training. Practice implicationsTeaching medical students about IM in a course comprising communication and research skills was shown to be feasible and effective. The application of IM-related skills needs to be evaluated during the clinical clerkship.

Are 2020’s medical students still suffering from gender stereotypes? An Italian study

Abstract Background Gender medicine is crucial to reduce health inequalities in Europe. Knowledge about medical students' attitudes and beliefs regarding sex and gender is important to improve gender medicine courses. The aim of this study is to evaluate gender awareness and its predictors in Italian medical students. Methods During 2020, we performed a cross-sectional study among medical students from the University of Turin, Italy. We used the validated Nijmegen Gender Awareness Scale in Medicine (N-GAMS) to investigate gender sensitivity (GS) and gender role ideology towards patients (GRIP) or doctors (GRID). Multivariable logistic regression model was performed to explore potential predictors of gender awareness. Results Globally, 430 participants completed the survey (68.4% were females). The 62.5% of male students had a poor knowledge of gender medicine. GRID score significantly differs between males and females (1.64±0.68 vs 1.51±0.49; p = 0.028). Males had lower GS scores (coefB -0.96, p &amp;lt; 0.05), while students who had a better knowledge on gender medicine (coefB 0.14, p &amp;lt; 0.05) and those who have received good example from tutors (coefB 0.14, p &amp;lt; 0.05) were more gender-sensitive. Older age (coefB 0.04, p &amp;lt; 0.05), a better knowledge on gender medicine (coefB 0.12, p &amp;lt; 0.05) and having had a tutor sensitive to gender issues (coefB 0.13, p &amp;lt; 0.05) were predictors of more stereotyped opinions towards patients. Having had a tutor aware of gender medicine (coefB 0.03, p &amp;lt; 0.05), male sex (coefB 0.12, p &amp;lt; 0.05) and older age (coefB 0.03, p &amp;lt; 0.05) were associated with more stereotypes towards doctors. Conclusions Gender stereotypes are still common. During university courses and practical training more attention must be paid to explain that stereotyped gender differences are not scientifically proven and they do not contribute to provide better care. Therefore, the implementation of gender specific teaching throughout elective courses should be seriously considered. Key messages Receiving more knowledge and more attention about gender medicine during university education was associated with higher gender stereotypes in our sample of medical students. Interventions in European university education are needed to make gender medicine education more effective in order to reduce gender stereotypes and contribute to better care.

A comparative study of community medicine and public health curriculum at medical schools in Iran and North America

Background: Community medicine and public health are the core subjects in medical education. One of the main competencies of general physicians in the national curriculum is having knowledge and skills in health promotion and disease prevention in the health system. Any curriculum revision in community medicine departments needs to incorporate the evidence and use pioneer countries’ experiences in this issue. This study aims to compare community medicine and public health courses in medical schools between Iran and selected universities in North America. Methods: The elements of a community medicine curriculum for medical students were compared in a descriptive-comparative study using the Bereday model. These elements included objectives and competencies, educational strategies, teaching and learning methods, assessment, and educational fields in a community medicine curriculum in Iran and in selected universities in North America. A literature search was conducted in CINAHL, SCOPUS, MEDLINE, Web of Science, EBSCO, and on university websites. Results: Essential aspects of community-based strategies among community medicine and public health curriculum of general medicine in universities in Canada and the United States included a longitudinal approach, training in urban and rural primary care centers, teaching by family physicians and health center staff, a spiral curriculum, focus on social determinants of health, taking of social and cultural histories and social prescriptions, learning teamwork, and using LIC (Longitudinal Integrated Curriculum). Conclusion: The objective of community medicine and public health curriculum in selected North American universities was to prepare general practitioners who work in Level 2 and 3 hospitals and to improve their skills to provide high-quality services to the community. Some of the successful points in the selected universities that could be replicated in Iranian faculties of medicine included using integration strategy, a spiral curriculum, and an LIC approach.