Design and validation of a model for improving the quality of clinical education for medical students at Qom University of Medical Sciences: a mixed-method research

Subject Areas : Instructional Excellence of management

fatemeh sadat saadatfard ¹ , Gholamreza Sharifirad ² , Siamak Mohebi ³ , Zabihollah Gharlipour ⁴

1 - ph.D. Student, Depatment of Educational Sciences, Qom Branch, Islamic Azad University, Qom,
2 - Department of Health Education and Promotion, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
3 - Department of Health Education ; Health Promotion, Faculty of Health, Qom University of Medical Sciences, Qom, Iran.
4 - Department of Health Education and Promotion, Faculty of Health, Qom University of Medical Sciences, Qom, Iran

Received: 2024-12-05 Accepted : 2025-03-10 Published : 2025-06-20

Keywords: Case Study, Clinical Education, Medical Students, Quality Improvement, Quality of Clinical Education,

Abstract :

Background and Objectives:

Clinical education is a crucial process in training medical students, playing a fundamental role in shaping their professional capabilities and competencies. It is a vital and key component in developing physicians responsible for maintaining and promoting community health. With the increasing importance of health care at various levels of the medical system and especially in dealing with patients, the improvement of clinical skills through appropriate clinical training has become essential and is regarded as a critical process in the academic activities of medical students. Given that learning in clinical environments is influenced by various factors—such as clinical setting, student characteristics, workplace challenges, social networks, and prior knowledge and skills—guiding and supporting medical students during clinical training is a highly complex and multidimensional task. Hence, this study aimed to design and validate a model for improving the quality of clinical education for medical students at Qom University of Medical Sciences, and to evaluate the current state of related components from students’ perspectives.

 

Methodology:

The research method used was a mixed-method, sequential exploratory approach of classification. The qualitative phase involved a qualitative case study, and the participants included 15 specialists and experts in clinical education who were selected using purposive sampling. Criteria for participation included a minimum academic rank of assistant professor, at least five years of clinical teaching experience, and prior authorship in the field of medical education. The data collection tool was in-depth semi-structured interviews, and content analysis based on the Attride-Stirling framework was employed to analyze the data. Forty basic themes, ten organizing themes, and one global theme—“Improving the Quality of Clinical Education”—were identified. Key components such as effective planning, human resources, financial resources, structure, clinical environment, professional ethics, supervision and control, communication, equipment, and technology emerged as central to the model. The validity of qualitative findings was ensured using Lincoln and Guba’s four criteria: credibility, transferability, confirmability, and dependability.

 

In the quantitative phase, the statistical population consisted of 280 medical students in internship and stager courses at Qom University of Medical Sciences. A sample of 200 was selected purposively for validating the model, and 162 students were selected using simple random sampling based on Cochran's formula to evaluate the current status of the components. A researcher-made questionnaire based on the qualitative phase findings was developed, including 40 items across 10 components, with responses measured on a 5-point Likert scale. Content validity was confirmed using the CVI index with expert input, and reliability was assessed using Cronbach’s alpha (α = 0.77 overall; ≥ 0.72 for the two key components).

 

Findings:

Confirmatory factor analysis (CFA) at both first and second order levels confirmed the construct validity of the proposed model. The CFA indices (χ²/df < 3, RMSEA < 0.05, NFI, NNFI, and CFI > 0.90) indicated a good fit for the model. According to students’ responses, the mean scores of all ten components—including clinical environment (2.12), effective planning (2.18), equipment (2.30), financial resources (1.94), technology (2.59), supervision and control (2.63), communication (2.70), structure (2.14), professional ethics (2.38), and human resources (2.77)—were significantly lower than the theoretical average of 3 (p < 0.001), indicating that none of the components were implemented effectively in the current clinical education environment.

 

Conclusion:

Achieving appropriate efficiency in clinical education by improving its quality for medical students requires extensive coordination at various levels of universities and hospitals. Programs for clinical education must be implemented considering the influential factors identified in this model. The study concludes that clinical education is a multidimensional and complex process that must be based on pre-planned and coordinated programming and preparation of learning environments. Developing competent medical professionals necessitates equipping them with the necessary knowledge, skills, and ethical frameworks through structured learning environments, consistent supervision, and updated training resources. The research findings emphasize that clinical learning environments must promote meaningful learning opportunities through exposure to real or simulated patients, supported by effective instructional methods, ethical engagement, and well-defined roles. Additionally, the findings revealed that the current state of clinical education quality at Qom University of Medical Sciences is unsatisfactory and needs urgent and comprehensive improvements across all dimensions of the proposed model. Strengthening clinical education processes can significantly enhance medical students’ capabilities in addressing patient needs and ensuring the effectiveness of healthcare services.

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