Universities assess their academic learning environment to improve students' learning. Students' experience in e-learning environment is different from faceto-face educational environment. So, in this study a specific valid and reliable instrument was devised for assessing perception of e-students from educational environment, that is, educational atmosphere. Firstly, we devised the primary instrument based on factors constituting educational atmosphere. Then Instrument's content and construct validity were assessed. Also, Cronbach's alpha and test-retest were used for studying the internal consistency and reliability of the instrument respectively. The final instrument named 'e-learning educational atmosphere measure' (EEAM) consisted of 40 items covering six factors, including programme effectiveness, teaching quality, ethics and professionalism, learner support, safety and convenience, and awareness of the rules, which accounted for 68.53% of variances. Content validity ratio was more than 0.51 and content validity index score of all questions was above 0.81. Test-retest reliability was 0.85 (p = 0.001) and Cronbach's alpha was 0.943. Assessing educational atmosphere in e-learning settings by EEAM could provide managers and investors with useful information to settle an effective education system by prioritising the necessary changes.

Background:Studying medicine is perceived to be stressful, and a high level of stress may have a negative effect on cognitive functioning and mental health of the students.Objectives:In this study, we assessed perceived stress and its severity, sources and determinants.Patients and Methods:In this cross-sectional study, we assessed the perceived stress and its severity, sources and demographic variables in 341 (136 males, 205 females) randomly selected medical students of Tehran university of medical sciences, Iran, in October 2013. A self-administered valid and reliable questionnaire with a possible range of scores from 0 to 56 was used to collect the data. Stress sources were determined using logistic regression analysis.Results:The overall perceived stress mean was 32.02 (SD = 5.08). Eighty-three percent of the medical students perceived stress. Students in clinical phase perceived more stress than basic sciences ones [OR 2.25, 95% CI 1.809 - 4.032]. Logistic regression analysis showed demographic (including gender and residential status), psychosocial and academic factors and the phase of study as sources of stress.Conclusions:The results of this study show that most of the medical students declared perceived stress. So, a change in medical education environment and empowering students to effectively cope with the perceived stress sources and their families to support their children is needed.

BackgroundWith the increasing popularity of e-learning programs, educational stakeholders are attempting to promote critical thinking in the virtual education system. This study aimed to explore the experiences of both the instructors and the students about critical thinking promotion within the virtual education system.MethodsThis qualitative study recruited the instructors and students from four academic disciplines provided by the Virtual School of Tehran University of Medical Sciences (Tehran, Iran). All programs were master’s degree programs and utilized a blended (combination of e-learning and face to face) training. Semistructured interviews with the participants were used to collect data.ResultsThe participants had a variety of experiences about how to promote critical thinking. These experiences were conceptualized in four main themes, namely, instructional design, educational leadership and management, local evidence, and belief systems.ConclusionThe present study clarified the factors affecting critical thinking promotion in e-learning. Not only the instructors but also the educational designers and leaders can benefit from our findings to improve the quality of virtual education programs and promote critical thinking.

Background In Iran, admission to medical school is based solely on the results of the highly competitive, nationwide Konkoor examination. This paper examines the predictive validity of Konkoor scores, alone and in combination with high school grade point averages (hsGPAs), for the academic performance of public medical school students in Iran. Methods This study followed the cohort of 2003 matriculants at public medical schools in Iran from entrance through internship. The predictor variables were Konkoor total and subsection scores and hsGPAs. The outcome variables were (1) Comprehensive Basic Sciences Exam (CBSE) scores; (2) Comprehensive Pre-Internship Exam (CPIE) scores; and (3) medical school grade point averages (msGPAs) for the courses taken before internship. Pearson correlation and regression analyses were used to assess the relationships between the selection criteria and academic performance. Results There were 2126 matriculants (1374 women and 752 men) in 2003. Among the outcome variables, the CBSE had the strongest association with the Konkoor total score ( r = 0.473), followed by msGPA ( r = 0.339) and the CPIE ( r = 0.326). While adding hsGPAs to the Konkoor total score almost doubled the power to predict msGPAs ( R 2 = 0.225), it did not have a substantial effect on CBSE or CPIE prediction. Conclusions The Konkoor alone, and even in combination with hsGPA, is a relatively poor predictor of medical students’ academic performance, and its predictive validity declines over the academic years of medical school. Care should be taken to develop comprehensive admissions criteria, covering both cognitive and non-cognitive factors, to identify the best applicants to become "good doctors" in the future. The findings of this study can be helpful for policy makers in the medical education field.

Background:Perimembranous Ventricular Septal Defect (PMVSD) is the most common subtype of ventricular septal defects. Transcatheter closure of PMVSD is a challenging procedure in management of moderate or large defects.Objectives:The purpose of this study was to show that transcatheter closure of perimembranous ventricular septal defect with Amplatzer Ductal Occluder (ADO) is an effective and safe method.Patients and Methods:Between April 2012 and April 2013, 28 patients underwent percutaneous closure of PMVSD using ADO. After obtaining the size of VSD from the ventriculogram a device at least 2 mm larger than the narrowest diameter of VSD at right ventricular side was chosen. The device deployed after confirmation of its good position by echocardiography and left ventriculography. Follow up evaluations were done 1 month, 6 months, 12 months and yearly after discharge with transthoracic echocardiography and 12 lead electrocardiography.Results:The mean age of patients at procedure was 4.7 ± 6.3 (range 2 to 14) years, mean weight 14.7 ± 10.5 (range 10 to 40) kg. The mean defect size of the right ventricular side was 4.5 ± 1.6 mm. The average device size used was 7.3 ± 3.2mm (range 4 to 12 mm). The ADOs were successfully implanted in all patients. The VSD occlusion rate was 65.7% at completion of the procedure, rising up to 79.5% at discharge and 96.4% during follow-up. Small residual shunts were seen at completion of the procedure, but they disappeared during follow-up in all but one patient. The mean follow-up period was 8.3 ± 3.6 months (range 1 to 18 months). Complete atrioventricular block (CAVB), major complication or death was not observed in our study.Conclusions:Transcatheter closure of PMVSD with ADO in children is a safe and effective treatment associated with excellent success and closure rates, but long-term follow-up in a large number of patients would be warranted.