Background: Due to the limitations of clinical learning and the consideration of patients’ rights, the emphasis on educating clinical and communication skills and creating attitudes in students has received much attention, which requires an appropriate educational environment. Methods: In a descriptive study, we examined challenges and proposed solutions in a clinical skills center in 2017. The study participants were 60 medical students and 29 faculty members at the Tabriz University of Medical Sciences who were selected randomly and followed for 12 months, from October 2016 to October 2017. The classical modified Delphi technique was used to collect data and study execution in three rounds. Results: From the perspectives of academic board members, the most critical weaknesses included "small and limited educational environment of workshops" (weight of consensus=212.5), "severe lack of educational facilities such as simulators" (weight of consensus=158.9), and "lack of adequate facilities for assessing students’ skills" (weight of consensus=140.9) based on the results. From the perspectives of academic board members, the most crucial weaknesses in the field of management and execution were "lack of adequate constructional infrastructure" (weight of consensus=239.2), "lack of adequate funding for the clinical skills center" (weight of consensus=200.1) and "lack of approved organizational chart for clinical skills center" (weight of consensus=200.1). Conclusion: The main challenges of the Clinical Skills Center of Tabriz University of Medical Sciences included the lack of definition of an organizational chart, lack of sufficient funding to provide educational facilities, lack of standard educational space, and clinical skills evaluation, which the Center for Clinical Skills developed. Most of the center’s problems were resolved by allocating sufficient funds to provide educational facilities and cultivate a culture of interdisciplinary collaboration supported by university authorities.

Background Given the importance and pivotal role of nurses in pain management and control, this study was conducted to determine the nurses’ knowledge and attitudes toward in emergency departments. Methods This study was designed and conducted as a descriptive-analytical cross-sectional study. Nurses’ attitude and knowledge towards pain management and control and relationship between their demographic characteristics have been assessed. Nurse Attitude Survey (NAS) and Pain management and control principles assessment Test (PMPAT) questionnaires were used. Results Totally 400 volunteers, including 148 (37.2%) male and 250 (62.8%) female nurses recruited from 23 hospitals in East Azerbaijan, Iran, with a mean age of 30.88 years (± 6.04 SD) and age range between 22 and 53 years old. The crude mean score of participants’ knowledge of pain management and control was 12.51 (± 2.77 SD), and standardized mean score was 40.34 (± 8.92 SD), which was low at 84.8% and moderate in 15.3% of the participants. Older nurses and nurses who previously participated in pain retraining courses had significantly less knowledge about pain management and control (r= -0.104, P = 0.038), and (r= -0.148, P = 0.003) respectively. The crude mean score of participants’ attitudes toward pain control and management was 15.22 (± 2.56 SD), and standardized mean score was 60.87 (± 10.26 SD). Nurses’ attitudes have become more negative with the increase of their work experience (r = -0.168, P = 0.001), and previously participation in pain retraining courses (r =-0.207, P < 0.001). Older nurses and highly educated nurses had significantly more negative attitudes towards pain control and management (r = -0.153, P = 0.002), and (r= -0.126, P = 0.005), respectively. Conclusions The current study revealed that pain management and control knowledge in most emergency nurses was low, and most of them had a moderate attitude. We need more scientific and comprehensive pain management and control training courses to improve knowledge and attitude among health workers and nurses.