BACKGROUND: During the course of their education, medical students must attain moral competence. The current study aims at designing a formative structured examination that would create the opportunity for learners to practice and interact with simulated patients under expert supervision. MATERIALS AND METHODS: This article reports an experience in developing and implementation of a formative assessment of moral competence and the point of view of medical students. In this study, the formative structured examination of medical ethics for 80 medical students in 2 rounds with eight stations was designed. In each station, a scenario was proposed, and the opportunity was provided to the learners to interact with a simulated patient under the supervision of a medical ethics expert. Then, the learners would receive structured feedback in accordance with their performance. All learners expressed their experience in reflective writing, and their opinions were put under content analysis. RESULTS: The content analysis of this reflective writing revealed three main categories, namely “Deeper understanding of ethical subjects,” “Collaborative thinking and synergy with peers,” and “Effective feedback of supervisors.” CONCLUSION: Within the framework of a formative structured examination of medical ethics, a safe space was created for interacting with simulated patients and practicing ethical reasoning, as well as dimensions of moral competence.

Background: Secondary hyperparathyroidism is prevalent among hemodialysis patients associated with vascular and skeletal complications. Thus, treatment is required, specially before kidney transplantation. Objectives: This study aimed to compare the efficacy of calcitriol and cinacalcet versus standard-dose calcitriol in treating severe secondary hyperparathyroidism in hemodialysis patients. Methods: This randomized clinical trial was conducted on 70 hemodialysis patients with severe secondary hyperparathyroidism who were randomly allocated to two intervention groups. Group A received calcitriol 1mg PO every other night, and group B took calcitriol 1mg PO every other night and cinacalcet 30mg PO daily. The improvement of laboratory parameters was investigated 3 and 6 months after the intervention. Results: There was no significant difference between the two groups regarding age, sex, body mass index, and duration of dialysis (P > 0.05). In group A, serum levels of calcium (P < 0.001) and parathyroid hormone (PTH) (P < 0.001) were significantly reduced compared to baseline. However, phosphorus (P = 0.175) and albumin (P = 0.143) serum levels showed no significant changes. In group B, calcium (P = 0.001), PTH (P < 0.001), and serum phosphorus (P < 0.001) levels were significantly decreased after the intervention. Nevertheless, serum albumin levels showed no significant changes from baseline (P = 0.061). Changes in serum phosphorus (P < 0.001) and PTH levels (P < 0.001) were significantly different between the groups. However, changes in serum calcium (P = 0.062) and albumin levels (P = 0.773) were not significantly different (Wilcoxon signed-rank test). Conclusions: The results of this study showed that treatment with cinacalcet and calcitriol was more effective than calcitriol alone without any side effects.