Development Strategies in Medical Education

Introduction
The higher education system is one of the key elements of human development in every country [1]. An important characteristic of higher education in the last four decades has been the rapid expansion of higher education institutions in developing countries, including Iran [1, 2]. In the examination of educational services in knowledge-based organizations, knowing the level of satisfaction of service recipients is of great importance. The satisfaction of people in these organizations can cause organizational dynamism and lead to the elevation of organizational goals [2, 3]. 
Students play a major role in evaluating the performance and educational activities of any university and provide us with the necessary information for the qualitative and quantitative improvement of this organization. Therefore, surveying students' satisfaction with educational activities is necessary. One of the educational courses offered to medical students, especially during the internship period in teaching hospitals, is training in the emergency department. Due to the full-time presence of professors of various specialized fields in this department and the high volume and variety of incoming patients, this department plays a significant role in the education of medical students, including interns [7, 8]. However, in most cases, it seems that the lack of a systematic and coherent training program in this department causes the desired result not to be achieved and the level of training and learning to be very low [9]. 
This causes stress and lower self-confidence in young graduated doctors and subsequently prevents them from providing optimal services to patients, especially in deprived and needy areas. Recent studies have shown that the more medical students work with patients in emergency situations alongside experienced professors, the more self-confidence they gain. Considering that scant research has been done on the satisfaction of interns with training in the emergency department of hospitals in Iran, and considering the importance of this high-risk department in medical internship training, this study aims to evaluate the satisfaction of medical interns with training in the emergency department of Shahid Beheshti Hospital in Kashan, Iran.

Methods
This is a descriptive-analytical study that was conducted in the internal emergency department of Shahid Beheshti Teaching Hospital. The study population consists of all interns who were working in this hospital in 2020 and had completed training in the emergency department. The number of samples was estimated to be 95 using Cochran's formula. To increase the accuracy, 100 questionnaires were distributed among the participants. The data collection tools were a demographic form (surveying age, gender, and marital status) and the questionnaire used by Masoomi and Dastgiri [14]. 
The questionnaire has 33 items rated on a Likert scale from very favorable (5) to very unfavorable (1). It measures satisfaction in four areas: The quality of time spent in the emergency department (4 items), the teaching quality of professors (9 items), the quality of teaching basic skills (8 items), and the quality of training in performing main medical procedures (12 items). The total score ranges from 33 to 165. The collected were analyzed in SPSS version 16 software using descriptive statistics (frequency, mean, and standard deviation) and inferential statistics (independent t-test to compare the mean satisfaction scores based on gender and marital status). The significance level was set at 0.05.

Results
In this study, 100 interns (69 females) with a mean age of 25.26±1.24 years (ranged 23-33 years) participated, of which 44 people were married. Overall, 56% of interns found the quality of clinical training in the internal emergency department of the hospital to be moderate, and 38% of them perceived the quality of training to be optimal. According to them, the quality of clinical training was favorable (>70%) in performing diagnostic-therapeutic measures, evaluating interns, the approach to chest problems, the approach to abdominal pain, the approach to multiple traumas, the approach to shortness of breath, the approach to gastrointestinal bleeding, performing CPR, NGT insertion and gastric lavage, blood sampling to check arterial blood gas, and simple stitching. In total, the male interns' satisfaction (116.77±16.58) was significantly higher compared to females (107.06±19.34) (P=0.017). Regarding the domains of satisfaction, the difference between males and females was significant only in the quality of time spent in the emergency department (P=0.012). In terms of marital status, the difference between interns was significant also only in the quality of time spent in the emergency department (P=0.028), which was higher in single interns compared to married ones.

Conclusion
In this study, the most of medical interns' satisfaction with clinical training in the internal emergency department of Shahid Beheshti Hospital in Kashan, Iran, was at a moderate level. The highest level of satisfaction was related to the quality of training in performing medical procedures, followed by the quality of teaching basic skills, the quality of time spent in the emergency department, and the teaching quality of professors. The current status of the emergency department in the present study is higher in comparison with the results of similar studies. This can be due to the recent changes in the emergency department and the separation of the trauma and internal emergency departments from each other in Shahid Beheshti Hospital, as well as attention to the training programs of this department in the hospital by the two training groups of emergency medicine and internal medicine.

Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval from Kashan University of Medical Sciences (Code: IR.KAUMS.NUHEPM.REC.1399.074).

Funding
This study was funded by Kashan University of Medical Sciences.

Authors' contributions
The authors contributed equally to preparing this paper.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the Clinical Research Development Unit of Shahid Beheshti Hospital and the Vice-Chancellor for Research of Kashan University of Medical Sciences for their cooperation and support.

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