Development Strategies in Medical Education

Introduction
One of the important parts of education is the educational materials, which should be in accordance with the defined goals and related developments to be effective. Improving the quality and dynamism of the study courses requires continuous quantitative and qualitative assessments. Revising or updating the study courses in universities should be considered continuously according to the latest developments so that the higher education system can meet the needs of the society. Considering the continuous changes in the health issues and the health care system and in the expectations and needs of consumers, technologies and demographic profile, there is a need for continuous improvement and innovation and the elimination of defects in the fields of study in medical universities. Due to the increase in Iran’s population ageing, the policy makers have tended to formulate policies whose main goal is to increase the population. According to the plan of “support for families and the youth of the population”, all higher education institutions of the country have been recommended to promote and raise awareness about the positive aspects of marriage, teaching skills during marriage, counseling for childbearing and the negative effects of low fertility, and timely detection and treatment of infertile people or those at risk of infertility, while removing educational content that are against childbearing. 
The graduates of counseling in midwifery play an effective role in the health of society and providing consulting services regarding health, education, research and management. They also play an important role in implementing the country’s population-related plans; therefore, this novel study aims to examine the need for revising the “counseling in midwifery” curriculum in medical universities for improving the plan of “Support for Families and Youth of the Population” in Iran.

Methods 
This is a qualitative study using conventional content analysis method. The data was obtained using semi-structured interviews with professors and graduates of counseling in midwifery from Kerman University of Medical Sciences, whose opinions were surveyed regarding the need for updating the counseling in midwifery curriculum. A purposive sampling was done, followed by a convenience sampling method until data saturation was reached. The interview included three general questions with the following details:
Question 1: Considering that the goal of the “support for families and the youth of the population” plan is to increase the population of Iran, which items of this plan should be included in the counseling in midwifery curriculum?
Question 2: For each of theory and specialized internships courses of this curriculum ( counseling and sexual health promotion, counseling on peri- and postmenopause periods,  common mental disorders during pregnancy, counseling on genetics and congenital diseases, communication skills part 1 and 2, family planning, pregnancy, prenatal and postpartum counseling, family health) comment on what should be revised or updated?
Question 3: In what areas can the counseling in midwifery curriculum be expanded at the community level in accordance with the “support for families and the youth of the population” plan?

Results 
The participants in this study included 5 graduates with a master’s degree in counseling in midwifery aged 27-35 years and 5 professors of this field of study aged 38-45 years and with 4-15 years of work experience. Six main categories of “population youth and family support”, “maintaining and improving the fertility rate of women and men”, “ training of experts to prevent infertility”, “ counseling for childbearing and sexual health “, “Improving mothers’ health status and children’s growth and development” and “Increasing the marriage rate and reducing divorce rate” were extracted each with sub-themes. 

Conclusion
Updating the curriculum of counseling in midwifery can be an important step in improving the “support for families and the youth of the population” plan in Iran. The revisions should be made based on the suggestions in this study in four areas of management, culture building, empowerment and research. Based on the findings of the present study, the necessary changes should be made in the theory and internships courses of the counseling in midwifery curriculum in accordance with the population growth policies and capabilities of professors, students and people. By holding educational workshops for supporting the youth of the population, empowering professors and students, and reviewing the curriculum, efforts should be made in implementing the plan. 

Ethical Considerations
Compliance with ethical guidelines
The study objectives were explained to the participants and their informed consent was obtained. Their information was kept confidential and they were free to leave the study at any time. This study was approved by the Ethics Committee of Kerman University of Medical Sciences (Code: IR.KMU. REC.1402.093).

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Conceptualization, methodology, formal analysis: Masoumeh Ghazanfarpour; investigation, resources, original draft preparation, and supervision: Sara Najibi; data curation, review & editing, visualization, and project administration:  Atefeh Ahmadi.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank the participants and the Reproductive Health, Family, and Population Research Center of Kerman University of Medical Sciences for their cooperation and support in this research.


References

1. Khaghanizade M, Malaki H, Abbasi M, Abbaspour A, Mohamadi E. [Faculty-related challenges in medical ethics education: A qualitative study (Persian)]. Iran J Med Educ. 2012; 11(8):903-16. [Link]
2. Kohan S, Bahrami M, Molaeinezhad M, Haghani F, Taleghani F, Taghizadeh Z, et al. [Exploring challenges of the reproductive health PhD curriculum: A qualitative research (Persian)]. J Med Educ Dev. 2016; 11(1):27-42. [Link]
3. Webster J, Zeshan U. READ WRITE EASY: Research, practice  and innovation in deaf multiliteracies. Lancaster: Ishara Press; 2021. [Link]
4. Maestas N, Mullen KJ, Powell D. The effect of population aging on economic growth, the labor force, and productivity. Am Econom J Macroeconom. 2023; 15(2):306-32. [DOI:10.1257/mac.20190196]
5. Fouladi M. [An analysis of demographic changes and transformations in Iran with an emphasis on the golden opportunity of the demographic window (Persian)]. J Soc Cult Knowl. 2019; 10(3):43-60. [Link]
6. Tayeri S, Jafari M, Alimohammadzadeh K, Hosseini S M, Shahanaghi K. [A conceptual model for Iranian older women’s health: A review study (Persian)]. Salmand. 2021; 16 (3):304-29. [Link]
7. Tabatabaei SM, Erfanmanesh MH, Abbasi M. Legal tourism, ethical considerations and applicable law in abortion. Med Ethics J. 2016; 9:77-106.[Link]
8. The Council of Islamic Republic of Iran. [Family and youth protection law (Persian)] Tehran: The Council of Islamic Republic of Iran; 2019. [Link]
9. Yazdani S, Akbarilakeh M. Explanation and clarification of the concept of value in medical education. J Pizhuhish dar din va salamat. 2017; 3(2):88-101. [Link]
10. Kerman University of Medical Sciences. [Master’s degree in midwifery counseling (Persian)]. Kerman: Kerman University of Medical Sciences; 2022. [Link]
11. Mohammadi M, Naseri Jahromi R, Moeini Shahraki H, Mehrabaniyan N. [Evaluation of internal efficiency and external effectiveness of the general medicine curriculum: Perspectives of students, graduates and faculty members at Shahid Sadughi University of Medical Sciences (Persian)]. Iran J Med Educ. 2013; 13(3):233-43. [Link]
12. Nasser JS, Chung KC. Recommendations for the reform of medical education in China: A SWOT analysis. Health Policy Open. 2020; 1:100018. [DOI:10.1016/j.hpopen.2020.100018] [PMID] 
13. Heintz F, Mannila L, Nordén LÅ, Parnes P, Regnell B. Introducing programming and digital competence in Swedish K-9 education. Paper presented at: 10th International Conference on Informatics in Schools: Situation, Evolution, and Perspectives. November 13-15 2017, Helsinki, Finland. [Link]
14. Couper I, Ray S, Blaauw D, Ng'wena G, Muchiri L, Oyungu E, et al. Curriculum and training needs of mid-level health workers in Africa: A situational review from Kenya, Nigeria, South Africa and Uganda. BMC Health Serv Res. 2018; 18(1):553. [DOI:10.1186/s12913-018-3362-9] [PMID] 
15. Ofori-Adjei D. Changing landscape of public health and medical education curriculum. Ghana Med J. 2018; 52(3):115. [DOI:10.4314/gmj.v52i3.1] [PMID] 
16. Mayring P. Qualitative content analysis: Demarcation, varieties, developments. Forum: Qualitative Social Research. 2019; 20(3):1-14. [Link]
17. Stevens PA. Qualitative data analysis: Key approaches. California: SAGE Publications; 2022. [Link]
18. Sohrabi H, Askari Tayibi F. Investigating solutions to increase population in Iran based on Islamic lifestyle. J Cult Relig Knowl. 2022; 3(1). [Link]
19. Khalajabadi Farahani F, Kiani Aliabadi F. [Rethinking the meaning & implications of child in life: A qualitative approach among voluntary childless married women in Tehran (Persian)]. J Popul Assoc Iran. 2018; 13(25):67-106. [Link]
20. Razeghi Nasrabad HB, Alimondegari M. Gender preference and its influence on fertility intention in the low-fertility context of Tehran, Iran. J Midwifery Reprod Health. 2019; 7(4):1972-80. [DOI:10.22038/JMRH.2019.38096.1422]
21. Khodakarami B, Naseritazehgeshlag M, Parsa P, Mohammadi U. [Effect of group counseling on attitude about” Child as a Pillar of Life” in women referring to Hamadan City Comprehensive Health Centers (Persian)]. Avicenna J Nurs Midwifery Care. 2020; 28(1):27-35. [DOI:10.30699/ajnmc.28.1.27]
22. Hosseini H, Askari Nodoushan A, Moradi N. [A comparative study of childbearing desires of Shia and Sunni Kurdish women in rural areas of Kamyaran (Persian)]. J Woman Fam Stud. 2016; 4(1):63-84. [DOI: 10.22051/JWFS.2016.2340]
23. Seymour JW, Frasso R, Shofer FS, Bennett IM. Cohort study of early literacy and childbearing over the reproductive lifecourse. BMJ Open. 2016; 6(12):e013522. [DOI:10.1136/bmjopen-2016-013522] [PMID] 
24. Dekker RL, King S, Lester K. Social media and evidence-based maternity care: A cross-sectional survey study. J Perinat Educ. 2016; 25(2):105-15. [DOI:10.1891/1058-1243.25.2.105] [PMID] 
25. Farrokh-Eslamlou HR, Vahabzadeh Z, Moeini R, Moghaddam Tabrizi F. [Pre-marriage couplesfertility attitude following recent childbearing persuasive policies in Iran (Persian)]. Nurs Midwifery J. 2014; 11(10):836-46. [Link]
26. Hosseini H, Bagi B. Socioeconomic, cultural and demographic determinants of childbearing desires among married women attending health centers in Hamedan (2012). J Kermanshah Univ Med Sci. 2014; 18(1):e74273. [DOI:10.22110/jkums.v18i1.1578]
27. No Author. Report of the International conference on population and development. New York: United Nations; 1995. [Link]
28. Khalajabadi Farahani F. [Meta Analysis of premarital heterosexual relationships among young people in Iran over the Past 15 Years (2001-2015) (Persian)]. J Fam Res. 2017; 12(3):339-67. [Link]
29. Vakilian K, Mousavi SA, Keramat A. Estimation of sexual behavior in the 18-to-24-years-old Iranian youth based on a crosswise model study. BMC Res Notes. 2014; 7:28. [DOI:10.1186/1756-0500-7-28] [PMID] 
30. Hedayati-Moghaddam MR, Eftekharzadeh-Mashhadi I, Fathimoghadam F, Pourafzali SJ. Sexual and reproductive behaviors among undergraduate university students in Mashhad, a city in Northeast of Iran. J Reprod Infertil. 2015; 16(1):43-8. [PMID]