Development Strategies in Medical Education

Introduction
Comparative studies, as one of the best research methods in the fields of education and planning, are of interest to scholars, because the differences and similarities between educational systems can be investigated in order to discover their strengths and weaknesses. The nurses should have scientific and practical abilities suitable to current knowledge to perform all nursing care at different levels. Identifying the problems in nursing education and taking action to solve them can lead to achieving educational goals and improving the quality of healthcare services. Nursing education, as a part of higher education, has been developing and expanding at a high speed in the world; however, this development has not only caused concern about the quality of education in this field, but also caused challenges such as the competence of the graduates and the quality of nursing curricula. Every educational curriculum must be developed, revised, and modified in accordance with the needs of the society. The present study aims to investigate the similarities and differences between the critical care nursing curricula for postgraduate students in Iran and Monash University in Australia.

Methods
This descriptive-comparative study was conducted in 2022 using Bereday’s four-step model, including description, interpretation, juxtaposition, and comparison. In the description step, research phenomena are extracted based on evidence and information. In the interpretation step, the information collected in the first stage is analyzed. In the juxtaposition step, the information that was prepared in the previous step is classified and put together in order to create a framework for comparing similarities and differences. Finally, in the comparison step, the similarities and differences between the two educational curricula are compared according to the research questions.
We first obtained the critical care nursing curricula for postgraduate students from the websites of the Iranian Ministry of Health and Medical Education and the Australian Monash University. Then, the data was listed in the tables for each element of the curricula, including: history and evolution of the major, philosophy, mission, vision and goals, expected outcomes and roles of graduates, conditions and methods of admission to the postgraduate course, and characteristics, structure and arrangement of sections in two curricula. Then, the two curricula were analyzed and their strengths and weaknesses were identified and compared according to the conditions of the two countries.

Results
The philosophy of the critical care nursing curricula for postgraduate students in Iran is based on human values and dignity, the right to make decisions, paying attention to Islamic values, ​​and social justice. In the Monash University, the philosophy is based on concepts such as critical thinking and the use of evidence-based practice. The vision of this course in the Monash University is to transform community health by using nurses’ impact on improving health. The vision in Iran is to achieve regional and international standards in the next ten years. The length of this course in Iran is 2-3 years and full-time, based on the educational regulations. While this course in the Monash University is offered both part-time and full-time; the length of the full-time course is 2 years and the length of the part-time course is about 3 years. In the Monash University, the students at the end of the course can have a project according to their interest experimentally based on clinical practice, or conduct a research project. In Iran, students do not have a flexible choice for this course and must present a thesis. 

Conclusion
Despite the many commonalities in the mission, vision and goals, and the roles of the students in the two critical care nursing curricula for postgraduate students in Iran and Monash University, differences were also revealed. The type of presentation of the project at the end of the course and the way of offering the course (full-time or part-time) were among the differences. Also, the lessons of this course in Australia are presented based on clinical evidence and an emphasis on nurses’ critical thinking. Based on the comparison made in this study, for the training of creative and efficient nurses, it is recommended to develop critical care nursing curriculum for postgraduate course in Iran with a collaborative approach by considering important concepts such as critical thinking, clinical decision making, clinical reasoning, and problem-solving. To facilitate the development of nursing education in Iran according to the existing capacities, it is necessary to change the thesis-oriented approach and replace it with a nursing practice-based approach. In fact, the type of presentation of the project at the end of the course should be chosen by the students. It is also recommended to offer part-time courses and use distance learning or to create an opportunity to study in the city where students live, in addition to offering full-time courses, given that most of the postgraduate students in this course are married or employed. The results of this study can help the planners in Iran to improve the quality of the critical care nursing course for postgraduate students.

Ethical Considerations
Compliance with ethical guidelines
In the current research, the ethical aspects of the review study have been observed, including the originality of the texts, honesty, and trustworthiness.

Funding
This article has not received any financial support and is the result of the class research project of the PhD in nursing.

Authors' contributions
Conceptualization: Tahereh Gilvari, Masoud Fallahi-Khoshknab; Methodology: Tahereh Gilvari, Masoud Fallahi-Khoshknab, Narges Arsalani; Validation: Masoud Fallahi-Khoshknab, Narges Arsalani; Formal Analysis: Tahereh Gilvari, Masoud Fallahi-Khoshknab, Narges Arsalani; Investigation: Tahereh Gilvari, Faezeh Khajemirzai, Soheila Zabolypour, Leila Rafiee-Vardanjani; Resources: Tahereh Gilvari, Faezeh Khajemirzai, Soheila Zabolypour, Leila Rafiee-Vardanjani; Writing – Original Draft Preparation: Tahereh Gilvari; Writing – Review & Editing, Visualization: Tahereh Gilvari, Masoud Fallahi-Khoshknab; Supervision, Project Administration: Masoud Fallahi-Khoshknab

Conflicts of interest
The authors declare that there is no conflict of interest in the present study.

Acknowledgments
The cooperation and assistance of the professors of the Nursing Department, University of Rehabilitation Sciences and Social Health are thanked and appreciated.



References

1. Mirzabeygi G, Sanjari M, Salemi S, Babaei F, Kheradmand M. [The necessity for specialty education in nursing MS program: Viewpoints of the faculty members of school of nursing and midwifery in Iran (Persian)]. Iran J Med Educ. 2010; 9(3):263-71. [Link]
2. Tehran University of Medical Sciences. M.Sc. in critical care nursing. Tehran: Tehran University of Medical Sciences; 2020. [Link]
3. Lameaei A. [Clinical education ahead of current event (Persian)]. Stud Med Sci. 2006; 17(1):9-15. [Link]
4. Ghaffari R, Amini A, Yazdani S, Alizadeh M, Salek Ranjbarzadeh F, Hassanzadeh Salmasi S. [Comparative study: Curriculum of undergraduate medical education in Iran and in a selected number of the world’s renowned medical schools (Persian)]. Iran J Med Educ. 2012; 11(7):819-31. [Link]
5. Hosseini Largani SM, Yadegarzadeh R. [University curriculum development models in higher education: A proposed model for higher education in Iran (Persian)]. J High Educ Curriculum. 2021; 11(22):49-88. [Link]
6. Khosravi M, Arman M. A model for implementing changes in curriculum in higher education. J Innov Entrep. 2019; 7(4):65-84. [Link]
7. Salminen L, Stolt M, Saarikoski M, Suikkala A, Vaartio H, Leino-Kilpi H. Future challenges for nursing education-A European perspective. Nurse Educ Today. 2010; 30(3):233-8. [DOI:10.1016/j.nedt.2009.11.004] [PMID]
8. Aliyari S, Maleki H, Pazargadi M, Abbaspour A. [Designing accreditation model for curricula of baccalaureate degree nursing education in Iran (Persian)]. Iran J Med Educ. 2016; 16(0):328-40. [Link]
9. Arshadi M, Rahkar Farshi M. Conformity of nursing researches with comprehensive health plan of Iran (case study: Master’s theses and Ph.D. in nursing of Tabriz university of medical sciences) (Persian)]. Health Inf Manage. 2015; 12(1):61-8. [Link]
10. Millear PM, Greenaway R, Schmidt J. Using curriculum design principles to renew teaching and learning in developmental psychology. Paper presented in: 40^th HERDSA Annual International Conference: Higher Education Research and Development Society of Australasia (HERDSA). 28 Jun 2017; Sydney, Australia. [Link]
11. Makarem A, Movahed T, Sarabadani J, Shakeri MT, Asadian Lalimi T, Eslami N. [Evaluation of educational status of oral health and community dentistry department at Mashhad dental school using CIPP evaluation model in 2013 (Persian)]. J Mashhad Dent Sch. 2014; 38(4):347-62. [Link]
12. Rokhafroz D, Mamashli L, Ramezanpour E, Kalani l. [Comparative comparison of critical care nursing master’s curriculum of Iran and Griffith University (Persian)]. Iran J Nurs Res. 2023; 18(2):60-72. [DOI:10.22034/IJNR.18.2.7]
13. Rezaie F, Sanagoo A, Araghian Mojarad F, Jouybari L. [Comparative study of master’s critical care nursing program in Iran and Scotland (University of Edinburgh) (Persian)]. Res Med Educ. 2022; 14(2):58-66. [DOI:10.52547/rme.14.2.58]
14. Ashrafi Z, Babamohamadi H, Nobahar M. [Comparative study of master’s critical care nursing program in Iran and Melbourne, Australia and strategies for promotion in Iran (Persian)]. J Nurs Educ. 2019; 8(4):9-18. [Link]
15. Nikfarid L, Ashktorab T. [Understanding of neonatal intensive care nurse practitioner students of situation of their profession in Iran: A qualitative study (Persian)]. Iran J Nurs Res. 2013; 8(2):37-46. [Link]
16. Borzou SR, Oshvandi K, Cheraghi F, Moayed MS. [Comparative study of nursing PhD education system and curriculum in Iran and John Hopkins school of nursing (Persian)]. Educ Strateg Med Sci. 2016; 9(3):194-205. [Link]
17. Shanghai Ranking. 2023 global ranking of academic subjects [Internet]. 2023 [Updated 2024 July 31]. Available from: [Link]
18. Topunivercities. QS world university rankings by subject: Nursing [Internet]. 2023 [Updated 2024 July 31]. Available from: [Link]
19. Monash University. Monash Courses brochures. Melbourne: Monash University; 2023. [Link]
20. Monash University. Monash School of Nursing and Midwifery. Melbourne: Monash University; 2023.
21. Wojniak J. George ZF Bereday (Zygmunt Fijałkowski) and his comparative method in educational research. Paper presented in: ERPA International Congresses on Education 2018 (ERPA 2018). 15 August 2018; İstanbul, Turkey. [DOI:10.1051/shsconf/20184801050]
22. Aghazade A, Ahghar G, Fazlalizade R. [Analytical and comparative study of characteristics curriculum higher education for distance studies in Iran and England and India (Persian)]. Interdiscip Stud Hum. 2012; 4(4):75-106. [Link]
23. Monash University. Monash Australia. Melbourne: Monash University; 2023.
24. Khoshkesht S, Navab E. [Comparative study of nursing PhD education program in Tehran university of medical sciences and McGill university (Persian)]. Iran J Nurse Res. 2019;14(4):72-80. [Link]
25. Ebadinejad Z, Nobahar M, Babamohamadi H. [Comparison of master’s degree curriculum for pediatric nursing in Iran and King of England: A comparative study (Persian)]. J Pediatr Nurs. 2020; 6(3):22-9. [Link]
26. Motahari M, Rahimibashar M, Ghasemnegad S. [The relationship between clinical self-efficacy and academic achievement motivation in nursing students (Persian)]. Res Med Educ. 2020; 12(2):10-20. [DOI:10.29252/rme.12.2.10]
27. Bolick BN, Haut C, Reuter-Rice K, Leflore J, McComiskey CA, Mikhailov TA, et al. The acute care pediatric nurse practitioner: Curriculum overview. J Pediatr Health Care. 2012; 26(3):231-7. [DOI:10.1016/j.pedhc.2011.11.001] [PMID]
28. Demeco A, Marotta N, Barletta M, Pino I, Marinaro C, Petraroli A, et al. Rehabilitation of patients post-COVID-19 infection: a literature review. J Int Med Res. 2020; 48(8):300060520948382. [DOI:10.1177/0300060520948382] [PMID]
29. Sanjesh. [Registration booklet for the masters exam of the Ministry of Health-1402 (Persian)]. Tehran: Sanjesh; 2023. [Link]
30. King MO, Gates MF. Perceived barriers to holistic nursing in undergraduate nursing programs. Explore. 2006; 2(4):334-8. [DOI:10.1016/j.explore.2006.04.002] [PMID]
31. Mariano C. Holistic nursing as a specialty: Holistic nursing-scope and standards of practice. Nurs Clin North Am. 2007; 42(2):165-88. [DOI:10.1016/j.cnur.2007.03.008] [PMID]
32. Vali Zadeh L, Zaman Zadeh V, Fathi Azar A, Safaeian A. [Barriers and facilitators of research utilization among nurses working in teaching hospitals in Tabriz (Persian)]. Hayat. 2002; 8(2):32-42. [Link]
33. Kermanshahi S, Parvinian AM. [Barriers to implementation of evidence-based care: Viewpoints of nursing staff (Persian)]. Iran J Med Educ. 2012; 12(2):84-92. [Link]
34. Hasani Narenjbaghi S, Valizadeh L, Bagheriyeh F. [Comparative study of master’s curriculum of neonatal intensive care nursing in Iran and Pennsylvania university united states (Persian)]. Nurs Midwifery J. 2017; 15(7):514-23. [Link]
35. Taghlili F, Arsalani N, Ahmadi M, Naseh L, Moghaddam F, Fallahi-khoshknab M. [Comparative study of Iranian postgraduate nursing and surgical nursing curriculum with university of pennsylvania in USA (Persian)]. Iran J Nurs Res. 2023; 18(2):73-82. [DOI:10.22034/IJNR.18.2.8]
36. Azimi H, Momeni M, Rezapour Nasrabad R. [Comparative study of medical and surgical nursing master’s education program in Iran and USA (Persian)]. Iran J Nurs Res. 2021; 16(5):80-94. [Link]
37. Papathanasiou IV, Kleisiaris CF, Fradelos EC, Kakou K, Kourkouta L. Critical thinking: The development of an essential skill for nursing students. Acta Inform Med. 2014; 22(4):283-6. [DOI:10.5455/aim.2014.22.283-286] [PMID]
38. Tajabadi A, Aghaei M, Roshanzadeh M. [Comparison of the educational system and the newest nursing graduate curriculum in Iran and Toronto: A comparative study (Persian)]. Educ Strateg Med Sci. 2019; 11(6):82-9. [DOI:10.29252/edcbmj.11.06.12]
39. Ahmadi M, Arsalani N, Taghlili F, Moghaddam F, Naseh L, Fallahi-Khoshknab M. [Comparison of Iranian master’s of psychiatric nursing curriculum with Duke university of America: A comparative study (Persian)]. Iran J Nurs Res. 2023; 17(6):32-42. [DOI:10.22034/IJNR.17.6.32]
40. Tabari Khomeiran R, Deans C. Nursing education in Iran: Past, present, and future. Nurse Educ Today. 2007; 27(7):708-14. [DOI:10.1016/j.nedt.2006.10.003] [PMID]
41. Farsi Z, Dehghan-Nayeri N, Negarandeh R, Broomand S. Nursing profession in Iran: An overview of opportunities and challenges. Jpn J Nurs Sci. 2010; 7(1):9-18. [DOI:10.1111/j.1742-7924.2010.00137.x] [PMID]
42. Arian M, Nobahar M, Babamohamadi H. Comparative study of nursing Master’s education program in Iran and John Hopkins school of nursing (Persian)]. J Nurs Educ. 2018; 7(3):34-48. [Link]
43. Talebi R, Jouybari L, Mahmoodi Shan GR. [Comparison of the curriculum of master of pediatric nursing in Iran and Ingram, McGill Canada: A comparative study (Persian)]. J Nurs Educ. 2021; 10(4):63-72. [Link]
44. Sekse RJT, Hunskår I, Ellingsen S. The nurse's role in palliative care: A qualitative meta-synthesis. J Clin Nurs. 2018; 27(1-2):e21-38. [DOI:10.1111/jocn.13912] [PMID]
45. Freed GL, Dunham KM, Lamarand KE, Loveland-Cherry C, Martyn KK; American Board of Pediatrics Research Advisory Committee. Pediatric nurse practitioners: Roles and scope of practice. Pediatrics. 2010; 126(5):846-50. [DOI:10.1542/peds.2010-1589] [PMID]
46. Claybourn C. Act vs. Sat: How to decide which test to take [Internet]. 2022 [Updated 2023 March 20] Available from: [Link]
47. Mehrdad N, Salsali M. [Strategies in developing research based nursing practice: A review article (Persian)]. Iran J Nurs Res. 2008;3(9):15-25. [Link]