Development Strategies in Medical Education

Introduction
The World Health Organization defines the quality of life as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”. College life is related to the life experienced during education, and for its assessment,  students’ level of satisfaction is used. Due to their heavy academic and non-academic needs, nurses face many stressful and complicated challenges and situations in their college life, which affects their quality of college life. Therefore, it is important to pay attention to the indicators of the quality of college life of nursing students to improve their quality of life. One of the important indicators is self-efficacy, which refers to a person’s belief in his/her own capacity to succeed in a specific situation. People with high self-efficacy face the problem instead of avoiding it and have a high commitment to achieve their goals. In previous studies, scholars have paid attention to the quality of life only from the psychological point of view, and the physical dimension and the college life quality have been neglected. Therefore, this study aims to assess the role of the quality of college life in the academic self-efficacy of Iranian nursing students.

Methods
This is a descriptive cross sectional study. By using stratified random sampling method, from among 501 nursing students of Gonabad University of Medical Sciences (GUMS) in 2024, 217 eligible students were selected. Consent to participate in the research was the criterion for inclusion, and unwillingness to cooperate and incomplete return of the questionnaire was the criterion for exclusion from the study. Mahdi’s 59-item Quality of College Life Scale (QOCLS) in Persian (with 15 dimensions including: professors’ teaching quality, classroom environment and conditions, university and field of study, cultural diversity in the university, conditions of dormitories, religious and cultural programs in the university, conditions of libraries, transportation/facilities/accessibility, medical facilities, sanitation status and environment of the university, communication services of the university, recreational/sports/welfare services of the university, facilities granted by welfare funds, career prospects and personal growth of students, hanging out with friends or peers) and Owen and Froman’s 32-item College Academic Self-Efficacy Scale (CASES) were used to collect data. In the CASES, a score of 32-53 indicates a low level; a score of 53-106 indicates a moderate level, and a score >106 indicates a high level of academic self-Efficacy. To analyze the data, descriptive statistics including mean and standard deviation as inferential statistics including Pearson’s correlation test and regression analysis were used. SPSS software, version 20 was used for data analysis. The significance level was set at 0.05.

Results
Participants were 131 males (61%) and 86 females (39%); 165 (76%) were nursing students and 52 (24%) were the emergency medicine students. The mean total score of QOCLS was 197.755±44.138 and the mean total score of CASES was 129.354±18.086. To investigate the relationship between quality of college life and academic self-efficacy, Pearson’s correlation test was used. There was a significant positive relationship between them (r=0.884, P<0.01). Also, there was a significant relationship between academic self-efficacy and dimensions of QOCLS (P<0.01). 
To know the role of college life quality dimensions in predicting the academic self-efficacy of the GUMS students, multiple regression analysis was used. The F statistic was significant and the R2 value showed that 24% of the variance in students’ academic self-efficacy was explained by the dimensions of college life quality including professors’ teaching quality, classroom environment and conditions, cultural diversity in the university, medical facilities, sanitation status and environment of the university. recreational/sports/welfare services of the university, and conditions of libraries.

Conclusion
The results showed a positive and significant relationship between the overall quality of college life and academic self-efficacy in the GUMS students. The academic self-efficacy can be predicted by professors’ teaching quality, classroom environment and conditions, cultural diversity in the university, medical facilities, sanitation status and environment of the university. recreational/sports/welfare services of the university, and conditions of libraries. conditions of dormitories, religious and cultural programs, students’ career prospects and future, field of study, transportation facilities, communication services, facilities granted by welfare funds, hanging out with friends or peers are not significant predictors of academic self-efficacy. It is recommended that health care system managers in Iran should consider individual and organizational factors affecting academic self-efficacy of medical students in their plans and improve their academic self-efficacy.

Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval (Code: IR.GMU.REC.1402.111) from the Research Ethics Committee of Gonabad University of Medical Sciences. After explaining the study objectives and method to the participants, their informed consent was obtained. They were assured that their information would remain confidential and were free to leave the study at any time.

Funding
This research was funded by the Nursing Research Center of Gonabad University of Medical Sciences.

Authors' contributions
Project management, Supervision: Ali Akbar Ajam; Conceptualization, Validation, Methodology, Editing and review: Ali Akbar Ajam and Asma Ebrahimian; Analysis: Ali Akbar Ajam, Asma Ebrahimian and Sedigheh Davari; Research, Resources, Visualization: Asma Ebrahimian and Sedigheh Dvari; Writing and preparation of the original draft: Asma Ebrahimian. All authors read and approved the final draft. 

Conflicts of interest
The authors declare no conflict of interest in any of the research stages.

Acknowledgements
The authors would like to thank all students and the Nursing Research Center of Gonabad University of Medical Sciences for their cooperation and support in this research.


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