Assessing educational gaps in Iran’s nursing education system: a mixed-method approach to the infectious diseases curriculum | BMC Medical Education

In the present study, an educational needs assessment was conducted using a mixed-methods approach, combining qualitative and quantitative research. In the qualitative phase, three main categories of needs were identified: the need for participants to pay attention to the content of the infectious diseases course, the need for participants to focus on the internship component of the course, and the need to consider educational strategies. In the quantitative phase, the needs questionnaire, developed from the qualitative findings, was analyzed in two rounds using the modified Delphi method and descriptive statistics (frequency, mean, and standard deviation).

The curriculum should be responsive to the needs of society and students, which necessitates the adaptation of the infectious diseases curriculum [13]. Welch et al. emphasize that key components for the effectiveness of a course include educational materials, teaching methods, course evaluation, management and organization, and the physical environment in which the course is delivered [14]. Watson criticized the traditional approaches to nursing education and argued that the curriculum should be designed based on the concept of care and the lived experiences of students and other learners [15].

Developing the content of the infectious diseases curriculum to adequately prepare students for effective performance in the dynamic healthcare environment is crucial. It is essential that the curriculum aligns with the practical settings in which graduates will work [16]. One of the most frequently mentioned issues by both students and professors in this study was the large volume of content in the infectious diseases course. This course, which only consists of 0.5 units across four class sessions, is limited in time and lacks integration of some relevant topics within the program. These concerns underscore the importance of reviewing and revising the infectious diseases curriculum in educational planning. These findings are consistent with the results of the study by Manning et al., who also argued that although certain infection-related concepts are included in nursing courses, there is limited evidence of their comprehensive integration throughout the curriculum—an issue that may contribute to nursing students’ inadequate understanding of infection prevention and control [17]. In this study, both professors and students, as well as experts involved in the Delphi stages, highlighted the necessity of using lesson plans to define the general and specific goals, as well as the expected outcomes of the course. Experts in the educational system believe that enhancing the teaching and learning process requires the implementation of effective teaching methods and techniques, especially through the development of lesson plans. A well-developed lesson plan serves as the foundation for educational planning and fosters interaction and dynamic engagement between professors and students. It is considered one of the most effective ways to improve the quality of education. However, in many medical universities in Iran, lesson plans are either not sufficiently developed by professors or, if they are, they are not adequately shared with students or effectively implemented [18].

Setting a lesson plan clearly defines important goals, such as “what we want” and “how to teach” for the teacher, and “how to learn” for the student. Moreover, by reducing inhibiting factors, it enables the optimal use of class time, enhancing both efficiency and effectiveness [19]. A suitable lesson plan should, at a minimum, include outlines, main and behavioral goals, learners’input behavior, assessment methods, educational activities, teaching methods, required educational tools, and supplementary activities outside the classroom.

In Shahrokhi et al.’s study, which analyzed 100 lesson plans from 24 nursing and midwifery schools in Iran, only 13% of the lesson plans were deemed optimal, while 83% were classified as average quality [18]. Similarly, Nik Bakhsh et al. found that most faculty members did not present their lesson plans to students in writing and did not use formative assessments to evaluate students [20]. The implementation of systematic evaluation in internships was one of the key points emphasized by experts in nursing education. Systematic evaluation allows for the accurate identification of problems, enables stakeholders to engage in finding solutions, optimizes the use of resources, and prevents redundant efforts. Additionally, it leads to higher-quality teaching and is an essential step in motivating learners. It clarifies problems, identifies opportunities, and defines relationships between people involved in the process [21]. In the present study, over 80% of professors agreed with preparing and presenting the lesson plan in the first session of the infectious diseases course. In contrast, Sabarian et al.’s study found that 49.1% of nursing professors were opposed to presenting the lesson plan at the first session [19].

Since many teachers have been trained in environments that predominantly use teacher-centered and lecture-based methods, they tend to prefer using the same teaching approach [22]. Various factors such as the ease of the lecture method, its suitability for crowded classes, a lack of teachers’skills in other teaching methods, limited teaching time, and the large volume of educational content contribute to the continued use of the teacher-centered approach [23]. These teachers are often content-oriented and prefer formal classes with fewer participants [24].

The shift away from traditional teaching methods, a topic frequently discussed in educational research, remains a major concern for the country’s education system. In Zareiyan Jahromi et al.’s study, the transition from teacher-centered strategies to more interactive approaches, such as pamphlet writing, was emphasized [24]. Haj Bagheri et al.’s study, which compared various teaching methods on nursing students’satisfaction, anxiety, and learning, revealed that involving students in teaching had a significant positive effect on their learning and satisfaction [25]. Chenjaler and Chomphtong, in their research on the student-centered teaching method, found that students taught using active, student-centered approaches were more satisfied than those taught through traditional methods [23, 26]. In Mohammadi Mehr’s study, it was highlighted that most students consider the correct use of educational tools as an important criterion for evaluating a competent teacher [27]. University professors who use various teaching tools and methods to present educational content can make the material more engaging, even with large and complex subject matter. Effective communication methods during teaching can help reduce student distraction and increase concentration. Additionally, a flexible classroom environment that fosters a two-way relationship between professors and students ultimately contributes to meaningful learning [28].

Clinical training is crucial in nursing education, as it provides students with real-world experiences that allow them to apply theoretical knowledge and develop essential decision-making and problem-solving skills [29, 30]. Clinical education, which comprises about half of nursing students’training, plays a vital role in professional development. Therefore, it is necessary to have appropriate evaluation methods for clinical environments. Evaluating clinical skills is one of the most critical aspects of assessing nursing students [31]. However, as highlighted by several studies, accurate and objective evaluation of students in clinical education remains a challenging and stressful task for professors [32].

Leaving students in clinical environments without an instructor, not utilizing professors from the infectious disease theory course during related internships, not involving professors skilled in the field of infectious diseases, and the gap between theory and clinical practice were some of the concerns raised by students in their interviews. Gazavi et al. also reported negative experiences of students feeling neglected by clinical professors in the clinical setting [32]. Similarly, Sabarian et al. found that most professors did not maintain a close relationship with their students [33].

Given the ever-evolving nature of clinical education, the need for new and innovative evaluation methods has become more pronounced. Currently, various evaluation methods have been developed for clinical environments, including workbooks, direct observation of skills (DOPS), objective structured clinical examinations (OSCE), short clinical exams, 360-degree evaluations, and exposure to simulated clinical conditions [33]. However, experts hold different views on which clinical evaluation methods are most effective. For instance, in a study conducted on Shiraz students, the use of a logbook for evaluating internal surgery and gynecology was met with relative dissatisfaction. Asgari et al. also found that this method did not meet all of the set learning goals [34]. Another new evaluation method, patient discussion, helps assess students’mental competence. However, it is time-consuming and may lack accuracy due to uncertainties regarding the students’documentation and the general comments used for grading, which poses challenges in ensuring objectivity [35, 36]. On the other hand, in Hosseini et al.’s study, midwifery students reported significantly higher satisfaction with modern clinical evaluation methods, such as DOPS, compared to the logbook method. This greater satisfaction is likely due to the more objective nature of the modern methods, which do not rely on the personal judgment of professors [31]. In generally the findings of this study are consistent with those of Farahani et al., who identified several key challenges in nursing education in Iran, including the dominance of the biomedical model in the curriculum, weak alignment between theoretical and clinical education, and inadequate educational infrastructure. These challenges may hinder the development of students’ professional identity and the implementation of competency-based education [3]. One of the limitations of the present study was the difficulty in accessing nursing faculty members who teach the infectious diseases course, particularly during the COVID-19 pandemic. This challenge hindered the qualitative interview process and may have affected the scope and diversity of the qualitative data collected.