Models that predict job satisfaction are
not appropriate to evaluate student satisfaction. Clinical experiences
for medical students are not the same as jobs, and the role of a student
in clinic is not the same as that of an employee. Unlike typical employees,
students are located at facilities temporarily. Students typically are
not paid and, therefore, do not have the same rights and privileges, or
work expectations as employees. Student often complete their experiences
at clinical sites, which are not the places they usually choose for regular
employment. Although the above-mentioned are between student's experiences
and employment, we can design a model for predicting satisfaction with
clinical experiences from combining some of the variables that predict
job or career satisfaction.
Although medical students and other students
in the health care professions appear to be satisfied with their clinical
practices and learning, the elements that contribute to this satisfaction
aren't well known.9,10
On the other hand, changes in health care system in Iran from 1994 have
had an enormous impact on the medical education, students, instructors
and health care workers satisfaction.
For some years, evaluation of medical teaching has been demanded in our
university. Thus, we designed a questionnaire study at Tehran University
of Medical Sciences to assess the medical student's satisfaction with
clinical education during their medical internship. We studied the separate
effects of variables in the organizational domain, as well.
This was a cross sectional descriptive
analytic study, which was conducted in 2000, at Tehran University of Medical
sciences. Subjects were medical students during their medical internship
(the last two years of sixth and seventh year medical students). Assuming
the previous available study that students' satisfaction with clinical
education was 40%, the calculated sample size was 250. After explaining
the study design and objectives, we obtained students’ verbal consent.
This study was approved by the faculty of medicine (Tehran University
of Medical Sciences).
We used a questionnaire based on job satisfaction
(Appendix 1). The clinical education was
classified into three categories including: outpatient, bedside and theoretical
teaching. In addition, the students' satisfaction of the way that they
were tested for clinical skills was also assessed. The students' satisfaction
with clinical education was classified into; completely, partial and none.
Students who were satisfied completely or partially with clinical education
were considered satisfied and those who didn't express satisfaction with
their education were defined as unsatisfied ones. Furthermore, the elements
of satisfaction were ranked according to scores given by students in this
study (the most important factor scored 1, while the least important factor
scored 7 for outpatient training and bedside teaching variables and score
5 for theoretical education variables).
The students recorded their age, the living state (dormitory or no dormitory),
their gender and marital status. We felt the questionnaire has face validity
based on the use of similar questions in previous studies, and the elements
that we considered as affective factors on clinical feducation in three
different domains, were those which were considered as the most important
elements in clinical education by an expert committee in the Tehran University
of Medical Sciences.
The statistical package for the social
sciences (SPSS version 9) was used for statistical analysis. The relation
between satisfaction of outpatient training, bedside teaching, theoretical
education and variables was analyzed by chi square. Manthel Haenzel Chi
square was computed whenever indicated. P values equal to or less than
5% were considered significant.
Two hundred and fifty medical students
were survied in this study. The mean age of the students was 26.5 years
(23-38 years) and 216 (86.4%) of them were male. Eighty-three students
(33.2%) lived in dormitories and 85 students (34%) were married. Overall
satisfaction was 38.8% (97/250) and 61.2% (153/250) were not satisfied
with their education. There was no statistically significant relationship
between age, gender, living in dormitory or marriage and the level of
Satisfaction with outpatient training
- Fifty two percent (130/250) were satisfied with outpatient training.
The most important factors (score 1) that contribute satisfaction with
outpatient training in our subjects are shown in Table 1. There was a
significant association with satisfaction and outpatient training and
class size; approach to rare diseases diagnosis of which requires specialty;
course planning and approach to common and epidemic diseases (P=0.01).
Satisfaction with bedside teaching - One
hundred and thirty students (52%) were satisfied with bedside teaching.
The factors chosen by students affecting satisfaction with bedside teaching
are mentioned in
Table 1. A significant association was found between satisfaction with
bedside teaching and teaching of rare diseases diagnosis of which requires
specialty, course planning, approach to common and epidemic diseases,
class size in bedside (P=0.01), and appropriateness of educational atmosphere
(P=0.027). Students’ satisfaction with appropriateness of educational
atmosphere was not significant according Pearson test (P=0.08). Duration
of bedside teaching had a significant effect when tested by Mantel Haenzel
Satisfaction with theoretical education
- One hundred and seventy seven subjects were satisfied with theoretical
teaching (70.8%). The elements that are correlated with satisfaction with
theoretical education are shown in Table 2. We found a significant association
between satisfaction with theoretical education and the quality of education,
class size, approach to rare diseases diagnosis of which requires specialty,
and common and epidemic diseases (P=0.01). The mean score given to the
different effective factors on the students' satisfaction with outpatient
training and bedside teaching in satisfied and unsatisfied students is
shown in Table 3.
Students' satisfaction with the way through
which they were tested - Sixty four percent (161 subjects) and 48.8% (122
students) were satisfied with the way they were tested from theoretical
education and practical training points of view, respectively. There was
a positive association between overall satisfaction and satisfaction with
the methods through which their abilities after theoretical education
and practical training were assessed (P=0.01).
The aim of our study was the evaluation
of medical students' satisfaction in clinical education and influence
of organizational domain variables on this satisfaction. Clinical education
is an important course in medical education and students spend about half
of their educational time both in clinics and hospitals. Those clinical
experiences that satisfy medical students are consistent with the literature
in the health care professions.7,9 Trainees' satisfaction is
an index for evaluating medical education, but there are few researches
measuring this factor.11 For this reason, the factors that
influence satisfaction in medical students are not well understood. In
a survey of physical therapist students performed by Stith et al, they
found a low relationship between satisfaction with clinical education
and organizational structure. After changes in health care system in Iran
during 1994, organizational structure in educational hospitals has not
been well defined. These changes have had an enormous impact on the medical
education. Medical schools are under the pressure to adapt to changes
in the health care system as well as maintaining excellence in education.12 This could have lead to the low overall satisfaction with clinical education
found in our study, though this needs more study.
In this study, we did not find a relationship
between satisfaction and gender which consistent with other studies.13,14 However, a few studies have shown that female students are more satisfied
than male students in terms of their clinical education .
In our study, the approach to common and
epidemic diseases and rare diseases diagnosis of which requires specialty
in outpatient and bedside teaching were significant predictors of satisfaction
in medical students. Although, this finding is similar to Seabrook et
al15 study on performance and satisfaction with day surgery
center teaching, the number of new inpatients and outpatients in Xu's
surveys was not related to students' overall satisfaction. When we analyzed
data using the mean score given to the effective factors in outpatient
teaching, there was not a significant association between approach to
common and epidemic diseases with students' satisfaction.
According to findings of Xu et al, frequent
contact of residents with students, providing valuable teaching experiences
by residents, serving as role models by attending faculty and residents,
showing respect for students by attending faculty and residents, and ratings
of teaching rounds and conferences were significant predictors of satisfaction
among students. In our survey, experienced instructors had a significant
association with students' satisfaction in theoretical education but did
not have a significant association with students' satisfaction in outpatient
and bedside teaching. However, these factors had a significant association
with students' satisfaction in bedside teaching with considering the mean
score given to the effective factors as well. Davis et al study16 that showed facilitator's content expertise alone dose not determine the
amount of students' learning and student's satisfaction as it has been
shown in Xu's study.
Duration of outpatient and bedside teaching
didn't have any significant association with student's satisfaction. It
seems that students' participation and practice is more important than
time of teaching,17 Course planning and curriculum structure
had a significant association with students' satisfaction. Prosser and
Trigwell believe that learning depends not only upon how teachers have
planned their courses and subjects, but also upon how their students understand
Students' satisfaction has a role as an
outcome of educational process because student satisfaction has been associated
with later professional attitudes, career commitment, and retention.9,19 Furthermore the outcome of the students' satisfaction has both immediate
and long-term consequences. For example, if medical students are not satisfied
with pediatric or infectious courses, the students will be less interested
in these areas and less likely to choose them as their specialty in future.
Limitations of the study
The questionnaire for assessing students'
satisfaction was not tested for reliability. The satisfactory response
was divided into two parts (complete or partial). It may be biased towards
satisfactory appraisals. We did not consider a neutral response.
The findings of this study suggest clinical
education should be reevaluated in our university with specific attention
to class size, variety of diseases and course planning for each session
in outpatient and bedside teaching. Also experiences of instructors should
be strengthened in theoretical education.