In this cross-sectional study, 97 students of continuous and discontinuous bachelor's majoring in public health who had enrolled in the national infectious disease combat program course over 2017-18 to 2019-20 academic years entered the study through consensus.
The study's data collection tool was a questionnaire of satisfaction with educational objectives' accomplishments consisting of 23 questions on a 7-point Likert scale (ranging from strongly agree to strongly disagree) containing nine questions about the Leishmaniasis unit, nine questions about the Rabies prevention unit, and five questions about the Brucellosis serological department. The students completed the questionnaire and ranked the items with scores of one to seven after the visit.
The questionnaire was designed by the teacher of the course and based on the curriculum, and was handed out to three faculty members to determine its validity; the required modification was then made according to faculty members' opinions. The questionnaire's reliability was measured through Cronbach's alpha, which was calculated to be 0.899 for the whole questionnaire, 0.843 for the Leishmaniasis section, 0.407 for the rabies prevention section, and 0.841 for the Brucellosis serology laboratory.
One question was considered to measure the overall satisfaction of each of the departments on a scale from zero to 100. In the end, one question measured the overall satisfaction of the whole visit on a scale from zero to 100. Also, one open question was considered to ask about other suggested diseases and treatment departments relevant to the course topics.
The teacher first referred to Gonbad-e Kavous healthcare center and got familiarized with the procedures and measures taken in the center, expressing the educational requirements and expectations. Afterward, the aforementioned departments expressed their preparedness to host the students, and correspondence with the Vice Chancellor for Education was done to send the students on the visit. After acquiring the required permits and confirming visit dates (November 2017 to 2019), the students were sent on a visit to Gonbad-e Kavous healthcare center. The visits were made so that the continuous bachelor’s students visited the center over one week and the discontinuous bachelor’s students visited it the next week. November was selected as the time for visits since it was the CL high season in Gonbad-e Kavous when patients would frequently refer to the healthcare center to treat their Leishmaniasis wounds. The students had received conventional learning material on CL, Rabies, and Brucellosis a couple of weeks before the field visits.
The order of visiting from the operational departments was so that the students would first visit the Leishmaniasis department, then the rabies prevention department, and finally, then the serological Brucellosis laboratory. During the Leishmaniasis department visits, the students watched how cryotherapy was performed and patients were treated, and learned about intramuscular and local injections and as well as the indications of each of these three treatment methods from the head of the department, and asked their respective questions. In the Leishmaniasis department, the students were divided into 5-7-people groups and watched the process of patient treatment in order. Then, the students went to the wound-sampling room and got acquainted with the process of taking samples from the Leishmaniasis wound, staining the sample, and obtaining test results. Afterward, they went to the department laboratory and observed slides of CL under microscopes, receiving explanations and training from the laboratory expert (Master of Parasitology) working in the department. The students finally learned about the process of recording, treatment follow-up, and completing the forms submitted by the respective ministry from the head of the Leishmaniasis department.
Afterward, the students referred to the rabies prevention unit and received explanations regarding how to wash the bite wound, serum and vaccine indications, vaccination sessions, following-up on the animal, how to determine the rabies serum dose, and how to inject it. Besides, the students visited the refrigerators containing rabies vaccines and antidote serum, and the first, second, or third vaccination of animal-bitten patients referring to the health center was delivered by the respective head of the unit in the presence of students. Besides, considering the heavy load of patients referring to the center, rabies wounds were washed by the respective department head in the direct presence of students after training the students regarding the standard safety precautions for washing the wound such as wearing gloves and glasses and how long the wound must be washed. Afterward, the respective department head gave explanations on how to fill in the animal bite form, the office book, and the computer software, and explained the process of following up on the patients and the necessity of 24-hour services in the said department. Eventually, the students had a Question and answer session with the respective head and got their answers. All the students visited this department in one group considering the suitable environment of the department.
Finally, a visit to the serology department of the healthcare center laboratory took place. The visiting students were divided into two groups in this department. Wright's tube and slide tests were conducted by the respective department head in the presence of the students, and the dilatation method for changing the dilution from 1/20 to 1/1280 was practiced. Eventually, the students observed and read a positive serum sample infected with Brucellosis. Also, Coombs Wright's indications were explained. In the end, the students had a question and answer session with the respective head and got their answers. It must be mentioned that positive serological Brucellosis samples were stored in the laboratory a couple of days ahead of the visit so that they could be presented to the students.
The teacher stayed with the students throughout all operational visits to provide them with suitable educational situations and offer them the required guidance to achieve the educational objectives. After the visits, a questionnaire measuring the students’ attitude toward the visit was handed out to them so that they could express their opinions. The anonymity of the questionnaire, confidentiality, and other ethical considerations such as personal consent were respected in completing the questionnaires. The general parts of this plan were approved by the Golestan University of Medical Sciences ethics committee under the number IR.GOUMS.REC.1396.236.
Completed questionnaires were entered into the statistical software v.15, and descriptive statistics (mean, frequency, standard deviation, etc.), as well as independent t-test, were used to compare the average scores of continuous and discontinuous bachelor's students. A significance level of 0.05 was considered for all tests.