In this qualitative research, the experiences of 13 clinical assistant professors of surgical and internal medicine departments of the contracted hospital of Islamic Azad University, Najafabad Branch, were analyzed employing inductive qualitative content analysis with the Krippendorff approach, which knows the content analysis process as collecting data, unitization, sampling, report, data reduction, inference, and analysis (14). The beginning of the analysis operation started after the first interview and the coding and classification after the second interview. This helped the researcher design the other required questions and better conduct the study path. Consequently, the following steps were thoughtfully followed in data analysis:
All interviews were implemented word-for-word, texts were examined line-by-line. Meaningful sentences related to the main topic of the research were then marked. The main concept of meaningful sentences was extracted in the form of code and the classification of codes started. In this way, codes with common sense were arranged in a category and named. The earlier categories were reviewed and merged, or a new category was formed with each new interview. The classification and naming performance of the classes were then reviewed under the supervision of an observer with experience in qualitative data analysis. Consequently, the principal themes of the study were extracted and the relationship between classes was recognized by forming a classification.
At the time of data analysis, it was tried to avoid any assumptions (15). The interview texts and codes extracted by both authors were examined to assure the accuracy of the codes, naming of categories, similarities, and differences to increase the validity and reliability of the research (16). During the data analysis, the researchers interacted with the participants and were given a summary of the researchers' interpretation of the findings to verify or correct the results.
Participants were selected with the highest diversity and the data collection process was continued to saturation level in order to increase the validity of the research. The achieved codes, subclasses, and categories were verified by an expert in qualitative research who did not participate in the extraction of the results to increase the reliability of the research.
Participants in this study were 13 faculty members with a mean work experience of 11.3 years, 3 women and 10 men, 6 surgeons, and seven internal medicine specialists. The results were achieved by analyzing 13 interviews directed to the creation of 229 initial codes, in which the number of codes was reduced to 63 codes after eliminating duplicate codes and merging similar codes.
The codes obtained from the perceptions and experiences of faculty members were finally set in 12 subcategories and 3 main categories, including fundamental roles, conscious ataraxy, and Counterproductive behavior. These categories include subcategories that examine different aspects of educational clinical supervision strategy (Table 1). The findings of the research are presented along with a selection of texts from the conducted interviews.
Main and subclasses extracted from the experience of clinical faculty of educational clinical supervision
Consolidation of cognitive construction Responsibility
Educational abilities are one of the principal skills of an educational supervisor. In this study, faculty members believed that the clinical supervisor has fundamental roles that play a significant role in accomplishing educational objectives. Participants in this category introduced concepts such as diversity in education methods, a re-examination of specific patients, assistance in increasing competence, Socratic questions and answers, and support.
A faculty member states in this regard:
"We had around every day. We did both stager and intern rounds. In detail, I usually operated in the part where we were talking about the patient and the patient's problems. From pathophysiology, diagnosis, treatment, etc., in the classroom, "We were operating to perform the tasks of the department that was a topic that we had presented them, consequently, we could theoretically explain to them, for example, an electrolyte disturbance." Interviewee 13
Another faculty member stated the following statements:
"We monitor what they do and what we check their daily note works if they have a problem or the history they write if they have a problem. We explain to them not to write like that for the next time or to correct their diagnosis next time." Interviewee 12
Relaxed alertness means dismissing the learner's fear and inspiring him/her to internalize the achieved information. Participants in this category explained concepts such as teaching professional behavior, providing a friendly atmosphere, respecting patient rights, utilizing other medical professions in student education, and assessing student progress.
A faculty member stated in explaining his experience:
"Interns should wash their hands in the operating room, and I teach them how to put chest tubes. I allow them all to do sutures. "If they are very interested, I will allow them to excision... I even had an intern who even performed laparoscopy for a broken hand, which was exceptional ... "Interns, I do pleural fluid or suture in the ward. Let the interns see what I do." Interviewee 5
A faculty member says about teaching ethical tips:
"... I try to tell them something about our medical ethics. For example, things like the patient's name are said a lot or which hospital it is in determining the history, and they say things that it is not necessary to say. The history and examination should be more scientific. They should not state the patient's private issues Interviewee 9
Counterproductive behaviors are behaviors in which a person cries and violates customs, policies, rules, and regulations and has a damaging effect on education and students, including inhibition of achieving the objectives, underemployment, waste of time, aggressive and violent behaviors such as threatening, severe verbal warnings, verbal violence in the form of cursing and insults, abuses, ridicule and discrimination(17). Participants in this category referred to concepts such as not allocating enough time to education, inadequate clinical education, prioritizing treatment, and visiting patients in other hospitals to educate, bored state, and unmotivated manner related to the professors.
Faculty member number 1 says:
"... In the second and third sessions, according to their interests, some of them do not show much interest until the end, and we have nothing to do with them so that if they are not interested, they will not even their hands and just watch. Interviewee1
Faculty member No. 8 says about dedicating little time to education:
"We have to pay attention to two issues. Well!? One case refers to the internship training issues and the other has to pay attention to my medical tasks. For example, now that I am going to the clinic, well, I must be aware that I have to go to visit these forty patients so that my organization and my patients do not complain. " Interviewee 8
The concept of educational clinical supervision strategy
Nevertheless, most participants declared that they were unfamiliar with the term educational clinical supervision. They explained the concepts such as educational supervision of student actions, the presence of the professor during clinical procedures, reviewing the quality of student actions, evaluation of teaching methods, information transfer, student evaluation, educator evaluation, providing feedback and direction.
One of the faculty members stated:
"We monitor how the students are educated as well as the practical tasks they perform. The tasks that are already being educated and they have to do them right. now" Interviewee 3
Another professor states:
"Monitoring, which I think occurs every day, now we do not know its name, but it occurs every day. Because it is an order and they have to write, interns write the orders before we come. That is, we should pay attention to this record that they make because they write the situations of the patients also in the file. It is possible to us how he/she examines, how he/she treats the patient in each encounter. How does he/she behave in his/her clinic and how does he/she read the things that we now add to the case? Does he/she really go and read from the text or not, he/she tells something of himself /herself. In short, this is how one professor monitors the students. Interviewee 2
Clinical supervision structure
The statements of all study participants showed that, although other medical personnel is sometimes employed to monitor students' clinical actions. Notwithstanding, most supervisions are provided in groups and by an observer, is usually the relevant professor; and in general, the supervisions performed do not have a formal structure and no specific model is employed to perform the supervisions.
A faculty member stated:
"... I ask others to check their histories and examinations. What is wrong with them? I try to tell them first what should they have asked or added. If they do not say it, I will say that it is wrong ...". Interviewee 5