Evidence Based Health Policy, Management and Economics

Transformational Leadership in Hospitals: Effects on Efficiency and Employee Satisfaction

Ameneh Marzban — 2026-07-20

The Article Abstract is not available.

Policy and Strategy Recommendations for Building Resilience in Iran's Medical Education System against Hybrid Warfare: A Macro-Regional Planning Perspective

Mohammad Khandan — 2026-07-20

The occurrence of the twelve-day warfare in Iran and its resultant damages and outcomes on medical science education, compounded by a complex and unique set of economic (sanctions), social, and cultural conditions, prompted researchers to develop a macro-framework. Drawing on global evidence and employing a systems model approach, this framework aims to analyze and enhance the resilience of the higher health education system against potential hybrid warfare, with an emphasis on the role of macro-regional medical science planning areas. Consequently, based on the formulated strategies, policy solutions and recommendations were proposed at the level of macro planning regions and across short-, medium-, and long-term timescales. These proposals target four key subsystems: human resources; technology and infrastructure; management and organization; and the external environment impacting educational processes. Design and activation of a comprehensive program for empowering human resource resilience and robustness, implementation of a psychosocial rehabilitation program for human resources, design and implementation of a comprehensive passive defense program for educational infrastructure, establishing and deploying an emergency educational and clinical service continuity system, designing and activating an education command unit, and establishing and designing a network of the strategic partners were the most important policy implications derived from this study’s results. This comprehensive set of programs is designed to serve as a robust framework for strengthening the resilience and robustness of medical science education under hybrid warfare conditions.

Management of Road Traffic Injuries in Healthcare Facilities: Challenges, Policy Recommendations, and Implications for Policymakers

Yaser Davodi — 2026-07-20

Road traffic accidents in Iran impose a considerable burden of mortality and disability. Despite widespread attention to prehospital interventions, the quality and coherence of trauma patient management in healthcare facilities remains one of the critical yet less well-organized components of the care continuum. This policy brief aims to identify key challenges in hospital-based trauma management and present actionable options to reduce preventable adverse outcomes. This study employed an analytical-participatory approach, beginning with a brainstorming session with selected stakeholders from Tehran University of Medical Sciences and a review of the evidence. Three authors independently analyzed the session data and existing evidence, and through subsequent consensus meetings, shared challenges were identified. Moreover, drawing on the same data, best available evidence, and the authors’ initiative, actionable policy options were formulated. Challenges were identified at four levels: 0) resource-level (workforce shortages, inadequate payment systems, technological and equipment deficiencies, and consumable mismanagement), 1) operational and clinical (team coordination failures, overcrowding, and inconsistent protocol implementation), 2) systemic and referral (fragmented care pathways, inadequate post-discharge follow-up, and scattered data systems), and 3) governance and intersectoral (weak accountability, insufficient continuous quality improvement, and lack of structured inter-organizational collaboration). Four complementary options were proposed: strategic resource optimization and sustainable trauma financing, standardizing emergency response to severe trauma, integrating the care pathway from admission through discharge and follow-up, and establishing performance monitoring and quality improvement mechanisms within hospitals. Prioritized and phased implementation of these options, tailored to hospital capacity, can reduce preventable delays, improve clinical outcomes, and strengthen post-hospital follow-up.

Strengthening the Implementation of the Patients’ Rights Charter in Hospitals: Evidence and Policy Options

Mehran Zare — 2026-07-20

The Article Abstract is not available.

Evidence-Based Medicine Education in Undergraduate Medical Students: A Scoping Review

Stephanie Quon — 2026-07-20

Introduction: Evidence-based medicine (EBM) is a foundational competency for medical trainees and a core principle of contemporary clinical practice. Medical schools increasingly integrate EBM teaching across pre-clerkship and clerkship training, yet substantial variability remains in curricular structure, pedagogy, assessment approaches, and real-world learning transfer. This scoping review aimed to map the existing literature on EBM education for medical students, with attention to curriculum models, teaching strategies, learner outcomes, and implementation challenges.

Materials and Methods: Following the PRISMA-ScR framework, the authors systematically searched MEDLINE, Embase, ERIC, PsycINFO, and Scopus from inception to July 2025. Eligible studies described EBM-related teaching, curricula, or assessment in undergraduate medical education. Also, data were extracted on study characteristics, pedagogical methods, EBM competencies targeted, outcomes (knowledge, skills, attitudes, behaviours), and reported barriers and facilitators.

Results: Twenty-seven studies were included, representing diverse geographic contexts and spanning pre-clinical and clinical training. Curricula commonly target question formulation, literature searching, critical appraisal, and application of evidence to patient care. Four themes emerged: 1) heterogeneity in curriculum design and competency frameworks, 2) active learning and clinically integrated teaching as key drivers of engagement, 3) assessment challenges and inconsistent outcome measurement, and 4) implementation barriers including faculty expertise, time constraints, and hidden curriculum influences. Most studies reported improved EBM knowledge and self-efficacy, while fewer demonstrated sustained skill retention or changes in clinical behavior. Programs that embedded EBM longitudinally within clinical contexts and used structured appraisal tools appeared more likely to report meaningful learner engagement.

Conclusion: EBM education for medical students is widely implemented but variably delivered and assessed. Evidence supports active, clinically contextualized approaches, yet robust evaluation of long-term outcomes and standardized assessment tools remains limited. For educational planners and instructors, findings suggest that integrating EBM longitudinally across training, embedding teaching within authentic clinical scenarios, investing in faculty development, and aligning assessments with competency-based frameworks may strengthen skill retention and practice transfer. Future work should prioritize longitudinal curricula, faculty development, and harmonized competency-based evaluation.

Investigating the Barriers and Solutions to Conducting Research in COVID-19 from the Perspective of Graduate Students

Adel Eftekhari — 2026-07-20

Introduction: Scientific research plays a critical role in improving health systems and social well-being; however, public health crises pose serious challenges to the research process, particularly for graduate students. This study aims to identify the barriers to conducting research during public health crises and propose potential solutions from the perspective of graduate students.

Materials and Methods: This descriptive cross-sectional study was conducted in 2020 among 210 graduate students at Mazandaran University of Medical Sciences. Data were collected using a researcher-developed questionnaire assessing personal and organizational research barriers and proposed solutions. Data were analyzed using descriptive statistics, independent t-tests, and Spearman’s correlation coefficient in SPSS version 27.

Results: Results indicated that “weakness in individual research skills” (6.42 ± 25.10) was the most significant personal obstacle, while “administrative obstacles” (2.63 ± 16.49) were the main organizational barrier. “Motivational support for students” received the highest solution score (2.97 ± 21.99). Moreover, significant positive correlations were found between organizational and personal obstacles (r = 0.35, p = 0.001) and between appropriate solutions
(r = 0.44, p = 0.001). Gender, marital status, research background, and completion of a research methods course significantly influenced perceived barriers

Conclusion: The findings suggest that addressing research challenges during public health crises requires strengthening research skills, reducing administrative barriers, and providing adequate motivational and institutional support.

Factors Affecting Classroom Concentration among Students at the School of Health, Zabol University of Medical Sciences: A Cross‑Sectional Study

Mohammad Sarani — 2026-07-20

Introduction: Concentration in classroom plays a vital role in students' academic success and effective learning. Understanding factors that affect concentration can help educators enhance teaching methods and classroom environments. This study aimed to identify and analyze factors affecting student concentration in classrooms of the School of Health, Zabol University of Medical Sciences.

Materials and Methods: A descriptive‑analytical cross‑sectional design was employed, involving 170 students selected through convenience sampling (response rate: 100%). Data collection was performed from January to March 2023 using a validated 25‑item questionnaire (three dimensions: instructor‑related [11 items], student‑related [11 items], and environmental factors [3 items]), rated on a 5‑point Likert scale (0–4). The questionnaire showed excellent internal consistency (Cronbach's α = 0.90). Data were analyzed using descriptive statistics, independent t‑test, one‑way ANOVA, and Pearson correlation in SPSS 26.

Results: Most participants were female (74.1%), single (78.8%), and non‑native (80%), with a mean age of 21.38 years. The highest total score was related to instructor‑related factors (45.78 ± 5.65), while environmental factors had the lowest total score (11.1 ± 2.06); however, mean‑per‑item scores were 4.16, 3.52, and 3.70, respectively, indicating that environmental factors were also perceived as relatively important. Significant gender differences were found, with female students reporting higher scores in all three domains (p < 0.05). Native and married students had higher scores in student‑related factors (p < 0.05). Environmental factors significantly differed by field of study, with Nutrition students reporting the highest levels (p < 0.05). Students reported greater concentration in front rows (34.1%) and during 10:00–12:00 time slot (38.8%). Reviewing notes or references before class (88.2%) and participation in note‑taking groups (84.1%) were the most frequently reported factors associated with perceived improvement in concentration. No significant relationship was found between age and other factors, while strong positive correlations existed among the three dimensions (p < 0.01).

Conclusion: Enhancing student concentration requires a multifaceted approach focusing primarily on improving teaching quality and addressing student behaviors, as well as optimizing environmental conditions. Policymakers, educators, and university administrators should consider these associative findings when developing targeted interventions to promote concentration and improve learning outcomes.

Epidemiological Characteristics of Road Traffic Injury in an Accident-Prone Area

Shiva Kargar — 2026-07-20

Introduction: Road traffic accidents (RTAs) are one of the top five causes of morbidity and mortality in South-East Asian countries, including Iran. The aim of this study was to assess the epidemiology of road traffic accidents in Khash, Sistan and Baluchestan Province, Iran

Materials and Methods: This cross-sectional study was conducted on 3,508 individuals injured in road traffic accidents who were transferred to the emergency department of Ali-Ibn Abitaleb Hospital in Khash between March 21, 2023, and February 18, 2024. Data were extracted from medical records using a structured checklist and were analyzed using descriptive statistics in SPSS version 22.

Results: The study found that road traffic injuries mainly affect young males, drivers, and urban residents, with cars and motorcycles being the most commonly involved vehicles. Nearly half of the patients required extended hospital stays, indicating a significant healthcare burden. These findings highlight the need for targeted preventive measures, including improved traffic safety, public education, and stricter law enforcement.

Conclusion: Road traffic accidents primarily affect young males and urban drivers, posing a significant public health and healthcare burden. Targeted preventive strategies, including enhanced traffic safety measures, public awareness, and stricter law enforcement, are urgently needed to reduce their occurrence and impact.