Vol.5, No.2, 175-178 (2013) Health
Teaching reproductive endocrinology in Iran: Pilot
assessment of hospital-based clinical modules for
medical students at Tehran University of Medical
Batool H. Rashidi1, Maryam Nemati1, Mahya Ghazizadeh1, Shala A. Salem2,
Gary S. Collins3, E. Scott Sills2,4#
1Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
2Office for Reproductive Research, Pacific Reproductive Center/PRC-Orange County, Irvine, USA
3Centre for Statistics in Medicine, Wolfson College Annexe, University of Oxford, Oxford, UK
4Graduate School of Life Sciences, University of Westminster, London, UK;
#Corresponding Author: dr.sills@prc-ivf.com
Received 12 December 2012; revised 14 January 2013; accepted 20 January 2013
This pilot study evaluated effectiveness and
acceptance of a new hospital-based reproduc-
tive endocrinology curriculum among Iranian
medical students. A voluntary, anonymous
questionnaire was used to compare two teach-
ing methods as applied to junior medical stu-
dents at Tehran University of Medical Sciences.
Students were randomly assigned to one of tw o
clinical teaching settings; no student experi-
enced both modules. Coursework for the pilot
(experimental) group (n = 19) utilized a teaching
approach comprising lectures, genetics labora-
tory, pelvic ultrasound, small group sessions,
and opportunities to observe advanced repro-
ductive technologies such as in vitro fertilization,
ICSI, and embryo transfer. A control group (n =
34) received reproductive endocrinology in-
struction by the ‘traditional curriculum’, con-
sisting mainly of lectures. Students were sam-
pled at baseline and again at the conclusion of
their reproductive endocrinology session. Pre-
and post-test data were analyzed for both
groups; post-test differences between groups
were also compared. No significant differences
in mean age or gender mix were identified be-
tween the two study groups. Overall, the ques-
tionnaire did not identify any significant inter-
group differences for any parameter investi-
gated. Although student acceptance rate ap-
peared similar for both educational modules, the
ratio of students having a “favorable regard” for
reproductive medicine declined only among
students randomized to t he control gr oup ( 41 . 2 %
vs. 32.3%). This report offers the first data on
teaching reproductive endocrinology to medical
students in Iran. Both traditional and innovative
approaches to teaching reproductive endocri-
nology were well-accepted by students, al-
though negative post-test responses were more
common among students in the control group.
While periodic quality assessments for existing
clinical teaching methods are necessary, intro-
duction of alternative teaching approaches is
also import ant. Addi tional studies are planned to
evaluate the impact this initiative may have on
results on standardized tests measuring repro-
ductive endocrinology knowledge, as well as
election of further specialization in training.
Keywords: Medical Students; Clinical Education;
Reproductive Endocrinology; Iran
To date, there has been little published on how best to
advance the state of teaching in Iran with respect to
medical students and how they acquire basic knowledge
in reproductive endocrinology. In common with medical
schools elsewhere, our programs embrace high-intensity
learning where considerable material requires mastery in
a relatively short time. To keep pace with changing times,
the medical school curriculum requires frequent reap-
praisal considering the limited academic calendar avail-
able to cover this information [1-3]. At present, learning
opportunities specifically dedicated to reproductive en-
*None of the authors report any c onflict of interest.
Copyright © 2013 SciRes. OPEN A CCESS
B. H. Rashidi et al. / Health 5 (2013) 175-178
docrinology and infertility are still evo lving in Iran. Here,
reproductive medicine lectures are often placed within
the general obstetrics and gynecology syllabus with no
practical application of material specific to the advanced
reproductive technologies being routinely provided. Us-
ing a traditional teaching methodology mainly composed
of didactic classroom lectures is one way to accomplish
this, although bringing medical students into the clinical
setting should augment this learning experience. Recent
research in Iran has shown how innovative teaching ap-
proaches in related disciplines can positively impact
learning at the residency training level [4], as well as
peer/community settings [5]. Yet, the belief among me-
dical school leadership that students would find early
clinical exposure to reproductive medicine unhelpful
may explain why such an approach may not yet have
found widespread application in Iran. Given the paucity
of published data on this topic, the current pilot investi-
gation was launched to measure acceptance and effec-
tiveness of a new hospital-based reproductive endocri-
nology curriculum among Iranian medical students.
Following affirmative review from the department
chair for medical student educational affairs at Tehran
University of Medical Sciences, approval was granted
for this voluntary, anonymous question naire cohort study
in association with a new teaching initiative which also
received independent approval.
2.1. Structure of Study
This pilot assessment was designed as part of a quality
audit for the new clinical teaching module for reproduc-
tive endocrinology, offered during an ambulatory clinic
rotation for infertility and endocrinology disorders dur-
ing a mandatory gynecology clerkship. Students were
randomly allocated to one of tw o groups for reproductiv e
endocrinology instruction. Students in the experimental
module (n = 19) were assigned to Vali-e-Asr Hospital, an
academic teaching affiliate of Tehran University of
Medical Sciences. Students in the control group (n = 34)
received a series of lectures and traditional exposure to
infertility clinics. In both study arms, the duration of
each module was one week.
2.2. Study Sample and Allocation
All participants were in their fifth year of medical
school, with appraisals occurring during the 2010-2011
academic term. Students in the experimental group par-
ticipated in a reproductive genetics laboratory, pelvic
ultrasonography clinic, and observed procedures carried
out in the IVF laboratory. The techniques of controlled
ovulation induction, in vitro fertilization and embryo
transfer were described (and subsequently demonstrated)
to the students in a clinical context with the assistance of
patients who had specifically consented to participate in
medical student teaching. The module also presented
information concerning reproductive medical ethics em-
phasizing the role of pre-treatment patient counseling.
Rather than structured lectures in large classrooms, in-
formal small group reproductive medicine discussion
sessions were offered each day. A laboratory component
offered opportunities to observe intracytoplasmic sperm
injection, assisted embryo hatching, human embryo cry-
opreservation/thaw, and extended blastocyst culture. To
show how these various elements integrate practically
with clinical practice, medical students observed faculty
during patient consultations in the office for new and
follow-up appointments. Students in the control group
received a series of standard lectures covering the same
material. Although audio-visual teaching aids were occa-
sionally used in the control module, instruction occurred
mainly in the classroom during th e one week session.
2.3. Assessment Methods and Statistical
Student data were obtained from an anonymous seven-
item questionnaire based on a previously published
methodology [6], and refined by a multidisciplinary edu-
cational team here. The questionnaire was administered
to all participants at study entry and again at the conclu-
sion of their reproductive endocrinology module. Likert-
scaled questions were used to measure student accep-
tance of their assigned module, student attitudes toward
this field, and the level of familiarity related to the prac-
tice of reproductive medicine in general. Students were
also queried about the module’s likely impact on their
own selected area of professional practice in the future.
Fisher ’s exact test was used to compare baseline vs. post-
module questionnaire data, as well as post-module re-
sults between groups. Matched pair analysis by McNe-
mar’s test was also performed. A p < 0.05 was consid-
ered statistically significant.
Completed pre- and post-module questionnaires were
returned from all 53 medical students enrolled in this
study (19 in the experimental group plus 34 in the con-
trol group). There were no significant differences in
mean age between the two study groups; the gender mix
was similar across the two groups as well. Overall, the
questionnaire did not identify any significant differences
between groups in the seven parameters investigated.
More students in both groups responded affirmatively
that reproductive endocrinology was “important in the
university medical curriculum” at the conclusion of their
Copyright © 2013 SciRes. OPEN A CCESS
B. H. Rashidi et al. / Health 5 (2013) 175-178
Copyright © 2013 SciRes. OPEN A CCESS
module, although this score was highest among students
who completed the experimental session.
Additionally, the proportion of students having a “fa-
vorable regard” for reproductive medicine declined among
students randomized to the control group (41.2% vs.
32.3%). This question provided different data for stu-
dents undergoing reproductive endocrinology instruction
in the experimental module, where a sharp increase in
“favorable regard”, fewer undecided responses, and
fewer students answering negatively about their percep-
tion of this area of study. When asked about exposure to
technical procedures in ART, post-module questionnaire
data from students in the control group reveal a higher
negative response rate compared to student post-module
responses in the experimental group (38.2% vs. 15.8%).
The findings identified from the aggregate, tabulated
data were similar to matched pair analysis using McNe-
mar’s test. A summary of all student responses is pro-
vided in Tables 1 and 2.
Students receive an uneven exposure to reproductive
endocrinology during medical school in Iran, and this
field remains among the most rapidly changing areas for
which a standard national curriculum has not yet been
developed. Given the frequency of women’s clinic en-
counters relating to pregnancy or establishing conception
[7], medical students require a familiarity with basic re-
productive endocrinology even if this is not their chosen
area of professional practice. While a decade’s experi-
ence has supported exposure to clinical reproductive en-
docrinology in other medical education settings [8], thus
far in Iran a traditional classroom-based format of re-
productive biology lectures has prevailed as the preferred
teaching method. This began to change in 2010, with the
launch of a pilot reproductive biology practicum for stu-
dents at Tehran University of Medical Sciences. The new
educational package was designed to demonstrate appli-
cation of the advanced reproductive technologies in a
“real-world” clinical environment. New advances in fer-
tility medicine were reinforced by small group sessions
covering the importance of medical ethics, epidemiology,
biostatistics, and experimental design, as described by
others [9].
Our investigation reports on student acceptance of this
new module—believed to be the first of its kind in
Iran—wh ich provided early expo sure to the full range of
assisted fertility therapy. While these pilot data show a
comparable acceptance for this educational initiative
compared to the default (traditional) curriculum, the fre-
quency of negative responses was higher among medical
students in the control group. For students in the experi-
mental group, their post-module questionnaire responses
were characterized by higher positive scores, reduced
ambiguity about reproductive medicine, and reduced
negative responses. These findings represent previously
unreported observations concerning medical education in
It must be acknowledged that this investigation was
unable to establish a statistica lly significant difference in
the seven assessment parameters between study groups.
This represents an important limitation of the study, al-
though further research is planned to include larger sam-
ples. In summary, this pilot study offers evidence for a
consistent level of student acceptance for a new clinical
module for reproductive endocrinology among Iranian
medical students. Given the myriad vital subjects (other
than reproductive medicine) which form a comprehen-
Table 1. Comparison of self-reported views on aspects of reproductive endocrinology among medical students in Iran before and
after completing a pilot module, as measured by questionnaire in the 2010-2011 academic term.
Experimental gr ou p
(n = 19) Control group
(n = 34) Post-test group
Pre-test Post-test p1 Pre-test Post-test p1
Yes 7(36.8) 10(52.6) 11(32.4) 15(44.1)
Unsure 7(36.8) 6(31.6) 0.07 12(35.3) 9(26.5) 0.62 0.58
Is reproducti v e e ndocr inology important in
the university medical curriculum? No 5(26.3) 3(15.8) 11(32.3) 10(29.7)
Yes 7(36.8) 12(63.2) 14(41.2) 11(32.3)
Unsure 7(36.8) 3(15.8) 0.23 12(35.3) 10(29.4) 0.47 0.10
Do you have a favorable regard for
reproductive medicine clinical practice? No 5(26.3) 4(21.5) 8(23) 13(38.2)
Yes 6(31.6) 10(52.6) 15(44.1) 17(50)
Unsure 9(47.4) 5(26.3) 0.38 12(35.3) 11(32.4) 0.90 0.87
Have you had adequate opportunities to
develop clinical skills in reproductive
endocrinology? No 4(21.5) 4(21.5) 7(20.6) 6(17.6)
Notes: all data presented as n (%). There were no statistically significant differences in age or gender between experimental vs. control groups. 1by Fisher’s
exact test (matched pair analysis confirmed by McNemar’s test).
B. H. Rashidi et al. / Health 5 (2013) 175-178
Table 2. Comparison of self-reported views on exposure to reproductive endocrinology and potential career choice among medical
students in Iran before and after completing a pilot module, as measured by questionnaire in the 2010-2011 academic term.
Experimental gr ou p
(n = 19) Control group
(n = 34)
Pre-test Post-test p1 Pre-test Post-test p1
Yes 5(26.3) 11(57.9) 12(35.3) 13(38.2)
Unsure 8(42.1) 5(26.3) 0.1512(35.3) 13(38.2) 0.91 0.49
Have you had adequate opportunities to
develop clinical skills in pelvic ultrasound
and reproductive genetics? No 6(31.6) 3(15.8) 10(29.4) 8(23.5)
Yes 5(26.3) 7(36.8) 13(38.2) 11(32.4)
Unsure 8(42.1) 9(47.4) 0.5911(32.4) 10(29.4) 0.43 0.22
Have you had adequate exposure to technical
procedures in ART? No 6(31.6) 3(15.8) 10(29.4) 13(38.2)
Yes 8(42.1) 9(47.4) 11(32.4) 12(35.3)
Unsure 6(31.6) 4(21.1) 0.847(20.6) 9(26.5) 0.82 0.76
Have you had sufficient time to int egrate your
understanding of reproductive endocrinology
into practice? No 5(26.3) 6(31.6) 16(47.0) 13(38.2)
Yes 5(26.3) 9(47.4) 13(38.3) 10(29.4)
Unsure 7(36.8) 6(31.6) 0.4112(35.3) 14(41.2) 0.82 0.48
Would you consider reproductive
endocrinology as your chosen professi onal
career in medicine? No 7(36.8) 4(21.1) 9(26.4) 10(29.4)
Notes: all data presented as n (%). There were no statistically significant differences in age or gender between experimental vs. control groups. 1by Fisher’s
exact test (matched pair analysis confirmed by McNemar’s test).
sive medical education, further research is needed to es-
tablish “how much time is enough” with respect to each
constituent part.
BHR was principal investigator, MN and MG carried
out the on-site investigation and collected data, SAS as-
sisted with background research and study design, GSC
was chief statistician, ESS supervised the study and de-
veloped the manuscript.
[1] McGrady, A., Brennan, J., Lynch, D. and Whearty, K.
(2012) A wellness program for first year medical students.
Applied Psychophysiology and Biofeedback, 37, 253-260.
[2] Scheele, F. (2011) The story of health care’s Achilles’
heel. Medica l Teacher, 33, 578-579.
[3] Harward, D.H., Tresolini, C.P. and Davis, W.A. (2006)
Can participation in a health affairs interdisciplinary case
conference improve medical students’ knowledge and at-
titudes? Academic Medicine, 81, 257-261.
[4] Alipour, S., Moini, A., Jafari-Adli, S., Gharaie, N. and
Mansouri, K. (2012) Comparison of teaching about breast
cancer via mobile or traditional learning methods in gy-
necology residents. Asia Pacific Journal of Cancer Pre-
vention, 13, 4593-4595.
[5] Peykari, N., Tehrani, F.R., Malekafzali, H., Hashemi, Z.
and Djalalinia, Sh. (2011) An experience of peer educa-
tion model among medical science university students in
Iran. Iranian Journal of Public Health, 40, 57-62.
[6] Sills, E.S. (2010) Assessing reproductive endocrinology
competencies among senior medical students in the
European Union: Deployment of a new clinical module at
the Royal College of Surgeons in Ireland [background
paper]. 14th Ottawa Conference on the Assessment of
Competence in Medicine and the Healthcare Professions,
[7] Women’s Health Council, Ireland (2009) Infertility and
its treatments. A Review of Psycho-Social Issues, 1-52.
[8] Fox, C.R. and Kirk, S.E. (2003) Subspecialty training in
the ambulatory clinic: A preliminary investigation of an
endocrinology curriculum. Academic Medicine, 78, 1170-
1174. doi:10.1097/00001888-200311000-00020
[9] Letterie, G.S. and Morgenstern, L.S. (2000) The journal
club. Teaching critical evaluation of clinical literature in
an evidence-based environment. Journal of Reproductive
Medicine, 45, 299-304.
Copyright © 2013 SciRes. OPEN A CCESS