Analyzing the Influence of Medical Stager and Intern Presentation in Simultaneous Seminars with Pre-Organizer Strategy on the Quality of Education From the Students' Perspective in Infectious Disease Ward (2012-2013)

Document Type: Original Article


1 Social Determinants of Health Research Center, EDC, Birjand University of Medical Sciences, Birjand, IRAN

2 Hepatitis Research Center, Department of Internal Medicine, Birjand University of Medical Sciences, Birjand, IRAN


Background: clinical education with patient-focused learning is very important in medical education. Therefore, it is very essential to select an appropriate education method. The current study was conducted to analyze the impact of simultaneous presentation of medical stager and inter in seminars provided with a pre-organizer strategy and from the students' perspective (2012-2013). 
Methods: this is a semi-experimental study with post-test method for a group of students. The students' perspective was evaluated via a questionnaire (including four arenas) designed by the researcher, after educating with seminar method and in the end of four semesters. The study population included stagers and interns studying during the four semesters. 33% of the students (36 people) were female and 70 students were male (66%).
Results: the results presented that 57.7% of the students believed this method enhanced team-working, and 67.9 % believed it activated the students. 89.6% declared this method upgrades learning and 50.9% mentioned that it organized and categorized the information in students' mind. In total, 70.8% of the students preferred this method to other methods. There was no significant relationship between average, age, gender and grade with students' perspective in relation with the influence of this method in organizing information, increasing learning, activating students, and enhancing team-working. (P>0.05)
Conclusions: according to the results, this method in recommended and it upgrades the quality of clinical education.



As the attention to principals of medical education increases, extensive researches have been conducted to use the best teaching methods at Medical Schools. Moreover, clinical education with a focus on patients is highly important. In Iran, between 0.1 to 1% of people who feel sick are hospitalized at educational hospitals that provide medical education for students. (1)

However, since there is one-month course for stager in infectious disease ward and many of infectious diseases spread at specific months of the year, students and interns do not face with some infectious diseases depend on the month that they pass the course. Therefore, they are not educated for a set of diseases which is very important issue and cannot be ignored. Part of infectious diseases training is provided by stager and intern seminars and under professors’ supervision. Both theoretical and practical, basic sciences and clinical education are provided simultaneously and also the responsibilities of a medical student is reminded. (2)

However, it is clear that when an attitude is obtained via gaining experience is more valuable therefore, according to the status of the community, education should be provided in accordacne with individual, social and group needs so that students recognize clinial symptoms of diseases and be trained for treatment (3). Consequently, appropriate opportunites are provided for recognition and treatment of patients and students are empowered and educated for treatment management and encountering with patients.

The hierarchy of the content is not organized mostly in seminar method that leads to students’ confusion. They cannot organize the presented information in their minds.  Therefore, it is essential to use an educational method that overcomes these challenges. Form Azoubel’s perspective, learning is meaningful when there is a relationship with the saved cognitive structure of the person. So cognitive structure or basic information that exists in mind and is related to the new content, prepares the learner to learn new content. 

When pre-organizing approach is used in teaching, a concise and general framework of the syllabus should be developed in the beginning for the learners. The detailed content should be provided in the following sessions; the learner realizes about the general syllabus and then learns the details gradually.  

Learner should be active in learning process that is if the learner be more active in discovery, perception and understanding, the motivation increases. The advantages of this method are presentation of more content and students’ involvement. Therefore, learning enhances and the data remains in mind for a longer period of time. Moreover, the data is organized in student’s mind since a framework is developed for them (4).

The results of the studies confirm this fact. A study conducted in 2008 on 80 female students in Marvdasht, showed that   learning process was significantly higher among pre-organizing method in compare with lecture method. (5) Chung et al (2013) and Azoubel (1960) conducted a research to analyze the influence of pre-organizers on students’ learning. The results confirm the importance of using pre-organizers to enhance learning (6 and 7). However, it should be mentioned that short-term learning is evaluated in these studies. Alien (1969) and Neis Worth (1967) studied the influence of this method on long-term learning (8 and 9). Dubravka Celinsek recommends pre-organizer method to increase learning among students (10).

Learning process in medical sciences is highly important owning to the fact that it is in direct contact with human beings’ life (11). In the present study, seminar method has been combined with pre-organizers strategy and students’ perspective on the influence of this method on empowerment of team-work, activation of students and increase of learning have been evaluated.


This is a semi-experimental (post-test for a group) study. Firstly, students were educated with seminar method with pre-organizer strategy (independent variable) and then its influence was evaluated. The results were presents descriptively and analytically.

In students’ opinion, data presented in seminar method were scattered. Therefore, the content was studied in order to solve this problem and pre-organizer method was chosen. It was decided to use seminar method with pre-organizer approach to teach infectious course. This method was conducted in four continuous semesters and students’ perspective was evaluated in four important teaching process including enhance learning, information retention in mind, activation of students and increase of team-working. The study population included 70 male students and 36 females that studies in four semesters during 2012 and 2013 in infectious ward.   

The instrument to assess students’ perspective was a questionnaire developed by the researcher incluing 21 questions using Likert scale (totally disagree to totally agree) that was designed according to theories. The validity was evalueted using books and scientific articles and also 5 facluty memebers of ethnic sciences assessed the questionnaire. Cronbach's alpha method was used to evaluate reliability. The coefficient was 89% for the whole questionnaire and for different parts were as follow: enhancement of team-working (91%), active participation of students (85%), learning enhancement (97%) and organization of data in mind (88%).

Implementation of seminar method with pre-organizing approach was as follow: firstly main and particular purposes of this method were explained for the students. Students were categorized in groups. A stager and an intern were in each group. The subjects of the syllabus were infectious diseases and students were supposed to study according to the syllabus provided for them. Each group selected the subject and time of presentation on their own. Groups were supposed to conduct research on the subject in team-working and read the most current scientific articles about the disease. Then according to the schedule they presented their subjects.

In pre-organizer strategy, stager was supposed to present about pathophysiology, pathology, epidemiology, and clinical and laboratory symptoms of disease about 20 minutes, then, intern presented about disease diagnosis, differential diagnosis, treatment and prevention of the same disease for 20 minutes. And 20 minutes was considered for professor to sum up and students to express their opinions. The schedule of the seminar was announced to students in advance and they were asked to have pre-reading and the professor asked questions during the seminar regularly. Therefore, data were organized in students’ minds regularly (from general to specific). Each seminar was evaluated according to two factors: presentation and the quality of the content. At the end of the semester, students’ perspectives were assessed about the approach.


The population study included 36 female students (33%) and 70 male students (66%). The age mean was 24.91 ± 2.01. 48 of participants were stager (45.3%) and 58 of them were intern (54.7). 33 percent of the particpants (35 %) stated that they have experienced this method before and 63.2 & (71 students) said that they have not experienced the method before and about 10 % that is 10 people provided no answer. The grade of the participants was between 12 to 19 and the average grade was 16.61± 34.1.  

61 participants (57.5%) believed that this method enahnces team-working. 95 of them (89.6%) mentioned it improves learning and 54 students (50.9) said it organizes the data in mind properly. 76 students (70.8%) prefered this method to other methods (Table 1)

There was no significant relationship between grade and age variables and students’ perspective in relation with the influence of this method on organizing data, enhancing learning, activating students, improving team-working and preferring this method to other methods. (P> 0.05) (Table 2)

There was a significant relationship between gender variable and students’ perspective in relation with the influence of this method on organizing data, enhancing learning, activating students, improving team-working and preferring this method to other methods. (P> 0.05) (Table 3)

There was no significant relationship between level of education and students’ perspective in relation with the influence of this method on organizing data, enhancing learning, activating students, improving team-working and preferring this method to other methods. (P> 0.05) (Table 4)

Table 1: Students’ perspective on the influence of seminar method on upgrading team-working, enhancing learning, activating the students, organizing data and preferring this method to other methods

Students’ perspective

Totally agree


No idea

Upgrading team-working




Activating the students




Enhancing learning




Organizing data




Preferring this method to other methods





Table 2: Analyzing students’ perspective with age and grade




Organizing data


0.04- = r

0.67= p

0.18= r

0.07= p

Increase learning

0.09-= r

0.35= p

 -0.02= r

0.81 = p


Active students


0.03- = r

0.7= p

0.002 = r

0.98= p

Upgrade team-working


0.13- = r

0.18= p

-0.06 = r

0.52= p

Total preference of the method

0.08- = r

0.4= p

-0.60 = r

0.54= p




Table 3: Comparing students’ perspective with gender

Significant relationship


Standard deviation







Organizing data








Enhance learning





31. 27



Activating students








Increase team-working








Total preference to other methods






Table 4: Comparing students’ perspective according to level of education

Significant relationship


Standard Deviation







Organizing data


1. 85






Increase learning





3. 68



Activating students








Upgrading team-working








Total preference of method






In this study, 89.8% of students stated that this teaching method enhances learning to a large scale that is similar to the results of Nemati and Fani (2008), and Chung et al (2013). Moreover, Azoubel (1960) study had similar results (5, 6), it focused on short-term learning and the results are very similar to the present study. It is recommended that in future studies this method combines with other teaching method and besides students’ perspective, level of learning and retention be assessed so that the results of these researches provide a clear vision of localized teaching method in Iran and especially in Health Education that is very important.

According to the results of the current study, it seems that this is an appropriate method but more attention should be paid to some factors such as motivation for team-working. The percentage of team-working was 67.5. Moreover, the method should be explained for students and also they should experience some practical cases of team-working and its advantages, no study was found in this respect.

Analyzing the influence of this method on activating students, 67.9 % of participants stated that it was very influential .Bloom considers active participation as one of the important indexes of effectiveness (12) and Jarrahi and Najafi (2013) realized that active students learn better (13). Accordingly, this method is influential.

From 50.9 % students’ perspective, mixing seminar method with pre-organizers strategy lead to proper organization of data in mind that results in retention of data, as well. In the studies of Alein (1969) and Neis Worth (1967), the influence of this method on long-term learning and retention was studied (8, 9) and have confirmed this result. Since the purpose of any training is to learn and remember the presented content, especially in medical education, therefore, the important of this issue is confirmed. 

70/8% of students preferred this method to other methods that was similar to other researches. According to the study, students prefer clinical-based training to traditional and regular methods. In addition, they like to have active participation in classes and presentations (14). In another study, students were eager to experience teaching-learning method. They presented their knowledge in smaller groups (15). The results were also similar to Dubravka Celinsek’s study (10).

According to the results of the present study, it could be stated that this method made students more eager to learn new subjects. As evidences show, students who had seminar course before this study, the course was considered as an assignment to gain score. After the implementation of this method, because they were expected to improve their scientific level and study more, they became more interested in learning and participating in seminars.

Another consequence of this method is that students skill in finding scientific national and internaitonal references upgraded. In addition, students’ motivation to particpate in group activites increased, and also the quality of training about diseases that they have not encountered improved.

The limitation of the study was that the researcher could not control interfering variables such as interest, motivation, and etc. Therefore, it is recommended that the practicality of this method be assessed in thorough laboratory condition. Moreover, it is suggested to use films and clips provided by students to enhance cognitive skills. In cases that a patient who has the specific disease is available, it is better to provide some part of presentation in the ward. If the students’ presentation about a subject is insufficient, professor should provide complimentary explanation. 

1. Kang SH. The effect of using an advance organizer on student learning in a computer simulation. J Educ Tech Syst 1997; 25: 57-65.
2. Norcini J, McKinley DW. Assessment method in medical education teaching. Teach Educ 2007; 23(3): 239-50.
3. Harden R. A practical guide for medical teachers: UK: Churchill Livingstone; 2009.
4. Brous J. Methods. Mohammad Reza Behrangi. 3rd ed. (translator). Tehran: Kamal Tarbiat; 2003. [In Persian].
5. Shah Nemati Z, Fani H. Comparing the influence of pre-organizers and lecture method on enhancing learning and level of transfer and its relationship with students’ performance at fourth grade of elementary school in Marvdasht, training researches. Journal of Islamic Azad University of Bojnord 2008; 16(4): 108-27. [In Persian].
6. Chung EK, Nam Ki, Oh SA, Han ER, Woo YJ, Hitchock MA. Advance organizes in a gross anatomy dissection course and their effects on academic achievement. Clin Anat 2013; 26(3): 327-32.
7. Ausubel DP. the use of organizers in the learning and retention of meaningful verbal material. J Educ Psychol 1960; 51: 267-72.
8. Ailen DI. Some effects of advance organizers and level of retention of written social studies material. Ph.D. Dissertation. University of California. Dissert Abs Int 1970; 30: 4267.
9. Neis worth J. The use of advance organizer with the educable mentally retarded. Ph.D. Dissertation. University of Pittsburgh. Dissert Abs Int 1967; 28: 4539.
10. Celinsek D, Markik M. Implementing a new approach in teaching and learning (pbl) in a higher education learning organization. Proceeding of the 20th Annual World ICSEI. [cited 2015]. Available from: URL;
11. Khazaei Z, Ramezanzade Kh, Moodi M , Moradi M. Quality of clinical education of the professors of School of Medicine in Birjand University of Medical Sciences from the perspective of students in school year 2009-2010. Future of medical education journal 2012; 2(1): 22-26.
12. Seif AA. Educational psychology (learning and education psychology). Tehran: Agah; 1997. [In Persian].
13. Jarahi L, Najafi M. Evaluation of teaching through lecture with new methods of student-centered teaching in medical students. Future of medical education journal 2013; 3(4): 6-9.
14. Amin Z, Chong YS, Khoo HE. Practical guide to medical student assessment. World Scientific; 2006.
15. Matthes J, Look A, Hahne AK, Tekian A, Herzig S. The semi-structured triple jump-a new assessment tool reflects qualifications of tutors in a PBL course on basic pharmacology. Archiv für Experimentelle Pathologie und Pharmakologie 2008; 377(1): 55-63. [In German].