Journal of Modern Medical

Introduction
Curriculum is a set of educational courses for the development of students, which is provided under the supervision of an educational organization. Higher education as an open system is facing many changes; in case of inability to respond to these changes, it will not be able to fulfill its mission. Curriculum in higher education plays an important role in responding to the needs of the environment. Curriculum evaluation is considered a fundamental issue in curriculum planning and the curriculum designer should consider the objectives of the course subjects, the needs of the learners, and society. Due to the impact of technology growth on health care environments and the field of health information management, and the continuous change of job expectations and professional qualifications of students, the health information management curriculum of Iranian students needs to be updated. According to the conducted studies, the repetition of course materials, students’ lack of access to the real environment, and the lack of balance in the complexity levels of the courses in this field are among the reasons for Iranian students’ tendency to update the health information management curriculum. In the studies by Farzandipour et al. and Mahdavi et al., [15, 16] the need to revise and change the curriculum of this study field has also been emphasized. This requires the modification of the curriculum based on the recent changes. However, to our knowledge, no evaluation has been made on the curriculum of health information management for PhD students in Iran. Considering the key role of the curriculum and the need to evaluate it to adapt to the goals, needs, growing environment, and changes in digital health, this study aims to evaluate the current curriculum of health information management (approved by 2013) for PhD students in Iran.
Methods
This descriptive study was conducted in 2021. The study population consists of all students and graduates in the filed of health information management, as well as all professors in the department of health information technology & management and the department of medical informatics from medical universities in Iran, who were selected for the study by a census sampling method. The collection tool was a researcher-made questionnaire, whose validity was checked, modified, and confirmed by a panel of experts. Fifteen PhD students also completed the questionnaire and corrections were made based on their opinions. To determine the reliability, Cronbach’s alpha was calculated which was obtained 0.9. The final version of questionnaire had three parts, including demographic characteristics, main and optional courses, the approved course title and recommendations. In the second and third parts, the questions were about the relevance of the content to the field, the applicability of the content, the amount of editing needed in the course title, the degree of overlapping in the content (open-ended question), and the changes intended by the participants (open-ended question). To determine the score of each course, the summed score of the items was used. In total (out of 5 points), a score of <3 indicates that the course needs to be removed, a score of 3.75-5 indicates the suitability of the course, and a score of 3.75-3.75 indicates that the course requires modification. The analysis of the answers to the open-ended questions was done using the content analysis method and the recommendations were organized in the form of groups and subgroups. Statistical analysis was done in SPSS software using descriptive statistics.
Results
Forty one faculty members and 26 students and graduates completed the questionnaires (response rate=84%).The field of study of most of the respondents was health information management. In terms of relevance, the courses “Clinical Governance Information Systems” and “Health Information Economy” were identified as those requiring modification. In terms of applicability, the courses “Clinical Governance Information Systems”, “Health Information Economy” and “Methods for Improving and Managing Information Quality” needed modification. Regarding the amount of editing required, most of the courses, except for the courses “Advanced Statistical Methods”, “Thesis”, “Research Seminar” and “Design and Development of Health Information Systems No. 1”, needed serious revision. Based on the total scores, only the courses “Design and development of Health Information Systems No. 1”, “Data Mining and Knowledge-based Systems”, “Thesis” and “Advanced Statistical Methods” were found suitable. The course “Clinical Governance Information Systems” was reported to be removed and other courses required revision. Furthermore, by comparing the title of courses with those for undergraduate and graduate students in health information technology, it was found out that the courses “Electronic Health File”, “Clinical Governance Information Systems”, “Health Surveillance and Monitoring System” and “Quality Improvement Methods” had a lot of overlap with the courses provided for the students in lower degrees. Also, the recurring topics considered by the participants to be included in the courses were: Big data, deep learning, data visualization, ontology, patient-centered health information management, new digital health technologies (such as social network, decision support system and game in health, telemedicine systems, Internet of Things and Web of Things, virtual reality technologies, augmented reality, cloud computing, fog computing, and blockchain in health), security of health information systems, evaluation of health information systems, governance of health information, entrepreneurship, network management, and advanced database design.
Discussion
The results of the present study, with the aim of identifying the shortcomings of the current curriculum of health information management for PhD students in Iran, showed that most of the current courses needed serious modification. Although, based on the criteria of relevance and applicability, most of the current courses were found to be suitable, but the overlapping of these courses with each other and with the courses provided for undergraduate and graduate students in health information technology showed the urgent need to revise the content and curriculum of the health information management for PhD students. Among the 17 studied courses, 13 courses (76%) needed to be removed or modified; only four courses were found to be suitable. It is recommended that these courses should be revised according to the changes in health towards digital health and the need to review the roles and professional qualifications required in this field. In the current study, based on the analysis of the answers to the open-ended questions, new topics for curriculum revision were identified, which mainly focused on considering new digital health technologies, advanced health data analyses, and health information governance. The present study had some limitations. The sample size was small. It was possible to recruit only 80 participants, of whom 67 participated in the study; the participation of students and graduates was low. In addition, the cooperation of some universities was low.

Ethical Considerations
Compliance with ethical guidelines
This study was financially supported by the National Agency for Strategic Research of Medical education, Tehran, Iran (NASR)) (Grant No: 4000337).

Funding
This study has ethical approval No. IR. NASRME REC.1400.309 from the Research Ethics Committee of he National Agency for Strategic Research of Medical education.

Authors' contributions
Conceptualization, Methodology: Maryam Ahmadi, Abbas Sheikhtaheri; Investigation: Maryam Ahmadi, Foziye Tahmasbi, Maryam Eslami Jahromi, Abbas Sheikhtaheri; Writing-Original Draft: Maryam Ahmadi, Foziye Tahmasbi, Maryam Eslami Jahromi, Abbas Sheikhtaheri; Writing-Review & Editing: Foziye Tahmasbi, Maryam Eslami Jahromi, Abbas Sheikhtaheri; Funding Acquisition, Resources, Supervision: Abbas Sheikhtaheri.

Conflicts of interest
The authors declare that there is no conflict of interest in this research

Acknowledgements
We would like to thank all students, graduates, and professors who freely participated in this study. We also would like to thank National Agency for Strategic Research in Medical Education, Iran for funding this study (Grant No: 4000337).

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