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Clinical medicine, Hospital departments, Qualitative research, Academies and institutes, IntroductionUniversities are institutions that do important functions in all societies teaching and research are clearly two fundamental and dominant missions of universities. The growing demand for higher education after the end of World War II and its effects on expanding the capacity of higher education institutions across the world has led to a shift in the nature of the university from elite to mass higher education institutions ( 1, ). Indeed, most countries need higher education institutions and programs that are responsive to the diverse needs of their community, that is different functions and missions should be considered for higher education institutions ( 2, ). The dimensions of teaching and learning, research involvement and knowledge exchange reflect the core functions of higher education institutions ( 3, ). The relationship between education and research especially in postgraduate programs has recently been highlighted so that a new term- &,lsquo research-teaching nexus&,rsquo - has been coined. In other words, teaching itself is just one element ( 4, ). Some methods such as problem-based learning and evidence-based practice can prove that education without research is meaningless. Elken and Wollscheid (2016) conducted a review of the literature on the relationship between research and education, referring to the range of typologies and indicators ( 5, ). Fung and Gordon (2016) found that leading research-intensive universities in the UK were increasingly rewarding education-focused leaders with promotions ( 6, ). Becker and Kennedy (2005) believe that although most research has addressed the benefit of a research-rich culture to students, the researchers benefit from teaching, as well ( 7, ). The differentiation can be considered a process in which new entities emerge in a higher education system resulting in more system diversity ( 8, , 9, ), or a process whereby a social unit changes to two or more units. According to this view, new social units are structurally distinct from each other, but their performance is equivalent to the original unit ( 10, ). The concept of differentiation in higher education has been widely discussed ( 11, - 16, ). There is a wide range of examples of innovative practices and specialized programs in mission differentiation around the world. For example, the University of Waterloo is a world leader in the field of cooperative education and McMaster has been a leader in problem-based education in its medical programs ( 17, ). Competition among higher education institutions is sometimes identified as a stimulus for differentiation ( 18, ). Competitive advantage in higher education came from the United States as higher education moved from elite to mass, a system including a diverse range of community college institutions and prominent research universities ( 18, , 19, ). The highlight of competition in the American higher education system has actually been to encourage universities to compete through differentiation. In fact, this research is a start for medical sciences universities to compete on a clean spot ( 20, ). There are various models in the world for calculating the competitive advantage and the point of distinction of higher education institutions such as the Porter model (2011) ( 21, ), the Zwanziger model (1996) ( 22, ), the Herfindal index (1950) ( 23, ), the Balassa, Specialized index (1965) ( 24, ), which are indicators that measure the point of differentiation in higher education. These indicators and models measure differentiation in higher education institutions in the dimension of education, and none is applicable to research. The evaluation of scientific products of universities, groups and organizations is not a new subject, and with the advancement of knowledge and increasing competition in this field, it becomes a challenging issue and an undeniable necessity. One of the most common ways to evaluate scientific products is to use methods of scientometrics related to the production and dissemination of knowledge and technology. Scientometrics is the science of measuring science using quantitative methods and models ( 25, ), and helps to analyze quantitative aspects of the scientific production and use of the information for better understanding of scientific research ( 26, ). In Iran, in 1849, the first modern course of Medicine at Dar-ol-Fonoon School was founded, and the pioneering graduates started the practice of modern medicine in 1856. In 1918, Dar-ol-Fonoon was renamed to College of Medicine, and in 1934 it turned into the&,nbsp School of Medicine&,nbsp of the University of Tehran. At present, higher education systems for medical sciences have amounted to 66 public colleges and universities of medical sciences. All these institutions are under the supervision of the Ministry of Health and Medical Education (MOHME) ( 27, , 28, ). A diverse range of higher education institutions with different missions allows the over-all system to meet students&,rsquo needs, provide opportunities for social mobility, meet the needs of different labor markets, serve the political needs of the interest groups, increase level of higher education institutions effectiveness, and offer opportunities for experimenting with innovation ( 29, ). However, in recent years, MOHME attempted to have mission-orientated universities. In this regard, the ",packages of transformation and innovation in medical sciences", have been developed and implemented with specific missions to the 10 regions&,nbsp of high education spatial planning program, which were not based on the study of the capacities and empowerment of college, universities and regions ( 30, ). The lack of diversity or de-differentiation occurs because of the policy and professional factors which contribute to increasing convergence or homogeneity within the higher education system leading to &,ldquo academic&,rdquo or &,ldquo mission&,rdquo drift ( 16, ). In this regard, Universities, and particularly the top research-intensive universities, are the higher education institutions that relate most directly to the global knowledge economy. It is these research-intensive universities that might qualify as &,ldquo world class&,rdquo institutions in their respective countries and most likely to be recognized in the international rankings ( 31, ).Therefore, due to the importance and necessity of mission differentiation and no previous studies with a generalized and agreed framework for differentiation and diversity in medical sciences universities in Iran, we conducted this study to identify the dimensions of the differentiation of Iran&apos,s medical sciences universities through scientific strength and competitive advantages of research activities in clinical specialty and sub-spatiality departments. The findings of this study can help the MOHME policy-makers to make appropriate planning for the allocation of missions in the field of research and in order to get an appropriate place at national and international levels.MethodsWe used a mixed methods design ( 32, - 33, ) that incorporated both qualitative (focus group discussion) techniques and quantitative (scientometric) study, ( 34, - 37, ). A protocol of scientific strength and competitive advantage in focus groups session was determined and was implemented during the scientometric study. The data were collected in February-April 2019. This study was conducted in Iran within the context of postgraduate training programs of the academic clinical specialties and sub-specialties departments in 66 colleges and universities of medical sciences. In this regard, we explored and identified opinions of research participants by involving the faculty members of Shahid-Beheshti University of Medical Science through focus group discussion (FGD) and used research activity data of the faculty members of the colleges and universities of medical sciences, using scientometric systems MOHME. In first stage, FGD was used to develop a protocol for determining the scientific strength and competitive of clinical specialty and sub-spatiality departments. Literature review showed that the focus group method of investigation is used as an explanatory data collection technique ( 32, ). The participants were selected using purposive sampling. In this technique, the participants are selected on the premise of a purpose in the mind of the researcher and the sample is then selected to encompass the interested participants and excludes those who do not suit the purpose ( 33, ). At the beginning of the meeting, the research objectives were introduced and the general information about the research and the meeting time were also explained. In addition, a full description of the meeting audio-recording and everyone&,rsquo s obligation to contribute was provided and the participants were ensured that the information remained confidential and anonymous. In this regard, during the meeting, one of the researchers conducted discussions keeping neutrality and lack of judging, encouraging the contributors to discuss the topic, interact with each other and express their opinions. The other researcher served as an observer, recording the interactions between individuals. After the focus group meeting, the audio-recording was implemented by one of the researchers. The validity, transferability, reliability and verifiability criteria were considered in the study. For validity, the researchers participated in all stages of the study. In addition, the process of data collection and analysis was performed shortly after the FGD. In relation to the transferability criterion, it was attempted to provide a comprehensive description of the study. Regarding reliability, data analysis was performed by two researchers and reviewed by a third person. An external observer was used to examine the data analysis in order to ensure the criterion of verification. We classified each statement in a matrix and searched for themes that summarized the various statements. The consistency of the matrix was checked by the researchers by coding the transcripts again while looking for blanks or inconsistencies that did not fit in the themes and establishing whether the themes were exclusive. Contradictory statements were also explicitly searched for and consensus was reached through discussion. No theoretical framework was used during the coding procedure. In the second stage, we implemented the protocol proposed in the first stage. We extracted the research activity data related to faculty members of clinical specialty and sub-spatiality departments from Scientometrics System MOHME including demographic characteristics, college and university name, H index, total of citations, ranking at national level in fields and specialized fields names. Indicators and formulae were modeled in Excel software. In order to examine the protocol, a pilot calculation was done on the data by Shahid Beheshti University of Medical Sciences, which proved the accuracy. Calculations done for all faculty members of 66 college and universities of medical sciences are available in the MOHME Scientometric System ( 34, ). At this stage, the accuracy of data was examined the data by the research team meetings and the data transfer were complete. After analyzing the scientometric data of all college and universities, the results were extracted based on the scientific strength Index and the competitive advantage index of results. The Scientometric data were analyzed using Microsoft Excel 2019 and Tableau software version 2018.3. Descriptive statistics (frequencies and percentages) were provided.ResultsFive faculty members took part in the focus groups from Shahid-Beheshti University of Medical Sciences. Five research participants took part in the research according to the literature, the number of research participants in a FGD meeting depends on the issue, the expected phenomenon characteristics and data saturation ( 38, , 39, ), and an ideal group size in FGD ranges from four to eight people ( 35, ). The mean age of the participants was 43.1 and three participants were female and the session lasted for approximately 120 minutes. In terms of academic rank, 1 was an assistant professor, 2 were associate professors and 2 were full professors. In order to gather rich data, the participants were selected 1) with specialties related to medical education, medical information and clinical specialty and sub-spatiality, 2) with a background in scientometrics and 3) willingness to participate in the study. It should be noted that because of the large number of departments and lack of science strength and competitive advantage in some college and universities only the colleges and universities with an &,ldquo inclusive advantage&,rdquo and &,ldquo competitive advantage&,rdquo were included, based on table (1). The data obtained from the FGD analysis were grouped into a protocol including 2 formulae (SSI &,amp CAI) and 4 indices (T10C, T10C/N, T10CU/N, H2 Index) and three main categories related to executive model ( Table 1,).Main CategoriesSub-categoriesModel inputUsing scientific indices of faculty members as the main arm of medical sciences universities in research.Using academic membership website as the main reference for extracting research data from universities as the only valid and existing system in this field. |