Anxiety in medical students: is preparation for full-time clinical attachments more dependent upon differences in maturity or on educational programmes for undergraduate and graduate entry students?

Analysis and suggestions on medical educators' roles

PURPOSE

This study aimed to investigate the differences in the perception between professors and students regarding medical educators' roles and discuss their desirable roles.

METHODS

A survey was administered to 116 professors and 379 students of the medical colleges from Dankook University and Hallym University. The subjects were given a self-created questionnaire designed to measure their perception of medical educators' roles.

RESULTS

First, "student performance management" for professors and "teaching skill development" for students were recognized as the most essential medical educators' role. Second, females students perceived the roles to be more important than males in eight of 10 roles.

CONCLUSION

First, "student performance management" for professors and "teaching skill development" for students were recognized as the most essential medical educators' role. Second, females students perceived the roles to be more important than males in eight of 10 roles.

The experience of widening participation students in undergraduate medical education in the UK: A qualitative systematic review

Introduction: Most widening participation (WP) research is focused on medical school recruitment; there is a paucity of research examining whether the experience of medical school itself is an equal experience for both 'traditional' and WP students.Methods: This qualitative systematic review used the Joanna Briggs Institute (JBI) meta-aggregative approach to characterise the experience of undergraduate medical education in the UK from the perspective of WP students. Seven databases were searched, 27 studies were critically appraised, and 208 findings were grouped into 12 categories and four synthesised findings.Results: The majority of the research found relates to ethnic minority groups, with reports of other WP groups being less frequent. Whilst WP programmes attempt to alleviate disadvantages prior to entering university, our findings suggest that difficulties follow WP students into medical school. Unfamiliarity with higher education and lack of representation of WP staff in faculty can deter help-seeking behaviour and result in lack of trust. Furthermore, students from different backgrounds can find their identity conflicted upon entering medical school. Despite difficulties in establishing social networks with 'traditional' medical student peers, WP students form strong relationships with students from similar backgrounds.Conclusions: Ultimately, these students find that the uniqueness of their experience is a useful tool for communicating with diverse patients which they come across and are able to overcome adversity with the help of a supportive institution.

A program evaluation reporting student perceptions of early clinical exposure to primary care at a new medical college in Qatar

BACKGROUND

Though common practice in Europe, few studies have described the efficacy of early clinical exposure (ECE) in the Middle East. The barriers to clinical learning experienced by these novice medical students have not been reported. This evaluation reports on introducing ECE in primary care, supported by Experiential Review (ER) debriefing sessions. The evaluation explores students' experiences of their acquisition of clinical and non-technical skills, sociocultural issues commonly encountered but underreported and barriers to clinical learning experienced.

METHODS

We conducted a cross-sectional study of three student cohorts in 2017-19: All second and third-year students at the new College of Medicine were invited to participate. The primary outcome was students' perceptions of the aims of the Primary Health Centre Placement (PHCP) programme and how it facilitated learning. Secondary outcome measures were students' perceptions of their learning in ER sessions and perceived barriers to learning during PHCPs. Student perceptions of the PHCPs were measured using a Likert scale-based questionnaire.

RESULTS

One hundred and fifty-one students participated: 107 in year 2 and 44 in year 3; 72.3% were female. Overall, most students (> 70%) strongly agreed or agreed with the purposes of the PCHPs. Most students (71%) strongly agreed or agreed that the PCHPs allowed them to learn about patient care; 58% to observe doctors as role models and 55% to discuss managing common clinical problems with family physicians. Most students (year 2 = 62.5% and year 3 = 67%) strongly agreed/agreed that they were now confident taking histories and examining patients. Student barriers to clinical learning included: Unclear learning outcomes (48.3%); faculty too busy to teach (41.7%); lacking understanding of clinical medicine (29.1%); shyness (26.5%); and finding talking to patients difficult and embarrassing (25.8%). Over 70% reported that ER enabled them to discuss ethical and professional issues.

CONCLUSIONS

Overall, our Middle Eastern students regard ECE as beneficial to their clinical learning. PHCPs and ER sessions together provide useful educational experiences for novice learners. We recommend further exploration of the barriers to learning to explore whether these novice students' perceptions are manifesting underlying cultural sensitivities or acculturation to their new environment.

Knowledge self-monitoring, efficiency, and determinants of self-confidence statement in multiple choice questions in medical students

BACKGROUND

Multiple-choice question (MCQ) tests are commonly used to evaluate medical students, but they do not assess self-confidence nor penalize lucky guess or harmful behaviors. Based on a scoring method according to the appropriateness of confidence in answers, the study aimed at assessing knowledge self-monitoring and efficiency, and the determinants of self-confidence.

METHODS

A cross-sectional study of 842 s- and third-year medical students who were asked to state their level of confidence (A: very confident, B: moderately confident and C: not confident) during 12 tests (106,806 events). A bonus was applied if the level of confidence matched with the correctness of the answer, and a penalty was applied in the case of inappropriate confidence.

RESULTS

Level A was selected more appropriately by the top 20% students whereas level C was selected more appropriately by the lower 20% students. Efficiency of higher-performing students was higher when correct (among correct answers, rate of A statement), but worse when incorrect compared to the bottom 20% students (among incorrect answers, rate of C statement). B and C statements were independently associated with female and male gender, respectively (OR for male vs female = 0.89 [0.82-0.96], p = 0.004, for level B and 1.15 [1.01-1.32], p = 0.047, for level C).

CONCLUSION

While both addressing the gender confidence gap, knowledge self-monitoring might improve awareness of students' knowledge whereas efficiency might evaluate appropriate behavior in clinical practice. These results suggest differential feedback during training in higher versus lower-performing students, and potentially harmful behavior in decision-making during clinical practice in higher-performing students.

Converting to Connect: A Rapid RE-AIM Evaluation of the Digital Conversion of a Clerkship Curriculum in the Age of COVID-19

BACKGROUND

With the advent of the 2019 coronavirus pandemic, a decision was made to remove medical students from clinical rotations for their own safety. This forced students on a core emergency medicine (EM) rotation at McMaster University to immediately cease all in-person activities. An urgent need for a virtual curriculum emerged.

METHODS

A virtual curriculum consisting of asynchronous case-based learning on Slack, ask-me-anything webinars, and online e-modules was created to fill the need. We describe a program evaluation using the RE-AIM framework and a social networking analysis of participants.

RESULTS

Medical students (n = 23) and 11 facilitators (five residents, six faculty members) participated in this pilot study. Faculty members sent a mean (±SD) of 115 (±117) messages (n = 6), and mean (±SD) message counts for students and residents were 49.96 (±25; n = 23) and 39 (±38; n = 5), respectively. A total of 62,237 words were written by the participants, with a mean of 1,831 per person. Each message consisted of a mean (±SD) of 25 words (±29). Students rapidly acquitted themselves to digital technology. Using the RE-AIM framework we highlight the feasibility of a virtual curriculum, discuss demands on faculty time, and reflect on strategies to engage learners.

CONCLUSIONS

The use of asynchronous digital curricula creates opportunities for faculty-resident interaction and engagement. We report the successful deployment of a viable model for undergraduate EM training for senior medical students in the COVID-19 era of physical distancing.

Perceived Benefits of a Standardized Patient Simulation in Pre-Placement Dietetic Students

The purpose of this study was to evaluate the effect of a simulation-based learning (SBL) experience on perceived confidence in monitoring and evaluation, as part of the delivery of nutrition care of pre-placement dietetic students, and to describe their perceived value of the learning experience post-placement. A mixed method explanatory sequential study design was used. A confidence appraisal scale was developed and completed by students before (n = 37) and after (n = 33) a low fidelity simulation using a volunteer patient in an acute care setting. Two semi-structured focus group discussions with post-placement students (n = 17) were thematically analysed, grounded in phenomenology. Overall perceived confidence in monitoring and evaluating, as part of nutrition care, improved after the simulation [pre-SBL: 74 (62–83) vs. post-SBL: 89 (81–98.5), p = 0.00]. Two factors emerged to modulate confidence, namely (i) structure and (ii) authentic learning. Structure in turn was modulated by two key factors; safety and process. A low fidelity simulation using a standardised patient can improve students’ perceived confidence in monitoring and evaluation, and a well-structured authentic learning experience was valued and positively perceived by most dietetic students.

Anxiety among newly-qualified doctors: An eight-year analysis

Background: Stressed and anxious doctors are more likely to make errors, take time off work and to leave medicine. This study aims to quantify the prevalence of anxiety among newly-qualified Foundation Year 1 doctors (FY1s), identify high risk groups and determine workplace factors associated with anxiety.Methods: We investigated self-reported anxiety among eight cohorts of FY1s between 2010 and 2017. Participants completed an online survey after their first week of work (n = 11,839), with a follow-up survey later in the year (n = 3502). Surveys included questions about the workplace and a validated screening tool for pathological anxiety.Results: Overall, a large proportion of doctors screened positive for pathological anxiety at the start of their FY1 year (27.3%) and after 4 months of work (21.0%). Year-on-year, we found a growing burden of anxiety at the start of FY1 (22.8% in 2010 vs. 29.6% in 2017, p < 0.01) and at follow-up. Anxiety was significantly higher among females (p < 0.01), those aged 21-25 (p < 0.05) and those who did not feel part of a team (p < 0.01).Conclusion: We found a growing burden of anxiety among FY1s associated with a perceived lack of support. We hope our findings will inform interventions to support newly-qualified doctors as they transition into the workplace.

Beyond the struggles: a scoping review on the transition to undergraduate clinical training

CONTEXT

The transition to clinical training within medical school is often seen as a struggle and students remain in distress despite numerous efforts to minimise threats. Efforts to change this may be misdirected if they are based on narrow conceptualisations of transitions. The authors conducted a scoping review to explore existing conceptual perspectives regarding the transition within medical school from pre-clinical training to clinical training to suggest a research agenda and practical implications.

METHODS

Between October 2017 and February 2018 the authors searched PubMed, MEDLINE, ERIC, PsycINFO, Web of Science and CINAHL for English language literature with no date limits and retrieved 1582 articles; 46 were included in this review. Two reviewers independently screened articles and extracted data. Data were then charted, analysed and discussed with the research team.

RESULTS

The transition to clinical training was often described negatively as 'difficult', 'a problem' and 'a struggle'. Our analysis found that researchers in medical education conducted studies on the transition to clinical training from three conceptual perspectives: educational; social, and developmental. Most research approached the transition to clinical training as a problem to be addressed from an educational perspective through transition to clerkship courses and curriculum innovations. Some research was conducted from a social perspective, focusing on building relationships. Regarding development, authors found a few articles highlighting opportunities for personal and professional development by nurturing transferrable learning strategies and reflection.

CONCLUSIONS

This review provides an empirical base on which future research can be built to better understand and support medical students' ability to navigate change. Finding new perspectives to approach the transition to clinical training could allow researchers to look beyond preparing students for struggles.

Challenges in the transition to clinical training in dentistry: An ADEE special interest group initial report

INTRODUCTION

Curricular integration in higher education has been widely supported in the educational literature. As a result, several health care and specifically dental curricula have evolved from compartmentalised disciplinary training to integrated modalities; however, in many courses, a pre-clinical-clinical watershed remains a barrier to integration in dental education. This article introduces a general description of the pre-clinical-clinical transition in dentistry according to the outcomes of the discussion held during the first working group session of the "Transition to Clinical Training" Special Interest Group during the 2016 annual meeting of the Association for Dental Education in Europe.

MATERIALS AND METHODS

An online questionnaire was made available before the meeting to survey the curricular characteristics of the participants' schools. During the meeting, a working session related to the pre-clinical-clinical transition occurred. Conclusions from the discussion are summarised in this article.

RESULTS

Fourteen dental schools from 12 countries participated in the online survey. The included programmes had an average duration of 5.3 years (SD = 0.48), with high school or the local equivalent as the required entrance level for dentistry. The hybrid curriculum was the leading curriculum design (n = 9) followed by competence-based curricula (n = 3), with patient treatment as the core of clinical training in every included programme.

CONCLUSION

The pre-clinical-clinical transition in dentistry is a recognisable matter in dental education that requires assessment and research to ease the management of a stage with relevant influence on educational outcomes. This article presents an initial framework for further research and educational intervention.

Medical students' preparedness for professional activities in early clerkships

BACKGROUND

Sufficient preparedness is important for transitions to workplace participation and learning in clinical settings. This study aims to analyse medical students' preparedness for early clerkships using a three-dimensional, socio-cognitive, theory-based model of preparedness anchored in specific professional activities and their supervision level.

METHODS

Medical students from a competency-based undergraduate curriculum were surveyed about preparedness for 21 professional activities and level of perceived supervision during their early clerkships via an online questionnaire. Preparedness was operationalized by the three dimensions of confidence to carry out clerkship activities, being prepared through university teaching and coping with failure by seeking support. Factors influencing preparedness and perceived stress as outcomes were analysed through step-wise regression.

RESULTS

Professional activities carried out by the students (n = 147; 19.0%) and their supervision levels varied. While most students reported high confidence to perform the tasks, the activity-specific analysis revealed important gaps in preparation through university teaching. Students regularly searched for support in case of difficulty. One quarter of the variance of each preparedness dimension was explained by self-efficacy, supervision quality, amount of prior clerkship experience and nature of professional activities. Preparedness contributed to predicting perceived stress.

CONCLUSIONS

The applied three-dimensional concept of preparedness and the task-specific approach provided a detailed and meaningful view on medical students' workplace participation and experiences in early clerkships.

Medical student changes in self-regulated learning during the transition to the clinical environment

BACKGROUND

Self-regulated learning (SRL), which is learners' ability to proactively select and use different strategies to reach learning goals, is associated with academic and clinical success and life-long learning. SRL does not develop automatically in the clinical environment and its development during the preclinical to clinical learning transition has not been quantitatively studied. Our study aims to fill this gap by measuring SRL in medical students during the transitional period and examining its contributing factors.

METHODS

Medical students were invited to complete a questionnaire at the commencement of their first clinical year (T0), and 10 weeks later (T1). The questionnaire included the Motivated Strategies for Learning Questionnaire (MSLQ) and asked about previous clinical experience. Information about the student's background, demographic characteristics and first clinical rotation were also gathered.

RESULTS

Of 118 students invited to participate, complete paired responses were obtained from 72 medical students (response rate 61%). At T1, extrinsic goal orientation increased and was associated with gender (males were more likely to increase extrinsic goal orientation) and type of first attachment (critical care and community based attachments, compared to hospital ward based attachments). Metacognitive self-regulation decreased at T1 and was negatively associated with previous clinical experience.

CONCLUSIONS

Measurable changes in self-regulated learning occur during the transition from preclinical learning to clinical immersion, particularly in the domains of extrinsic goal orientation and metacognitive self-regulation. Self-determination theory offers possible explanations for this finding which have practical implications and point the way to future research. In addition, interventions to promote metacognition before the clinical immersion may assist in preserving SRL during the transition and thus promote life-long learning skills in preparation for real-world practice.

Can Nursing Students Practice What Is Preached? Factors Impacting Graduating Nurses' Abilities and Achievement to Apply Evidence-Based Practices

BACKGROUND

In order to meet national Australian nursing registration requisites, nurses need to meet competency requirements for evidence-based practices (EBPs).

AIMS

A hypothetical model was formulated to explore factors that influenced Australian nursing students' ability and achievement to understand and employ EBPs related to health care provision.

METHODS

A nonexperimental, descriptive survey method was used to identify self-reported EBP efficacy estimates of 375 completing undergraduate nursing students. Factors influencing participants' self-rated EBP abilities were validated by Rasch analysis and then modeled using the partial least squares analysis (PLS Path) program.

RESULTS

Graduating nursing students' ability to understand and apply EBPs for clinical improvement can be directly and indirectly predicted by eight variables including their understanding in the analysis, critique and synthesis of clinically based nursing research, their ability to communicate research to others and whether they had actually witnessed other staff delivering EBP.

LINKING EVIDENCE TO ACTION

Forty-one percent of the variance in the nursing students' self-rated EBP efficacy scores is able to be accounted for by this model. Previous exposure to EBP studies facilitates participants' confidence with EBP, particularly with concurrent clinical EBP experiences.

A comparison of stress levels, coping styles and psychological morbidity between graduate-entry and traditional undergraduate medical students during the first 2 years at a UK medical school

BACKGROUND

Stress levels and psychological morbidity are high among undergraduate medical students (UGs), but there is a lack of research into the psychological health of UK graduate-entry medical students (GEs). GEs are likely to experience different (perhaps more severe) stressors and to cope with stress differently. We compared stress levels, psychological morbidity and coping styles in GE versus UG medical students studying at the same UK medical school in the same academic year. A cross-sectional self-rated questionnaire study of all first- and second-year GE and UG medical students was conducted. Perceived stress, psychological morbidity, recent adverse life events, stress-related personality traits and coping styles were assessed using standard questionnaires.

RESULTS

75% GEs and 46% UGs responded to the questionnaire. Both groups reported equally high levels, and similar profiles of, perceived stress and psychological morbidity. Levels of recent adverse life events and stress-related personality traits were similar in both groups. Compared to UGs, GEs were more likely to use active coping (p = 0.02) and positive reframing (p = 0.03), but were also more likely to use substances (alcohol and other drugs; p < 0.001) to help them cope. Unlike UGs, second-year GEs showed less perceived stress (p = 0.007) and psychological morbidity (p = 0.006) than first-year GEs although levels of both were still high.

CONCLUSION

Our results show that both GE students and their younger UG counterparts on a traditional medical course have similar profiles of stress symptoms. They do, however, cope with stress differently. GEs are more likely to use active problem-focused coping strategies, and they are also more likely to cope by using substances (alcohol or other drugs). GE students need interventions to prevent maladaptive coping styles and encourage adaptive coping that are tailored to their needs. Such interventions should be targeted at first-year students. It is vital that these students develop positive coping skills to benefit them during training and in a future career that is inherently stressful.

Predicting surgical skill acquisition in preclinical medical students

BACKGROUND

The purpose of this study was to identify factors that predict medical student success in acquiring invasive procedural skills. We hypothesized that students with interest in surgery and with prior procedural experience would have higher rates of success.

METHODS

Preclinical students were enrolled in a simulation course comprised of suturing, intubation, and central venous catheterization. Students completed surveys to describe demographics, specialty interest area, prior experience, and confidence. Using linear regression, variables predictive of proficiency were identified.

RESULTS

Forty-five participants completed the course. Under univariate analysis, composite pretest score was inversely associated with confidence (P = .039). Under multivariable analysis, female gender was associated with higher pretest suturing score (P = .016). Male gender (P = .029) and high confidence (P = .021) were associated with greater improvement in suturing.

CONCLUSIONS

Among novices, higher confidence can predict lower baseline technical proficiency. Although females had higher pretest suturing scores, high confidence and male gender were associated with the greatest degree of improvement.

Training demands on clerk burnout: determining whether achievement goal motivation orientations matter

BACKGROUND

In the education field, learning experiences are considered learners' properties and are viewed as a key determinant in explaining learners' learning processes, especially for training novices such as clerks with varying levels of commitment to the medical profession. This study explored whether clerks' achievement goal motivation orientations might buffer the negative well-being to a certain extent, considering their training demands during clinical training.

METHODS

Ninety-four clerks at a tertiary medical center were longitudinally traced during their 2-year clerkship spanning from September 2013 to April 2015. Web-based, validated, structured, self-administered questionnaires were used to evaluate the clerks' properties of achievement goal motivation orientation and personal background at the beginning of the clerkship. Regular surveys were conducted to evaluate their perceptions of training demands and burnout at each specialty rotation. Overall, 2230 responses were analyzed, and linear mixed-effects models were used to examine the repeated measures of the clerks.

RESULTS

The results revealed that higher perceived psychological and physical demands of training were related to higher perceived burnout during the 2-year clerkship. Although both the clerks' task and ego orientations were related to reduced burnout (direct effects), only task orientation was indicated to exert a buffering effect on their perception of physical demands on burnout in the 1st year of the clerkship.

CONCLUSIONS

Considering the negative effects of training demands (psychological and physical), we observed a limited effect of the task achievement motivation orientation of medical students; therefore, additional studies might focus on strategies to facilitate medical students in clerkships in addressing both the psychological and physical demands inherent in training workplaces to improve their learning experience and well-being.

Student perceptions of clerkship handbooks

BACKGROUND

When students transition into new clerkships, it can be useful to provide them with information to assist them in their adjustment to the new social environment. Handbooks could support students by providing information, particularly during clerkship orientation. The authors explored aspects of existing handbooks that students found useful, and sought additional desirable content.

METHODS

During seven semi-structured focus group discussions, 48 final-year medical students discussed their perceptions of six handbooks at the end of their training. Focus group discussions continued until data saturation. Transcripts were thematically analysed.

RESULTS

Students appreciated handbooks that were concise, and valued reviewing handbooks with faculty members who could highlight important content. Most students valued and desired content related to assessment, and specifically used handbooks when preparing for examinations. Most students appreciated handbooks that provided study guidance such as a syllabus. Students also appreciated logistical aspects such as a timetable and information on clerkship cultural norms. Students disliked handbooks with vague descriptions of faculty member expectations and students' roles.

CONCLUSIONS

Students liked, disliked and desired many aspects of clerkship handbooks. The findings of our study could be used when designing handbooks to enhance their perceived value to students. Further research is needed on the impact of handbooks on learning and increasing students' engagement with handbook content. There are many aspects of handbook content and delivery that could be used to improve students' perceptions regarding handbooks. Handbooks could support students by providing information.

How Does Student Educational Background Affect Transition into the First Year of Veterinary School? Academic Performance and Support Needs in University Education

The first year of university is critical in shaping persistence decisions (whether students continue with and complete their degrees) and plays a formative role in influencing student attitudes and approaches to learning. Previous educational experiences, especially previous university education, shape the students' ability to adapt to the university environment and the study approaches they require to perform well in highly demanding professional programs such as medicine and veterinary medicine. The aim of this research was to explore the support mechanisms, academic achievements, and perception of students with different educational backgrounds in their first year of veterinary school. Using questionnaire data and examination grades, the effects upon perceptions, needs, and educational attainment in first-year students with and without prior university experience were analyzed to enable an in-depth understanding of their needs. Our findings show that school leavers (successfully completed secondary education, but no prior university experience) were outperformed in early exams by those who had previously graduated from university (even from unrelated degrees). Large variations in student perceptions and support needs were discovered between the two groups: graduate students perceived the difficulty and workload as less challenging and valued financial and IT support. Each student is an individual, but ensuring that universities understand their students and provide both academic and non-academic support is essential. This research explores the needs of veterinary students and offers insights into continued provision of support and improvements that can be made to help students achieve their potential and allow informed "Best Practice."

Medical student satisfaction, coping and burnout in direct-entry versus graduate-entry programmes

CONTEXT

There is ongoing debate regarding the optimal length of medical training, with concern about the cost of prolonged training. Two simultaneous tracks currently exist in Australia: direct entry from high school and graduate entry for students with a bachelor degree. Medical schools are switching to graduate entry based on maturity, academic preparedness and career-choice surety. We tested the assumption that graduate entry is better by exploring student preferences, coping, burnout, empathy and alcohol use.

METHODS

From a potential pool of 2188 participants, enrolled at five Australian medical schools, a convenience sample of 688 (31%) first and second year students completed a survey in the middle of the academic year. Participants answered questions about demographics, satisfaction and coping and completed three validated instruments.

RESULTS

Over 90% of students preferred their own entry-type, though more graduate-entry students were satisfied with their programme (82.4% versus 65.3%, p < 0.001). There was no difference between graduate-entry and direct-entry students in self-reported coping or in the proportion of students meeting criteria for burnout (50.7% versus 51.2%). Direct-entry students rated significantly higher for empathy (concern, p = 0.022; personal distress, p = 0.031). Graduate-entry students reported significantly more alcohol use and hazardous drinking (30.0% versus 22.8%; p = 0.017).

CONCLUSIONS

Our multi-institution data confirm that students are generally satisfied with their choice of entry pathway and do not confirm significant psychosocial benefits of graduate entry. Overall, our data suggest that direct-entry students cope with the workload and psychosocial challenges of medical school, in the first 2 years, as well as graduate-entry students. Burnout and alcohol use should be addressed in both pathways. Despite studies showing similar academic outcomes, and higher total costs, more programmes in Australia are becoming graduate entry. Further research on non-cognitive issues and outcomes is needed so that universities, government funders and the medical profession can decide whether graduate entry, direct entry, or a mix, is ideal.

Exploring the transition of undergraduate medical students into a clinical clerkship using organizational socialization theory

BACKGROUND

Transitions in medical education are emotionally and socially dynamic; this may affect learning. Students transitioning from preclinical to clinical training may experience negative consequences. Less is understood about students' experiences during transitions within clinical training and influential factors.

METHODS

The authors used organizational socialization theory to explore a transition within the clinical years. Final-year medical students experienced a nine-week internal medicine clerkship; willing students participated. Students (n = 101; 97 %) completed a questionnaire with open-ended questions at the beginning and end of the clerkship and participated in six consecutive focus groups, until data saturation occurred (n = 37). Data were thematically analyzed.

RESULTS

Socialization was challenging. Many students experienced difficulty developing relationships with team members. Students with a positive attitude experienced a smoother transition. Many students were uncertain of their roles, concerned about the workload and desired guidance to meet clerkship demands. This transition resulted in varied outcomes from enjoyment, increased confidence and student development through to disinterest.

CONCLUSION

Transitions within clinical training are complex. Faculty should focus on adequate socialization in a new clerkship as this may facilitate a smoother transition. This may necessitate orientations, staff training, and formal student support. Further research is needed on the impact of these recommendations on learning and well-being.

Peer assisted learning in the clinical setting: an activity systems analysis

Peer assisted learning (PAL) is a common feature of medical education. Understanding of PAL has been based on processes and outcomes in controlled settings, such as clinical skills labs. PAL in the clinical setting, a complex learning environment, requires fresh evaluation. Socio-cultural theory is proposed as a means to understand educational interventions in ways that are practical and meaningful. We describe the evaluation of a PAL intervention, introduced to support students' transition into full time clinical attachments, using activity theory and activity systems analysis (ASA). Our research question was How does PAL transfer to the clinical environment? Junior students on their first clinical attachments undertook a weekly same-level, reciprocal PAL activity. Qualitative data was collected after each session, and focus groups (n = 3) were held on completion. Data was analysed using ASA. ASA revealed two competing activity systems on clinical attachment; Learning from Experts, which students saw as the primary function of the attachment and Learning with Peers, the PAL intervention. The latter took time from the first and was in tension with it. Tensions arose from student beliefs about how learning takes place in clinical settings, and the importance of social relationships, leading to variable engagement with PAL. Differing perspectives within the group were opportunities for expansive learning. PAL in the clinical environment presents challenges specific to that context. Using ASA helped to describe student activity on clinical attachment and to highlight tensions and contradictions relating PAL in that setting. Planning learning opportunities on clinical placements, must take account of how students learn in workplaces, and the complexity of the multiple competing activity systems related to learning and social activities.

Is there a risk profile for the vulnerable junior doctor?

BACKGROUND

Mental ill health is prevalent among doctors, especially those in the early stages of postgraduate training. However, a paucity of research has examined factors predictive of psychological distress in this population.

AIMS

To report the findings from a multi-centre survey of mental health among junior doctors in Ireland, and assess the extent to which moderator variables (e.g., age, academic performance, nationality, etc.) alter the levels of psychological distress caused by internship.

METHOD

An online, anonymous, questionnaire was distributed to all interns in the Republic of Ireland in January 2012.

RESULTS

A total of 270 interns responded to the survey (45.0 % response rate), with 48.5 % of the respondents having a score indicative of psychological distress. A regression model found that nationality, academic performance, intern training network, rating of work stressors, home stressors, and work-life balance were associated with differing levels of mental health as measured by the General Health Questionnaire-12.

CONCLUSIONS

There is a need to consider moderator variables when examining mental health in healthcare populations to avoid drawing overly simplistic conclusions. Interns in Ireland reported particularly high levels of psychological distress compared to other studies of mental health among healthcare populations.

Older doctors and progression through specialty training in the UK: a cohort analysis of General Medical Council data

OBJECTIVE

To determine whether older age at graduation is associated with any difference in outcomes from the annual specialty training progression assessment.

DESIGN

An open cohort of 38 308 doctors who graduated from a UK medical school with annual assessments of progression in their specialty training programme with data centrally collected by the General Medical Council between 5 August 2009 to 31 July 2012.

RESULTS

Mature junior doctors (≥29 years at graduation) were more likely to have problems with progression on their annual review of competence progression record of in training assessment (ARCP/RITA) than their younger colleagues (OR 1.34, 95% CI 1.22 to 1.49, p<0.001). This association was, if anything, even stronger (OR 1.57, 95% CI 1.41 to 1.74, p<0.001) after adjustment for gender, ethnicity, type of University and specialty. The same was true when only looking at the most extreme ARCP outcome (4) which is being asked to leave their specialist programme (OR 1.81, 95% CI 1.34 to 2.44, p<0.001).

CONCLUSIONS

Mature doctors are a growing part of the medical workforce and they are likely to broaden the spectrum of doctors by bring different life experience to the profession. These results suggest that they are more likely to have problems with progressing through their specialist training programme. More research is required to determine the reasons behind these associations and how mature doctors can be supported both in choosing the best training programme and in coping with the complex demands of higher training at a later stage in their lives.

Enhanced research assessment performance in graduate vs. undergraduate-entry medical students: implications for recruitment into academic medicine

BACKGROUND

Studies investigating variance between the academic performance of direct-entry (DEM) versus graduate-entry (GEM) medical students have yielded conflicting results, but their performance in undergraduate research-based assessments has not been compared to-date.

AIM

We aimed to compare the results of DEM and GEM students with respect to their senior research dissertation module.

METHODS

This retrospective study examined the final year results between 2011-2012 in DEM, (n = 219) and GEM (n = 84) students. Between-group comparisons of dissertation module marks were conducted using independent t-tests. Correlations between marks in dissertation module and in other disciplines assessed during the final year were attained using Pearson's correlation. Multiple regression analysis was employed to adjust for potential confounding factors such as student age and gender.

RESULTS

No apparent difference was apparent between the DEM and GEM students with respect to results achieved across the clinical disciplines examined. However, GEM students performed significantly better than DEMs in their senior research dissertation assessment (Mean = 66.81% vs. 65.00%, fully adjusted p = 0.048). The variable which remained influential in regression analysis was nationality, where North American and Asian students were demonstrated to score lower than their Irish counterparts in the dissertation module (B coefficient = -1.90, SE = 0.94, P = 0.045 and B coefficient = -4.88, SE = 1.00, P < 0.001 respectively).

CONCLUSIONS

Performance in the research-based module was significantly better in GEM relative to their DEM colleagues. This finding may have implications for future recruitment into academic medicine, as aptitude and interest in research at undergraduate level has been shown to be associated with increased likelihood of an academic career in medicine.

Development and psychometric evaluation of scales to measure professional confidence in manual medicine: a Rasch measurement approach

Background

Health professionals in athletic training, chiropractic, osteopathy, and physiotherapy fields, require high-level knowledge and skills in their assessment and management of patients. This is important when communicating with patients and applying a range of manual procedures. Prior to embarking on professional practice, it is imperative to acquire optimal situation-specific levels of self-confidence for a beginner practitioner in these areas. In order to foster this professional self-confidence within the higher education context, it is necessary to have valid and reliable scales that can measure and track levels and how they change. This study reports on the development and psychometric analysis of two new scales, Patient Communication Confidence Scale (PCCS) and the Clinical Skills Confidence Scale (CSCS), to measure confidence in these two areas for students in manual medicine programs. The Rasch measurement model was used to guide the development of the scales and establish their psychometric properties.

Methods

The responses to 269 returned questionnaires over two occasions were submitted to psychometric analysis, with various aspects of the scales examined including: item thresholds; item fit; Differential Item Functioning; targeting; item locations; item dependencies; and reliability. To provide further evidence of validity, scores were correlated with two existing valid scales.

Results

Analyses showed that the scales provided valid and reliable measures of confidence for this sample of persons. High Person Separation Indices (0.96 for PCCS; 0.93 for SCSC) provided statistical evidence of reliability, meaning the scales are able to discriminate amongst persons with different levels of confidence. For the PCCS, item categories were operating as required, and for the CSCS only two items’ thresholds were slightly disordered. Three tests of fit revealed good fit to the model (indicating the internal consistency of both scales) and results of the correlations with two existing valid scales were consistent with expectations.

Conclusions

The importance of confidence cannot be overlooked in health education because students learning new information and skills, and dealing with challenging situations can be negatively impacted by a lack of confidence which can result in students disengaging from placements or leaving a program. Valid and reliable instruments are essential in tracking change in levels of confidence in specific skills over time and the examination of the degree of congruence between confidence and competence. Analysis of responses to the two confidence scales established that they are valid and reliable instruments.

Influence of the workplace on learning physical examination skills

BACKGROUND

Hospital clerkships are considered crucial for acquiring competencies such as diagnostic reasoning and clinical skills. The actual learning process in the hospital remains poorly understood. This study investigates how students learn clinical skills in workplaces and factors affecting this.

METHODS

Six focus group sessions with 32 students in Internal Medicine rotation (4-9 students per group; sessions 80-90 minutes). Verbatim transcripts were analysed by emerging themes and coded independently by three researchers followed by constant comparison and axial coding.

RESULTS

Students report to learn the systematics of the physical examination, gain agility and become able to recognise pathological signs. The learning process combines working alongside others and working independently with increasing responsibility for patient care. Helpful behaviour includes making findings explicit through patient files or during observation, feedback by abnormal findings and taking initiative. Factors affecting the process negatively include lack of supervision, uncertainty about tasks and expectations, and social context such as hierarchy of learners and perceived learning environment.

CONCLUSION

Although individual student experiences vary greatly between different hospitals, it seems that proactivity and participation are central drivers for learning. These results can improve the quality of existing programmes and help design new ways to learn physical examination skills.

Quantifying factors influencing operating theater teaching, participation, and learning opportunities for medical students in surgery

AIMS

Operating room experience offers a unique learning resource, potentially exposing medical students to surgical disease and treatments, use of anesthesia, basic science, team working, and communication skills. However, the alien nature of this environment to newcomers poses particular difficulties in harnessing this resource. This study aimed to assess the operating theater-based teaching and learning experiences of new medical graduates during their medical school course.

METHODS

A 41-item, self-administered questionnaire survey was distributed to newly qualified medical school graduates from 1 university consisting of 5 separate teaching hospitals. Results were analyzed using GraphPad Prism 5.0.

RESULTS

Questionnaires were returned by 209 of 312 graduates (67%). Overall, 121 (59%) respondents attended ≤50% of opportunities available to attend operating theater; 47% felt they knew what was expected of them when attending and only 13% had specific learning objectives set. An interest in pursuing a surgical career was stated by 24 (12%) respondents; this group was more likely to have attended ≥50% of operating theater opportunities (p = 0.0064). Those not intending to pursue a surgical career were more likely to have been discouraged by their experiences (p = 0.0001). Active participation while scrubbed, knowing what was expected, being made to feel welcome, and being set learning objectives were all significantly positively correlated with attendance. Although female respondents felt equally welcome, in comparison with their male colleagues, they were more likely to receive negative comments (p = 0.0106). The majority of respondents (80%) stated that attendance at operating theater sessions should be a mandatory component of the curriculum.

CONCLUSIONS

Although operating theater attendance is recognized as an important component of the medical school curriculum, overall attendance at sessions was low. Attendance could be increased by ensuring students knowing what is expected of them, making them feel welcome, setting learning objectives, and allowed them to actively participate. These results highlight the need to ensure that the time spent by medical students in the operating room is positive and maximized to its full potential through structured learning involving all members of the theater team.

The road map to better knowledge? Care pathways as an educational tool during surgical internship

INTRODUCTION

Changes in medical practice have promoted a culture of standardized care. Care pathways have been proven to raise the quality of clinical care. Their effect as an educational tool has not been evaluated to date.

AIMS

To examine the educational role of care pathways in elective surgical admissions during surgical internship and the effect of their introduction on interns' confidence in performing tasks.

METHODS

A questionnaire survey was filled in by interns to determine their confidence in performing different tasks during elective surgical admission and postoperative care. Care pathways were then formulated for the commonest procedures within the Department of Colorectal Surgery. The same interns then repeated the same questionnaire after they were exposed to the care pathways.

RESULTS

Thirty interns participated in the study with a 100% response rate. There was statistically significant improvement in tasks performed confidently in 20 out of 21 areas surveyed after the introduction of the care pathways. The percentage of tasks performed with no confidence decreased from 25% to 1% (p<0.001).

CONCLUSION

Care pathways are an effective method to improve the efficiency and confidence of interns in different aspects of surgical care, thereby improving patient safety. They also function as a valuable educational tool to aid interns in the management of patients with complex surgical issues.

An integrated virtual family curriculum to introduce specialty-specific clinical skills to rising third-year medical students

BACKGROUND

Transitioning from a preclinical to a clinical curriculum can be challenging for medical students. As a central component of a new 3-week transition course, we designed, implemented, and evaluated an innovative Virtual Family Curriculum to introduce rising 3rd-year medical students to the knowledge, skills, and cultures of 6 core medical and surgical specialties.

DESCRIPTION

The authors designed a 6-case, 24-hour, 3-generation Virtual Family Curriculum and a 6-station summative Objective Structured Clinical Examination (OSCE). Each case contains a lecture, video, discussion questions, skills practice, and faculty guide. We used both qualitative and quantitative evaluation methods.

EVALUATION

Ninety-eight students took the inaugural course in 2012. All students passed the final OSCE. Students rated the virtual family curriculum a 5.17/6 (6 = highest). Comments about the curriculum were uniformly positive.

CONCLUSIONS

We created and implemented an integrated Virtual Family Curriculum that systematically teaches specialty-specific knowledge and skills. This curriculum facilitates students' transition to clinical clerkships.

Tracing the evolution of chiropractic students' confidence in clinical and patient communication skills during a clinical internship: a multi-methods study

BACKGROUND

Anecdotal evidence points to variations in individual students' evolving confidence in clinical and patient communication skills during a clinical internship. A better understanding of the specific aspects of internships that contribute to increasing or decreasing confidence is needed to best support students during the clinical component of their study.

METHODS

A multi-method approach, combining two large-scale surveys with 269 students and three in-depth individual interviews with a sub-sample of 29 students, was used to investigate the evolution of change in student confidence during a 10-month long internship. Change in levels of confidence in patient communication and clinical skills was measured and relationship to demographic factors were explored. The interviews elicited students' accounts and reflections on what affected the evolution of their confidence during the internship.

RESULTS

At the start of their internship, students were more confident in their patient communication skills than their clinical skills but prior experience was significantly related to confidence in both. Initial confidence in patient communication skills was also related to age and prior qualification but not gender whilst confidence in clinical skills was related to gender but not age or prior qualification. These influences were maintained over time. Overall, students' levels of confidence in patient communication and clinical skills confidence increased significantly over the duration of the internship with evidence that change over time in these two aspects were inter-related. To explore how specific aspects of the internship contributed to changing levels of confidence, two extreme sub-groups of interviewees were identified, those with the least increase and those with the highest increase in professional confidence over time. A number of key factors affecting the development of confidence were identified, including among others, interactions with clinicians and patients, personal agency and maturing as a student clinician.

CONCLUSION

This study provides insight into the factors perceived by students as affecting the development of professional confidence during internships. One particularly promising area for educational intervention may be the promotion of a pro-active approach to professional learning.

Clinical assessment performance of graduate- and undergraduate-entry medical students

BACKGROUND

Recent evidence suggests that graduate-entry medical students may have a marginal academic performance advantage over undergraduate entrants in a pre-clinical curriculum in both bioscience knowledge and clinical skills assessments. It is unclear whether this advantage is maintained in the clinical phase of medical training.

AIM

The study aimed to compare graduate and undergraduate entrants undertaking an identical clinical curriculum on assessments undertaken during clinical training in the medical course.

METHODS

Clinical assessment results for four cohorts of medical students (n = 713) were compared at the beginning and at the end of clinical training for graduate and undergraduate entrants.

RESULTS

Results showed that graduate- and undergraduate-entry medical students performed similarly on clinical assessments. Female students performed consistently better than male students.

CONCLUSION

The findings of this study suggest that any academic performance advantage held by graduate-entry medical students is limited to the early years of the medical course, and is not evident during clinical training in the later years of the course.

Predicting success in graduate entry medical students undertaking a graduate entry medical program

BACKGROUND

Success in undergraduate medical courses in the UK can be predicted by school exit examination (A level) grades. There are no documented predictors of success in UK graduate entry medicine (GEM) courses. This study looks at the examination performance of GEM students to identify factors which may predict success; of particular interest was A level score.

METHODS

Data was collected for students graduating in 2004, 2005 and 2006, including demographic details (age and gender), details of previous academic achievement (A level total score and prior degree) and examination results at several points during the degree course.

RESULTS

Study group comprised 285 students. Statistical analyses identified no significant variables when looking at clinical examinations. Analysis of pass/fail data for written examinations showed no relationship with A level score. However, both percentage data for the final written examination and the analysis of the award of honours showed A level scores of AAB or higher were associated with better performance (p<0.001).

DISCUSSION

A prime objective of introducing GEM programs was to diversify admissions to medical school. In trying to achieve this, medical schools have changed selection criteria. The findings in this study justify this by proving that A level score was not associated with success in either clinical examinations or passing written examinations. Despite this, very high achievements at A level do predict high achievement during medical school.

CONCLUSIONS

This study shows that selecting graduate medical students with the basic requirement of an upper-second class honours degree is justifiable and does not disadvantage students who may not have achieved high scores in school leaver examinations.

Use of mannequin-based simulation to decrease student anxiety prior to interacting with male teaching associates

BACKGROUND

Previous studies have compared the usefulness of teaching associates versus mannequin trainers for learning physical exam skills. Little work has been done to assess the usefulness of mannequin trainers prior to students' interaction with teaching associates.

PURPOSE

We studied the effects of mannequin-based simulators on student comfort levels toward learning the male genitourinary examination.

METHODS

First-year medical students (N = 346) were surveyed before and after a mannequin-based curriculum to assess their comfort levels toward learning the male genitourinary examination.

RESULTS

The mannequin-based curriculum significantly increased (p < .001) student comfort levels toward the male genitourinary exam. However, the pre-post improvements were small, and on average students only progressed from being "very uncomfortable" to "somewhat comfortable." The intimate nature of the examination was the top cause of anxiety toward learning the male genitourinary exam. Students were least comfortable with the digital rectal examination at the beginning of class.

CONCLUSIONS

We suggest that mannequin-based simulators be used prior to students' experience with male teaching associates when learning the male genitourinary exam.

An instructional model for training competence in solving clinical problems

We examined the design of a course that aims to ease the transition from pre-clinical learning into clinical work. This course is based on the premise that many of the difficulties with which students are confronted in this transition result from a lack of experience in applying knowledge in real practice situations. It is focused on the development of competence in solving clinical problems; uses an instructional model with alternating clinical practicals, demonstrations, and tutorials; and extends throughout the last pre-clinical year. We used a "proof-of-concept" approach to establish whether the core principles of the course design are feasible with regard to achieving the intended results. With the learning functions and processes as a frame of reference, retrospective analysis of the course's design features shows that this design matches the conditions from theories of the development of competence in solving clinical problems and instructional design. Three areas of uncertainty in the design are identified: the quality of the cases (information, openness), effective teaching (student and teacher roles), and adjustment to the development of competence (progress, coherence).

Alternating skills training and clerkships to ease the transition from preclinical to clinical training

BACKGROUND

The transition from preclinical to clinical training is perceived as stressful with a high workload being the main difficulty. To ease this transition, we implemented a dual learning year, where just-in-time skills training and clerkships alternated.

AIMS

To examine the effect of the dual learning year on students' stress and perceptions of workload and skills level, and to compare these data with a baseline measurement from a curriculum in which skills training was provided in advance of clerkships.

METHOD

During the first Master year, students completed four rotations in which 5 weeks of skills training and 5-week clerkships alternated. In the second clerkship week of each rotation, students (n = 476) completed questionnaires measuring their experienced workload, perceived skills level and stress. Analysis of variance was used for trend analysis and to determine differences with the baseline measurement (n = 83).

RESULTS

During the dual learning year, 'experienced workload' decreased (F(1,471) = 9.408, p < 0.01), 'perceived skills level' increased (F(1,471) = 94.202, p < 0.001) and stress decreased (F(1,471) = 3.309, p < 0.10). 'Experienced workload' was lower (F(5,553) = 7.599, p < 0.001) and 'perceived skills level' was comparable to the baseline measurement.

CONCLUSIONS

Compared to the baseline measurement and the results of earlier studies on transition difficulties, alternating just-in-time skills training and clerkships seem to ease the transition from preclinical to clinical training.

Opportunity or threat: the ambiguity of the consequences of transitions in medical education

OBJECTIVES

The alleged medical education continuum is interrupted by a number of major transitions. After starting medical school, the first transition students encounter is that from non-clinical to clinical training. The second transition is that of graduated student to junior doctor or specialist trainee, and the third concerns the specialist trainee's transition to medical specialist. As a first step towards a better understanding of the effects of transitions, this paper provides a critical overview of how these transitions have been conceptualised in the medical education domain. The findings are complemented with perspectives from the fields of transitional psychology and organisational socialisation. The transition into medical school is not reviewed.

METHODS

Using the term 'transition', six leading medical education journals were searched for relevant articles. A snowballing technique on the reference lists of the 44 relevant articles yielded 29 additional publications. Studies were reviewed and categorised as representing objectifying, clarifying, or descriptive and/or justifying research.

RESULTS

When students enter clinical training, they need to relearn what they thought they knew and they must learn new things in a more self-directed way. As junior doctors or specialist trainees, their main challenges involve handling the many responsibilities that accompany the delivery of patient care while simultaneously learning from the process of providing that care. As medical specialists, new non-medical tasks and decisions on how to delegate responsibilities become issues.

CONCLUSIONS

Research on transitions has objectified the challenges students and doctors face. Clarifying studies often lack conceptual frameworks that could help us to gain deeper insight into the observed phenomena. Psychology offers valuable theoretical perspectives that are applicable to medical education transitions. To transform a transition from a threat to a learning opportunity, medical education should assist students and doctors in developing the coping skills they need to effectively deal with the challenges presented by new environments.

Comparing the performance of graduate-entry and school-leaver medical students

OBJECTIVES

Between 2000 and 2006 Leicester-Warwick Medical Schools (LWMS) provided parallel courses for graduate and school-leaver entrants into medicine. The parallel courses were based upon a single curriculum with ;identical teaching programmes and assessment methods over the two sites (Warwick and Leicester). Warwick runs the curriculum over an accelerated 4-year period for its graduate-entry students. LWMS hence provides a unique opportunity to compare outcomes for these two contrasting groups of students.

METHODS

We carried out an observational, quantitative cohort study over a 6-year period covering three cohorts of students who graduated in 2004, 2005 and 2006, respectively, using examination scores as outcome measures. We compared the examination performance of school-leaver and graduate-entry students in written and clinical examinations. These included intermediate clinical examinations, final clinical and final written examinations for both sets of students. Examination data were collected from original mark sheets and university databases at Warwick and Leicester. A-level data were collected from the national University College Admissions Service (UCAS) and compared against examination performance throughout medical school examinations.

RESULTS

Graduate-entry students performed as well as school-leaver students prior to entering the full-time clinical element of the course despite having significantly lower A-level grades. School-leaver entrants performed better on midpoint examinations, but had lost this advantage by the time they sat final professional examinations.

CONCLUSIONS

This is the first large-scale UK study to compare the performance of graduate-entry and school-leaver medical students following the same clinical curriculum and using the same assessments. Graduate-entry students performed as well as undergraduates in final examinations despite lower A-level grades and a shorter 4-year accelerated course.

Vertical integration in medical school: effect on the transition to postgraduate training

OBJECTIVES

Recently, many medical schools' curricula have been revised so that they represent vertically integrated (VI) curricula. Important changes include: the provision of earlier clinical experience; longer clerkships, and the fostering of increasing levels of responsibility. One of the aims of vertical integration is to facilitate the transition to postgraduate training. The purpose of the present study is to determine whether a VI curriculum at medical school affects the transition to postgraduate training in a positive way.

METHODS

We carried out a questionnaire study among graduates of six medical schools in the Netherlands, who had followed either a VI or a non-VI curriculum. Items in the questionnaire focused on preparedness for work and postgraduate training, the time and number of applications required to be admitted to residency, and the process of making career choices.

RESULTS

In comparison with those who have followed non-VI programmes, graduates of VI curricula appear to make definitive career choices earlier, need less time and fewer applications to obtain residency positions and feel more prepared for work and postgraduate training.

CONCLUSIONS

The curriculum at medical school affects the transition to postgraduate training. Additional research is required to determine which components of the curriculum cause this effect and to specify under which conditions this effect occurs.

Comparing the academic performance of graduate- and undergraduate-entry medical students

OBJECTIVE

This study compared the academic performance of graduate- and undergraduate-entry medical students completing the same pre-clinical curriculum and assessment at a large metropolitan university. Arguments have been made for the relative merits of both graduate- and undergraduate-entry medical programmes. However, data on the academic performance of graduate and undergraduate entrants are relatively scarce.

METHODS

This retrospective study adopted a quasi-experimental design to compare data from assessments of bioscience knowledge and clinical skills undertaken across 2 years for four cohorts of medical students (who commenced their studies between 2002 and 2005). Percentage final results for four bioscience knowledge subjects and four clinical skills assessments (based on objective structured clinical examination [OSCE] results) were compared for 240 graduates and 464 undergraduates using multivariate analysis of variance (manova).

RESULTS

Graduate-entry students performed marginally better than undergraduate-entry students on all four bioscience knowledge assessments (partial eta-squared [n(p)(2)], n(p)(2)=0.04) and also on early clinical skills assessments (n(p)(2)=0.06).

CONCLUSIONS

Graduate-entry students had a marginal academic performance advantage during the early years of this medical course. Most graduate-entry students had a first degree in a science discipline; thus their advantage may be explained by prior bioscience knowledge. Their performance advantage in clinical skills is less easily attributed to prior learning. Instead, this result provides some evidence for a possible advantage related to age. The marginal differences in early academic and clinical performance probably suggest that both graduate and undergraduate entry should exist in parallel to preserve multiple points of entry to the medical profession.

Examination performance of graduate entry medical students compared with mainstream students

OBJECTIVES

To assess whether medical students on graduate entry/fast- track programmes perform as well as students on standard courses.

DESIGN

Retrospective cohort study.

SETTING

University of Birmingham Medical School.

PARTICIPANTS

Medical students on graduate entry/fast-track course and standard (5-year) course ('mainstream').

MAIN OUTCOME MEASURES

Examination marks from all assessments taken simultaneously by graduate entry course (GEC) and mainstream course students once the cohorts have combined: i.e. for the final three years of the programme. Honours awards for 2007 and 2008 graduates.

RESULTS

In total 19,263 examination results were analysed from 1547 students. Of these 161 were GEC students and 1386 were mainstream medical students. On average mainstream students, male students, overseas students and students of South Asian ethnicity obtained lower examination marks than graduate entry students, female students, home or EU students and students of non-South Asian ethnicity, respectively. Graduate entry students were significantly more likely to achieve honours degrees than mainstream students.

CONCLUSION

On average the academic performance of Graduate Entry medical students at the University of Birmingham is better than mainstream medical students.

What influences student experience of Graduate Entry Medicine? Qualitative findings from Swansea School of Medicine

BACKGROUND

The Graduate Entry Programme (GEP) in Medicine delivered by Swansea University (currently in collaboration with Cardiff University) accepts students from a diverse range of academic backgrounds with no restriction in relation to the field of first degree. There is a growing body of literature, predominantly quantitative in nature, regarding the influence of academic background on student achievement but little published information on students' views.

AIM

To examine students' views regarding the extent to which previous higher education and wider life experience influence their student experience on the GEP course.

METHOD

Recruitment from three student cohorts and group interview data followed by descriptive thematic analysis of anonymized data.

RESULTS

Data themes were: (1) previous study experience and its impact on present student experience; (2) the impact of life experience; (3) the impact of the present study on life experience; (4) skills, status and difference; (5) characteristics and expectations of the course; (6) finances and (7) next steps. Previous study experience had little impact on present student experience. However, previous life experience, with time between first degree and GEP, clearly enhances the learning experience. Added maturity and early clinical contact enables students to manage the challenges of the course and the NHS environment despite financial strain and heavy coursework.

CONCLUSIONS

Analysing students' views is informative and provides richer insight into experience and expectations than that accessible from quantitative data alone.

Maturity and medical students' ease of transition into the clinical environment

BACKGROUND

Medical education has been characterized in terms of points of transition, which are accentuated by lack of relevant prior experience and can lead to extreme positive and negative emotions.

AIMS

Quantify the effect of maturity on medical students' transitions into the clinical environment and identify how experiences of transition might be improved.

METHOD

Eleven weeks after entering the clinical environment, 29 mature students (age over 21 at entry, median age 22) in a horizontally-integrated, predominantly undergraduate entry, problem-based curriculum offering little early clinical exposure and 58 matched non-mature students (median age 18 years) rated their experiences of transition and wrote free text comments about them.

RESULTS

62% of mature students compared with 24% of controls described 'good transitions' (odds ratio [OR] for a good transition 6.1; p = 0.002) and mature students were more likely than controls to describe how they drew on their previous years in medical school (OR 2.7, p = 0.04) and their wider life experiences in making the transition (OR 3.9, p = 0.01). They were less likely to feel confused or daunted. Whether mature or not, prior workplace experience, having learned the theory of medicine by PBL, and being confident in their knowledge and skills helped students' transitions. Both mature and non-mature students valued the support of teachers and peers and would have valued clinical experience earlier.

CONCLUSIONS

The fact that just a few extra years of life experience made such a large difference to students' experiences of transition illustrates how important social factors are in the personal development of medical students. In respondents' views, early clinical experience and early skills training could ease students' passage into the clerkship phase of their education.

Transitional clerkship: an experiential course based on workplace learning theory

Starting clerkships is anxiety provoking for medical students. To ease the transition from preclerkship to clerkship curricula, schools offer classroom-based courses which may not be the best model for preparing learners. Drawing from workplace learning theory, the authors developed a seven-day transitional clerkship (TC) in 2007 at the University of California, San Francisco School of Medicine in which students spent half of the course in the hospital, learning routines and logistics of the wards along with their roles and responsibilities as members of ward teams. Twice, they admitted and followed a patient into the next day as part of a shadow team that had no patient-care responsibilities. Dedicated preceptors gave feedback on oral presentations and patient write-ups. Satisfaction with the TC was higher than with the previous year's classroom-based course. TC students felt clearer about their roles and more confident in their abilities as third-year students compared with previous students. TC students continued to rate the transitional course highly after their first clinical rotation. Preceptors were enthusiastic about the course and expressed willingness to commit to future TC preceptorships. The transitional course models an approach to translating workplace learning theory into practice and demonstrates improved satisfaction, better understanding of roles, and increased confidence among new third-year students.

Easing the transition from student to doctor: how can medical schools help prepare their graduates for starting work?

BACKGROUND

In 2000/1, a survey found that 42% of newly qualified UK doctors felt their medical training had not prepared them well for starting work.

AIM

To determine factors associated with preparedness.

METHODS

A questionnaire to all 5143 newly qualified doctors in May 2005.

RESULTS

The response rate was 2062/4784 = 43.1%. 15% of respondents felt poorly prepared by medical school for starting work. There were no associations between gender or graduate entry status and preparedness. The personality traits of conscientiousness (r=0.14; p < 0.001) and extraversion (r=0.15; p < 0.001) were associated with high preparedness. Neuroticism was associated with low preparedness (r= -0.16; p < 0.001).Respondents who had done shadowing attachments were more likely to feel prepared (58.6% vs 48.5% felt prepared; 2=4.0; p=0.05), as were graduates of problem based learning courses (61.3% vs 56.1%; 2=5.0; p=0.03). Preparedness correlated with agreement with the statements 'My teaching was relevant to real life as a doctor' (rho=0.36; p < 0.001), and 'As a house officer I found it easy to get help when I needed it' (rho=0.29; p < 0.001).

CONCLUSIONS

Improvements in the preparedness of UK medical school graduates may be due to increased relevance of undergraduate teaching to life as a junior doctor and increased support in the workplace.

Fear of causing harm: use of mannequin-based simulation to decrease student anxiety prior to interacting with female teaching associates

BACKGROUND

There is a paucity of research assessing the potential benefits of mannequin trainers when preparing students to interact with teaching associates.

PURPOSE

The goal of this study was to better understand the effects of mannequin-based simulators on student comfort toward learning specific aspects of the clinical female pelvic exam.

METHODS

First-year medical students (N = 344) were surveyed before and after a mannequin-based simulation curriculum to assess their comfort levels toward learning the female pelvic exam.

RESULTS

Causing harm was the top cause of student anxiety toward learning the pelvic exam. Although the mannequin-based simulation curriculum was effective in significantly increasing (p < .001) student comfort levels toward learning the pelvic exam, the majority of students progressed from being "very uncomfortable" with the exam to being "somewhat comfortable."

CONCLUSION

We suggest that mannequin-based simulators be used prior to students' learning experience with pelvic exam teaching associates.

Medical student gender and issues of confidence

OBJECTIVE

To review the literature on gender differences and issues of self-confidence in medical students and to present original research on observers' perceptions of medical student confidence.

METHODS

One hundred forty-one 3rd year medical students at Indiana University School of Medicine were videotaped during their objective structured clinical examination (OSCE). Trained coders rated how confident the student appeared and coded a variety of nonverbal behaviors at the beginning, middle, and end of the interaction. Analysis focused on gender differences in coders' ratings of perceived confidence.

RESULTS

Female medical students were viewed as significantly less confident than male medical students (F(1,133)=4.45, p<0.05), especially at the beginning of the interaction.

CONCLUSION

Past research indicates that despite performing equally to their male peers, female medical students consistently report decreased self-confidence and increased anxiety, particularly over issues related to their competence. In a standardized patient interaction examination situation, female medical students also appeared significantly less confident than male medical students to independent observers.

PRACTICE IMPLICATIONS

Medical educators should focus on issues of female students' confidence, increasing faculty sensitivity, and publicly recognizing and discussing perceptions of confidence.