1
|
Groene OR, Bergelt C, Ehrhardt M. How good are medical students at communicating risk? An implementation study at three German medical schools. PATIENT EDUCATION AND COUNSELING 2022; 105:128-135. [PMID: 34020838 DOI: 10.1016/j.pec.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/01/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the objective and subjective risk communication skills of medical students in three universities in Germany METHODS: We developed a risk communication skills Objective Structured Clinical Examination (OSCE) station and implemented it in three medical schools in Germany. 596 students contributed data to a risk communication checklist and a risk communication self-assessment. Multiple linear regression models were used to identify factors associated with the risk communication OSCE performance. RESULTS Participants in our study achieved on average 73.5% of the total risk communication skills score, which did not differ between locations (F(2-595) = 1.96; p = 0.142). The mean objective performance of students who assessed their skills as poor was significantly worse than the performance of students who assessed their skills as good (t(520) = -5.01, p < 0.001). The risk communication skills score was associated with native language but not with gender nor General Point Average (p < 0.001). CONCLUSIONS Medical students demonstrated acceptable risk communication skills scores and were able to self-assess their performance. However, selected communication techniques should be re-emphasised in the undergraduate medical curriculum. PRACTICE IMPLICATIONS Our research identified shortcomings in particular subgroups that can be addressed through tailored curriculum interventions.
Collapse
Affiliation(s)
- Oana R Groene
- Institute of Biochemistry and Molecular Cell Biology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Germany.
| | - Corinna Bergelt
- Corinna Bergelt, Institute of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Maren Ehrhardt
- Maren Ehrhardt, Institute of General Practice, University Medical Center Hamburg-Eppendorf, Germany
| |
Collapse
|
2
|
Asghar Z, Williams N, Denney M, Siriwardena AN. Performance in candidates declaring versus those not declaring dyslexia in a licensing clinical examination. MEDICAL EDUCATION 2019; 53:1243-1252. [PMID: 31432557 DOI: 10.1111/medu.13953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/01/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT High-stakes medical examinations seek to be fair to all candidates, including an increasing proportion of trainee doctors with specific learning differences. We aimed to investigate the performance of doctors declaring dyslexia in the clinical skills assessment (CSA), an objective structured clinical examination for licensing UK general practitioners. METHODS We employed a cross-sectional design using performance and attribute data from candidates taking the CSA between 2010 and 2017. We compared candidates who declared dyslexia ('early' before their first attempt or 'late' after failing at least once) with those who did not, using multivariable negative binomial regression investigating the effect of declaring dyslexia on passing the CSA, accounting for relevant factors previously associated with performance, including number of attempts, initial score, sex, place of primary medical qualification and ethnicity. RESULTS Of 20 879 CSA candidates, 598 (2.9%) declared that they had dyslexia. Candidates declaring dyslexia were more likely to be male (47.3% versus 37.8%; p < 0.001) and to have a non-UK primary medical qualification (26.9% versus 22.4%; p < 0.01), but were no different in ethnicity compared with those who never declared dyslexia. Candidates who declared dyslexia late were significantly more likely to fail compared with those candidates who declared dyslexia early (40.6% versus 9.2%; p < 0.001) and were more likely to have a non-UK medical qualification (79.3% versus 15.6%; p < 0.001) or come from a minority ethnic group (84.9% versus 39.2%; p < 0.001). The chance of passing was lower for candidates declaring dyslexia compared to those who never declared dyslexia and lower in those declaring late (incident rate ratio [IRR], 0.82; 95% confidence interval [CI], 0.70-0.96) compared with those declaring early (IRR, 0.95; 95% CI, 0.93-0.97). CONCLUSIONS A small proportion of candidates declaring dyslexia were less likely to pass the CSA, particularly if dyslexia was declared late. Further investigation of potential causes and solutions is needed.
Collapse
Affiliation(s)
- Zahid Asghar
- Community and Health Research Unit (CaHRU), School of Health and Social Care, University of Lincoln, Lincoln, UK
| | | | | | | |
Collapse
|
3
|
Curtis E, Wikaire E, Jiang Y, McMillan L, Loto R, Poole P, Barrow M, Bagg W, Reid P. Examining the predictors of academic outcomes for indigenous Māori, Pacific and rural students admitted into medicine via two equity pathways: a retrospective observational study at the University of Auckland, Aotearoa New Zealand. BMJ Open 2017; 7:e017276. [PMID: 28847768 PMCID: PMC5724058 DOI: 10.1136/bmjopen-2017-017276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/30/2017] [Accepted: 07/07/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine associations between admission markers of socioeconomic status, transitioning, bridging programme attendance and prior academic preparation on academic outcomes for indigenous Māori, Pacific and rural students admitted into medicine under access pathways designed to widen participation. Findings were compared with students admitted via the general (usual) admission pathway. DESIGN Retrospective observational study using secondary data. SETTING 6-year medical programme (MBChB), University of Auckland, Aotearoa New Zealand. Students are selected and admitted into Year 2 following a first year (undergraduate) or prior degree (graduate). PARTICIPANTS 1676 domestic students admitted into Year 2 between 2002 and 2012 via three pathways: GENERAL admission (1167), Māori and Pacific Admission Scheme-MAPAS (317) or Rural Origin Medical Preferential Entry-ROMPE (192). Of these, 1082 students completed the programme in the study period. MAIN OUTCOME MEASURES Graduated from medical programme (yes/no), academic scores in Years 2-3 (Grade Point Average (GPA), scored 0-9). RESULTS 735/778 (95%) of GENERAL, 111/121 (92%) of ROMPE and 146/183 (80%) of MAPAS students graduated from intended programme. The graduation rate was significantly lower in the MAPAS students (p<0.0001). The average Year 2-3 GPA was 6.35 (SD 1.52) for GENERAL, which was higher than 5.82 (SD 1.65, p=0.0013) for ROMPE and 4.33 (SD 1.56, p<0.0001) for MAPAS. Multiple regression analyses identified three key predictors of better academic outcomes: bridging programme attendance, admission as an undergraduate and admission GPA/Grade Point Equivalent (GPE). Attending local urban schools and higher school deciles were also associated with a greater likelihood of graduation. All regression models have controlled for predefined baseline confounders (gender, age and year of admission). CONCLUSIONS There were varied associations between admission variables and academic outcomes across the three admission pathways. Equity-targeted admission programmes inclusive of variations in academic threshold for entry may support a widening participation agenda, however, additional academic and pastoral supports are recommended.
Collapse
Affiliation(s)
- Elana Curtis
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Erena Wikaire
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Louise McMillan
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Robert Loto
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Phillippa Poole
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark Barrow
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Warwick Bagg
- Medical Programme Directorate, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
4
|
Nicholson S, Cleland JA. "It's making contacts": notions of social capital and implications for widening access to medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:477-490. [PMID: 27844179 DOI: 10.1007/s10459-016-9735-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/31/2016] [Indexed: 06/06/2023]
Abstract
In the UK widening access (WA) activities and policies aim to increase the representation from lower socio-economic groups into Higher Education. Whilst linked to a political rhetoric of inclusive education such initiatives have however failed to significantly increase the number of such students entering medicine. This is compounded by a discourse that portrays WA applicants and students as lacking the essential skills or attributes to be successful in medical education. Much of the research in this area to date has been weak and it is critical to better understand how WA applicants and students negotiate medical admissions and education to inform change. To address this gap we amalgamated a larger dataset from three qualitative studies of student experiences of WA to medicine (48 participants in total). Inductively analysing the findings using social capital as a theoretical lens we created and clustered codes into categories, informed by the concepts of "weak ties" and "bridging and linking capital", terms used by previous workers in this field, to better understand student journeys in medical education. Successful applicants from lower socio-economic groups recognise and mobilise weak ties to create linking capital. However once in medical school these students seem less aware of the need for, or how to create, capital effectively. We argue WA activities should support increasing the social capital of under-represented applicants and students, and future selection policy needs to take into account the varying social capital of students, so as to not overtly disadvantage some social groups.
Collapse
Affiliation(s)
- S Nicholson
- Institute of Health Science Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 3rd Floor Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UK.
| | - J A Cleland
- Division of Medical and Dental Education, University of Aberdeen, Polwarth Building, Foresterhill, AB25 2ZD, UK
| |
Collapse
|
5
|
Griffin B, Porfeli E, Hu W. Who do you think you are? Medical student socioeconomic status and intention to work in underserved areas. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:491-504. [PMID: 27812820 DOI: 10.1007/s10459-016-9726-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Abstract
A frequently cited rationale for increasing the participation of students from low socioeconomic status (SES) backgrounds is that it will create a workforce who will choose to work in low SES and medically underserviced communities. Two theoretical arguments, one that supports and one that contradicts this assumption, are proposed to explain the practice location intentions of medical students which we examine in a longitudinal analysis. SES background and future intentions of 351 applicants to an undergraduate medical degree were assessed at Time 1, with intentions re-assessed one year later for 96% of those who were enrolled as medical students. Students from very low (and very high) SES backgrounds indicated lower intention to practice in low SES or medically underserviced areas than those from mid-range SES backgrounds. Males and students from non-English speaking backgrounds indicated less desire to work in low SES areas, perhaps explained by high aspirational motivation. SES accounted for a relatively small amount of variance in practice intentions. Alternate predictors of practice location, including individual values and training effects, and their implications for selection practice, are discussed.
Collapse
Affiliation(s)
- Barbara Griffin
- Department of Psychology, Macquarie University, Sydney, 2109, Australia.
| | - Erik Porfeli
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - Wendy Hu
- Western Sydney University, Sydney, Australia
| |
Collapse
|
6
|
Girotti JA. Why the cultural implications of mentoring in Africa might help us to understand mentoring elsewhere. MEDICAL EDUCATION 2016; 50:604-606. [PMID: 27170077 PMCID: PMC5849422 DOI: 10.1111/medu.13061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Jorge A Girotti
- Department of Medical Education, University of Illinois at Chicago College of Medicine Chicago, Illinois, USA
| |
Collapse
|
7
|
Dowell J, Norbury M, Steven K, Guthrie B. Widening access to medicine may improve general practitioner recruitment in deprived and rural communities: survey of GP origins and current place of work. BMC MEDICAL EDUCATION 2015; 15:165. [PMID: 26428081 PMCID: PMC4591588 DOI: 10.1186/s12909-015-0445-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/21/2015] [Indexed: 05/07/2023]
Abstract
BACKGROUND Widening access to medicine in the UK is a recalcitrant problem of increasing political importance, with associated strong social justice arguments but without clear evidence of impact on service delivery. Evidence from the United States suggests that widening access may enhance care to underserved communities. Additionally, rural origin has been demonstrated to be the factor most strongly associated with rural practice. However the evidence regarding socio-economic and rural background and subsequent practice locations in the UK has not been explored. The aim of this study was to investigate the association between general practitioners' (GPs) socio-economic and rural background at application to medical school and demographic characteristics of their current practice. METHOD The study design was a cross-sectional email survey of general practitioners practising in Scotland. Socio-economic status of GPs at application to medical school was assessed using the self-coded National Statistics Socio-Economic Classification. UK postcode at application was used to define urban-rural location. Current practice deprivation and remoteness was measured using NHS Scotland defined measures based on registered patients' postcodes. RESULTS A survey was sent to 2050 Scottish GPs with a valid accessible email address, with 801 (41.5 %) responding. GPs whose parents had semi-routine or routine occupations had 4.3 times the odds of working in a deprived practice compared to those with parents from managerial and professional occupations (95 % CI 1.8-10.2, p = 0.001). GPs from remote and rural Scottish backgrounds were more likely to work in remote Scottish practices, as were GPs originating from other UK countries. CONCLUSION This study showed that childhood background is associated with the population GPs subsequently serve, implying that widening access may positively affect service delivery in addition to any social justice rationale. Longitudinal research is needed to explore this association and the impact of widening access on service delivery more broadly.
Collapse
Affiliation(s)
- J Dowell
- School of Medicine, University of Dundee, Scotland, UK.
- Head of Division of Undergraduate Medical Education, School of Medicine Deanery, Ninewells Hospital and Medical School, Level 8, Room LB8 001, Mail box 16, DD1 9SY, Dundee, UK.
| | - M Norbury
- Raven Song Community Health Centre, Vancouver, BC, Canada.
| | - K Steven
- School of Medicine, University of Dundee, Scotland, UK.
| | - B Guthrie
- School of Medicine, University of Dundee, Scotland, UK.
| |
Collapse
|
8
|
Fettiplace MR, Akpa BS, Rubinstein I, Weinberg G. Confusion About Infusion: Rational Volume Limits for Intravenous Lipid Emulsion During Treatment of Oral Overdoses. Ann Emerg Med 2015; 66:185-8. [PMID: 25737211 DOI: 10.1016/j.annemergmed.2015.01.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Indexed: 01/25/2023]
Affiliation(s)
- Michael R Fettiplace
- Department of Anesthesiology, University of Illinois College of Medicine, Chicago, IL; Research and Development Service, Jesse Brown Veterans Affairs Medical Center, Chicago, IL.
| | - Belinda S Akpa
- Department of Chemical Engineering, University of Illinois at Chicago, Chicago, IL
| | - Israel Rubinstein
- Section of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, University of Illinois College of Medicine, Chicago, IL; Research and Development Service, Jesse Brown Veterans Affairs Medical Center, Chicago, IL
| | - Guy Weinberg
- Department of Anesthesiology, University of Illinois College of Medicine, Chicago, IL; Research and Development Service, Jesse Brown Veterans Affairs Medical Center, Chicago, IL
| |
Collapse
|