Factors associated with declaration of disability in medical students and junior doctors, and the association of declared disability with academic performance: observational study using data from the UK Medical Education Database, 2002-2018 (UKMED54)

"Because people don't know what it is, they don't really know it exists": a qualitative study of postgraduate medical educators' perceptions of dyscalculia

BACKGROUND

Dyscalculia is defined as a specific learning difference or neurodiversity. Despite a move within postgraduate medical education (PGME) towards promoting inclusivity and addressing differential attainment, dyscalculia remains an unexplored area.

METHODS

Using an interpretivist, constructivist, qualitative methodology, this scoping study explores PGME educators' attitudes, understanding and perceived challenges of supporting doctors in training (DiT) with dyscalculia. Through purposive sampling, semi-structured interviews and reflexive thematic analysis, the stories of ten Wales-based PGME educators were explored.

RESULTS

Multiple themes emerged relating to lack of educator knowledge, experience and identification of learners with dyscalculia. Participants' roles as educators and clinicians were inextricably linked, with PGME seen as deeply embedded in social interactions. Overall, a positive attitude towards doctors with dyscalculia underpinned the strongly DiT-centred approach to supporting learning, tempered by uncertainty over potential patient safety-related risks. Perceiving themselves as learners, educators saw the educator-learner relationship as a major learning route given the lack of dyscalculia training available, with experience leading to confidence.

CONCLUSIONS

Overall, educators perceived a need for greater dyscalculia awareness, understanding and knowledge, pre-emptive training and evidence-based, feasible guidance introduction. Although methodological limitations are inherent, this study constructs novel, detailed understanding from educators relating to dyscalculia in PGME, providing a basis for future research.

Legibility: knowing disability in medical education inclusion

How medical students, their teachers, and school administrators understand disability appears connected to ongoing, unequal access to medical education for disabled people. The stigmatization of disability within medical education affects students' disability disclosures, yet few studies have explored how understandings of disability influence inclusion practices beyond individual student actions. This paper develops the concept of legibility, derived from a constructivist grounded theory study that examined disability inclusion at four U.S. medical schools through interviews with 19 disabled students and 27 school officials (faculty and administrators). With two dimensions (recognition and assessment of possibility), legibility demonstrates that knowing disability is relational, contextual, and equivocal. Drawing from the field of disability studies, the paper argues that the current paradigm of disability inclusion demands that students' disability experiences be highly legible to themselves and others, yet increased legibility comes with potential risk due to prevalent ableism. While individual interactions can shift understandings of disability towards greater inclusivity, systemic action that embeds liberating discourses of disability into medical education is needed.

The Utility of Multiple-Choice Assessment in Current Medical Education: A Critical Review

In recent years, healthcare education providers have boasted about a conscious shift towards increasing clinical competence via assessment tests that promote more active learning. Despite this, multiple-choice questions remain amongst the most prevalent forms of assessment. Various literature justifies the use of multiple-choice testing by its high levels of validity and reliability. Education providers also benefit from requiring fewer resources and costs in the development of questions and easier adaptivity of questions to compensate for neurodiversity. However, when testing these (and other) variables via a structured approach in terms of their utility, it is elucidated that these advantages are largely dependent on the quality of the questions that are written, the level of clinical competence that is to be attained by learners and the impact of negating confounding variables such as differential attainment. Attempts at improving the utility of multiple-choice question testing in modern healthcare curricula are discussed in this review, as well as the impact of these modifications on performance.

The educational value of situational judgement tests (SJTs) when used during undergraduate medical training: A systematic review and narrative synthesis

INTRODUCTION

Situational judgement tests (SJTs) are a recognised assessment method for admission into medical school, selection into postgraduate training programs, and postgraduate competency assessment. More recently, however, SJTs have been used during undergraduate medical training (UMT). This systematic review identifies, describes, and appraises the evidence for SJTs in UMT to determine educational associations and outcomes.

METHODS

MEDLINE, EMBASE, ERIC, PsycINFO, SCOPUS, Web of Science, and grey literature were searched for original research studies evaluating SJTs implemented within UMT to 1 November 2022. Studies reporting evaluation outcomes were included. Narrative data syntheses were undertaken. Risk of Bias was appraised using the Quality in Prognosis Studies tool.

RESULTS

24 studies were included. National database-derived SJTs (n = 14) assessed against professionalism, postgraduate attainment, construct of medical degree, medical school admissions scores, personality attributes, and declaration of disability. In-house derived SJTs (n = 10) assessed against professionalism, clinical skills, and personality attributes. Most evidence evaluated and reported inverse SJT associations with professionalism and were moderate risk of bias.

CONCLUSION

SJTs may have utility for developing professional behaviours in medical students. However, further research testing SJT robustness, standard setting methodologies, and prospectively evaluating SJTs against objective outcome measures within the context of UMT is warranted.

Do medical students with a disability experience adverse educational outcomes on UK medical courses?

BACKGROUND

International data demonstrate that medical students with disabilities experience differential awarding. One cross-sectional study finds lower graduation rates and scores in written exams, with no impact on clinical exams. Disabled students graduated with lower decile scores. This quantitative, retrospective, longitudinal study explored the impact of disability on exam performance, course performance and course discontinuation.

METHOD

Anonymised data were obtained for 1743 students on a UK graduate medical programme from 2011 to present. Statistical tests, including t-tests and one-way ANOVA were conducted for main effects of demographic variables on exam results and categorical outcomes. Regression models established the effects of variables and sub-categories of variables on results and categorical outcomes.

RESULTS

Significant main effects of disability on exam scores were identified, as well as failure probability. Regressions showed significant differences in outcomes between different types of disability, with mental health conditions predicting course discontinuation. A significant amplifying effect was found for BAME students with disability.

CONCLUSION

Disability had a significant negative impact on all course outcomes, illustrating inequity in medical training and an area of focus for curriculum development. Intersectional data identified a key disadvantaged subgroup of medical students.