Impact of medical school experiences on the career choice of neurosurgery: a cross- sectional study from Pakistan

BACKGROUND

Pakistan grapples with the issue of an inadequate neurosurgery workforce but the reasons for such a disparity remain uncertain. Previous studies have highlighted how various factors including medical school experiences have an impact on career choice, but no study has delved into the impact of medical school exposure among Pakistani medical students, especially for the field of neurosurgery. This study aims to evaluate the impact of neurosurgery exposure, mentorship, and interest groups on medical students' decision to pursue neurosurgery.

METHODS

A national cross-sectional survey was conducted in Pakistan, collecting data from medical students, interns, and medical officers over a one-month period. Ethical approval was obtained from the Ethical Review Committee at Aga Khan University, Pakistan. The data was analyzed using SPSS version 26.

RESULTS

Out of 2618 participants, 38.0% were male and 62.0% were female, with an average age of 21.82 years (± 2.65). Among them, only 358 (13.6%) were interested in pursuing neurosurgery as a career, while the remaining 2,260 (86.3%) were not. More females (58.9%) than males (41.1%) expressed interest in pursuing neurosurgery as their intended career. Most medical students interested in pursuing neurosurgery were in the early years of their medical school (1st Year: 19.6%, 2nd Year: 26.0%, 3rd Year: 20.9%). In our study, students from public sector institutions (52.2%) showed more interest in neurosurgery as a career choice compared to those from private sector institutions (44.1%). The main deterrents for choosing neurosurgery were intense training (42.2%), work-life balance (39.9%), limited residency slots (56.7%), medical knowledge (34.1%), and surgical skills (36.6%).

CONCLUSION

This study highlights the need for increased student engagement to inculcate the decision to pursue neurosurgery among medical students in Pakistan. A significant gap is highlighted, with the majority of interested students in early years. Public sector students show higher interest than their private sector counterparts. However, barriers like intense training, limited residency slots, and work-life balance concerns influence career choice. Targeted interventions like mentorship programs are crucial for fostering future neurosurgeons and advancing patient care and research. By addressing the identified disparities in experiences and promoting a supportive educational environment, it is possible to cultivate a future generation of skilled and dedicated neurosurgeons who can contribute to advancements in patient care and research in the field.

The power of rotation schedules on the career selection decisions of medical students

Choosing a career pathway in medicine is a high stakes decision for both medical students and the field of medicine as a whole. While past research has examined how characteristics of the medical student or specialties influence this decision, we introduce temporal elements as novel variables influencing career selection decisions in medicine. Specifically, we investigate how timing and duration of residency options, based on a rotation schedule that medical students have limited control over, influence their career selection decisions. An archival study investigating 5 years of medical student rotation schedules (N = 115) reveals that clinical rotation options appearing earlier and more often in the schedule were more likely to be selected. Moreover, timing and duration of exposure interacted such that residency options appearing later in the schedules were more likely to be selected if they also appeared more often. Conditional logistic regressions using student fixed-effects to control for idiosyncratic medical student differences (i.e., gender, & debt, etc.), and residency fixed-effects to control for idiosyncratic residency differences (income, and lifestyle, etc.), revealed the rotation schedule had a significant impact on residency selection decisions even when controlling for factors typically influencing this decision. Medical students' career decisions are influenced by when and how long different choice options appear in their rotation schedule, especially when they have limited influence over this schedule. The results have implications for healthcare policy by highlighting a tool for adjusting physician workforce composition by broadening exposure to a greater array of career options.

Prioritizing ethical patient care responsibilities: A call to restructure student training practices in federally qualified health centers

Federally Qualified Health Centers (FQHCs) are federally funded clinics that often serve medically underserved groups. Many Colleges of Pharmacy have faculty and non-faculty pharmacist preceptors who provide clinical services such as drug therapy management to FQHCs. It is critical that Colleges of Pharmacy and pharmacist preceptors reinforce and uphold the standard of providing high quality and evidenced based care when students rotate at these sites. Learners may have implicit biases and variable levels of emotional intelligence prior to a clinical rotation at an FQHC, which can affect the quality-of-care patients receive. Colleges of Pharmacy who send learners onto rotations at FQHCs should collaborate with FQHC sites to ensure learner readiness in clinical and emotional levels and mediate for any concerns that may arise.

How do peer group reflection meetings support medical students' learning and personal development during clinical rotations?

BACKGROUND

Medical schools look to support students in coping with challenges and stressors related to clinical rotations. One potential approach is implementing Intervision Meetings (IM): a peer group reflection method during which students address challenging situations and personal development issues with peers, guided by a coach. Its implementation and perceived effectiveness in undergraduate medical education has however not yet been widely studied and described. This study evaluates how students perceive the effect of a three-year IM-programme during their clinical rotations, and explores which processes and specific factors support students' personal development and learning during clinical rotations.

METHODS

Using an explanatory Mixed Methodology, medical students participating in IM were asked to evaluate their experiences through a questionnaire at three time points. Questionnaire results were further explored through three focus groups. Data were analysed using descriptive statistics and thematic analysis.

RESULTS

Three hundred fifty seven questionnaires were filled out by students across the three time points. Students perceived IM to contribute to their ability to cope with challenging situations during clinical rotations. Participants in the focus groups described how IM created an increase in self-awareness by active self-reflection supported by peers and the coach. Sharing and recognizing each other's' situations, stories or problems; as well as hearing alternative ways of coping, helped students to put things into perspective and try out alternative ways of thinking or behaving.

CONCLUSIONS

IM can help students to better deal with stressors during clinical rotations and approach challenges as learning opportunities under the right circumstances. It is a potential method medical schools can use to aid their students on their journey of personal and professional development.

Preceptors' preparedness to teach about substance and opioid use disorder: a qualitative study

STUDY AIM

Little is known about preceptors' comfort and readiness to teach clinical students about the care of patients with substance and opioid use disorder (SUD/OUD). This study explores preceptors' views about caring for such patients, and their preparedness to teach about SUD/OUD management, to improve graduate competencies.

METHODS

Participants were recruited by convenience and snowball sampling. Semi-structured interviews were conducted with physician, physician assistant, and nurse practitioner preceptors who taught medical and physician assistant students. Interviews were conducted via Zoom® videoconferencing. Transcripts were generated and independently analyzed for themes by 4 experienced coders using constant comparison and a grounded theory approach.

RESULTS

Fifteen interviews were conducted to theme saturation. We identified 3 major themes and 10 subthemes supported by exemplar quotes. The major themes were: education about SUD/OUD in primary care (subthemes include need for longitudinal curriculum, redefining 'success' in treatment, and precepting challenges), treatment of SUD/OUD in primary care (need for systemic support and care continuity), and medication-assisted therapy (MAT) training as a tool for teaching (preceptors' own training, and need for clinical students to be trained).

CONCLUSIONS

Preceptors agreed that treatment of SUD/OUD belongs in primary care and students should learn about SUD/OUD from the start of their medical education. Data analysis enabled the construction of an emerging conceptual framework reflecting a diversity of experiences and opinions of preceptor comfort and preparedness to teach about SUD/OUD, associated with various barriers and motivators. This framework can guide future strategies to address facilitators and obstacles to advance and promote preceptor preparedness to teach students about the care and management of patients with SUD/OUD.

Workplace violence directed at nursing and medical students - What can students tell us about it?

BACKGROUND

Workplace violence (WPV) directed at healthcare teams is a widespread growing phenomenon that affects students as well. The negative consequences of WPV may impede patient care and future retention rates.

PURPOSE

To explore (a) the incidence and type of WPV experienced by nursing and medical students during their clinical rotations; (b) the associations between the emotional consequences of WPV events for students and their perceived professional performance; (c) students' preparedness and current training on WPV.

METHOD

One hundred and fifty-one Israeli nursing and medical students completed an online questionnaire that included closed and open-ended questions. Quantitative data and qualitative data were analyzed separately, before their integration.

RESULTS

More than half the students reported having experienced verbal violence during their clinical rotations. Experiencing WPV caused some students (14.6%) to consider leaving the profession and about one third (27.8%) reported that it had affected patients' care. The vast majority of students did not report experiencing incidents of physical violence.

CONCLUSIONS

There is an essential need to promote and implement multidisciplinary programs aimed at eliminating WPV, beginning at the students' level. Students need preparation and practical tools for coping with WPV. At the same time, health organizations must act to examine how cases of WPV against students are handled.

Nursing student experiences in turmoil: A year of the pandemic and social strife during final clinical rotations

Background

The duration and magnitude of the coronavirus (COVID-19) posed unique challenges for nursing students, whose education was altered because of the pandemic.

Purpose

To explore the perceptions and experiences of nursing students whose clinical rotations were abruptly interrupted by COVID-19's initial surge in the United States.

Methods

This qualitative study was conducted at a midwestern, academic medical center to elicit senior nursing students' experiences. An online survey was administered with eight open-ended questions asking about: initial impressions of the pandemic; experiences of being a senior nursing student; sources of stress and coping mechanisms; preparing to work as a registered nurse; and views on the nursing profession.

Results

Among the 26 students who completed the survey, the majority were female (92%), aged 28 ∓ 4.1 years. A total of 18 subcategories emerged with four main themes identified as: a) breakdown of normal systems, b) feeling alone and the inability to escape, c) protective factors/adaptability, and d) role identify and formation.

Conclusions

Findings indicate students implemented a variety of strategies while adapting to the abrupt interruption of in-person clinical rotations, mandated restrictions, and social unrest. The cascading themes illustrate the enormity of sudden changes and their significant impact on daily life.

The Relationship Between Surgeon Faculty Emotional Intelligence and Medical Student Evaluations

OBJECTIVE

We sought to measure the emotional intelligence (EI) of surgical faculty and the relationship between faculty EI and medical student (MS) evaluations of faculty.

DESIGN

Faculty completed the Emotional Intelligence Appraisal. Aggregate, anonymous MS evaluations were collected from the Program Director's office. Parametric and nonparametric tests were used for analysis.

SETTING

This study was first performed in a single surgical division at 1 center which informed an expanded study including the entire General Surgery Department at a single academic institution.

PARTICIPANTS

A pilot study was conducted in 1 surgical division which was then expanded to all clinical faculty in the Department of Surgery. All clinical faculty in the Department of Surgery were eligible for enrollment.

RESULTS

Pilot study faculty EI scores were positively correlated with MS evaluations (r = 0.92, p < 0.001). The follow-up study enrolled 41 surgeons with a median age of 48 (inter-quartile range 12). The sample was mostly white (70.7%). Mean EI for the group was 76 (standard deviation ± 7.8). Total faculty EI scores were not significantly correlated with MS evaluations (r = 0.30, p = 0.06).

CONCLUSIONS

MS evaluations of surgeon faculty were not related to EI in the larger sample. However, EI did correlate to MS evaluations in 2 surgical specialties. Further exploration into the utility of EI training in surgical departments should be conducted to determine the true value of such endeavors.

USMLE Scores and Clinical Rotation Role in Predicting ABSITE Performance Among Surgery Interns

BACKGROUND

The American Board of Surgery In-training Examination (ABSITE) is an important marker of medical knowledge. It is unclear what factors predict or improve these scores. We evaluated demographics, United States Medical Licensing Examination (USMLE) step 1 and 2 scores, and surgical rotations during the intern year to determine if there were any correlations with the ABSITE performance.

METHODS

This was a multicenter retrospective review during a 6-y period, investigating the correlation and association of demographics, USMLE scores, and types of rotations on the ABSITE percentile score of interns. Demographics included age, gender, race/ethnicity, U.S. versus international/foreign medical graduate for stratified analyses. Descriptive analysis was performed with ANOVA, correlation was evaluated with 95% confidence interval, and significance was defined as P < 0.05.

RESULTS

Complete records obtained on 89 interns from six different general surgery programs over 6 y revealed that there was a significant correlation between USMLE 1 and 2 with the ABSITE. USMLE 2 correlation was the strongest (r = 0.44, 95% confidence interval = [0.25-0.60], P < 0.05). There was a significant difference in ABSITE performance (mean score difference of 17.3 percentile, P = 0.01) of interns who had an intensive care unit rotation before examination. Other surgical rotations were not associated with an ABSITE difference. Demographic factors such as age, gender, race/ethnicity, or medical graduate background status were not associated with ABSITE scores.

CONCLUSIONS

USMLE step 2 scores had a higher correlation with intern ABSITE performance. An intensive care unit rotation before taking the ABSITE was associated with a significant difference in their percentile scores. Demographic factors were not correlated with ABSITE performance.

Using an Adaptive, Self-Directed Web-Based Learning Module to Enhance Residents' Medical Knowledge Prior to a New Clinical Rotation

BACKGROUND

The effect of self-directed adaptive learning on internal medicine residents' knowledge prior to a new clinical rotation is not known.

METHODS

We developed an adaptive, online, self-directed spaced repetition module and determined the effect on medical knowledge acquisition. We randomized postgraduate year 1 internal medicine residents into two groups. The intervention group (n = 27) received an electronic version of the clinical rotation curriculum as portable document format (PDF) files and participated in the online module, delivered via Moodle, a free, open-source learning management system. The non-intervention group (n = 27) only received the PDF files. All residents participated in a medical knowledge test at baseline and 3 months later.

RESULTS

Both groups were similar at study baseline in terms of age, trainee type, years since graduation, results at United States Medical Licensing Examination (USMLE) Step 1, 2, In-Training Examination (ITE), and pre-intervention evaluation. There was a statistically significant improvement in scores on the post-intervention medical knowledge assessment for the intervention group when compared with the non-intervention group (24.2 ± 15.4% vs. 8.6 ± 9.9%, p < 0.001).

CONCLUSION

An online, self-directed, adaptive spaced repetition-learning module can offer a simple and effective method to increase the medical knowledge present at the start of residents' clinical rotations.