Contribution of medical students to admission interviews

Objective  Medical students were included in 3-person interview panels selecting applicants for a 4-year medical programme for graduates and health professionals. We analysed student contributions to the interview panels.
Methods  A total of 188 semi-structured interviews were carried out over 2 years. The scores of 17 student interviewers were compared with those of the other 2 members of the panels.
Results  Students were positive about the interview process and their involvement. Overall interview scores did not differ between students and other interviewers. However, students gave lower scores overall and in a number of individual areas to those who had the highest consensus scores and were offered places on the programme. Students were more likely than other interviewers to be indecisive between 2 scores (25.2% versus 17.5%; P  <   0.01).
Conclusions  Students can be integrated effectively into the interview process. However, they tend to be more reluctant to give high scores and less decisive about committing to a single score than more experienced interviewers. Students value the experience of participating in the selection process, especially when combined with an exploration of the literature related to selection procedures.     

Introducing medical students to family therapy using simulated family interviews

Small groups of medical students are introduced to the subject of family therapy using a technique involving the simulation of family interviews. The students are called upon to enact a situation in which family members visit their general practitioner with a problem relating to one of the children, and the diffusion of this problem within the family is traced during the course of the simulation. Discussion is focused on the feelings evoked by the simulation, the psychodynamics of the simulated family and the quality of the relationship between the general practitioner and the family as it arises out of the interview. An effort is made to help the students to get in touch with some of their feelings towards disturbed families and to mobilize these feelings towards the effective management of the family's problems.
By role playing the general practitioner, students can prepare themselves for their future professional roles in a situation which allows for feedback from colleagues and experimentation. At the same time, when family members are role-played, the process of identification and empathy with patients is enhanced.
The technique is potentially stressful because of the unusual demands that it makes upon the students in terms of personal involvement, but the experience derived from successive groups of students over a 2 year period has been consistently rewarding, and most students have expressed an enthusiastic interest in the exercise.     

Health protective behaviors in first year medical students

Individual health behaviors are an important aspect of preventive care. A survey of 164 entering medical students examined their health protective behaviors, including the three things they most frequently did to protect their health and thirty specific health behaviors studied in a previous analysis of the general population. The first semester results show similarities between the students and the general population. Diet and sleep were among the most important health protective behaviors in students and the population, but exercise and relaxation/stress control were more prevalent in students than in the public. Medical students were much more likely to be nonsmokers and wear seat belts than the public, but less likely to get regular checkups or see doctors when they felt healthy. Students also reported fewer personal safety and accident prevention behaviors. A resurvey at the beginning of the second semester showed a very high consistency with original behaviors. Among the students there were few health behavior differences by sex and martial status. These findings suggest students in medical school practice common but not extensive health protective behaviors which do not decline severely upon entry to medical school.     

Interpreting course evaluation results: insights from thinkaloud interviews with medical students

PURPOSE: To determine whether some of the fundamental assumptions that frequently underlie interpretation of course evaluation results are justified by investigating what medical students are thinking as they complete a typical basic science course evaluation. METHODS: A total of 24 students participated in thinkaloud cognitive interviews, voicing their thoughts while completing a typical evaluation instrument that included items on overall course design, educational materials and methods, and faculty teaching. Students' responses were organised to consider how they interpreted questions, formed judgements and selected response options. Major themes relevant to the meaningful interpretation of course evaluation data were identified. RESULTS: Medical students understood educational terms such as 'independent learning' in different ways from both one another and common usage. When formulating responses, students' judgements were sometimes based on unique or unexpected criteria, and they described editing their judgements by considering factors such as effort or caring on the part of teaching faculty. Students tended to avoid using the lower end of the rating scale, used the highest rating option selectively, but chose the second highest category indiscriminately. CONCLUSIONS: These results call into question fundamental assumptions that frequently underlie interpretation of course evaluation results, such as whether students understand the intended meanings of terms used in items; whether faculty members who receive the same rating are perceived similarly; whether ratings actually reflect teaching effectiveness, and whether 'positive' ratings reflect positive opinions. This study also demonstrates how thinkaloud interviews can be used in validity studies, providing information to supplement statistical and psychometric analyses.     

The professional attitudes of Nigerian first year medical students

In a study of the development of professional attitudes in medical students, a modified version of the Medical Attitudes Inventory ( Harris, 1974 ) was administered to 141 male and female first year medical students in Lagos, Nigeria. The results show that the students have well-defined attitudes on certain issues and are divided on others. The findings are discussed in terms of their implications for medical education, attitude research and durability of students' attitudes in and beyond medical school. The influence of contemporary social factors on student professional attitudes is also considered. The instrument has sufficient psychometric attributes to warrant further use.     

Health‐related quality of life of medical students

Medical Education 2010: 44 : 227–235 Objectives Mental problems such as stress, anxiety and depression have been described among medical students and are associated with poor academic and professional performance. It has been speculated that these problems impair students’ quality of life (QoL). The authors aimed to assess the health‐related QoL (HRQL) of medical students throughout their 6 years of training at a school with a traditional curriculum. Methods Of a total of 490 students attending our institution’s medical school, 38 were surveyed in February 2006 (incoming Year 1 group, surveyed when students were in the second week of Year 1 classes) and 352 were surveyed in February 2007 (students in Years 1–6). Students self‐reported their HRQL and depressive symptoms using the Short‐Form Health Survey (SF‐36) and the Beck Depression Inventory (BDI). Comparisons were performed according to year in training, presence of depressive symptoms, gender, living arrangements and correlations with family income. Results The students’ ages ranged from 18 to 31 years (median 22.3 years). Students in Years 2, 3, 4 and 6 had lower scores for mental and physical dimensions of HRQL compared with the incoming Year 1 group (P < 0.01), with the largest difference observed for Year 3 students. Students with depressive symptoms had lower scores in all domains of the SF‐36 (P < 0.01). Female students had lower HRQL scores than males (P < 0.01). No differences were observed for students living with versus without family and no correlation with family income was found. Conclusions Major impairments in HRQL were observed among Year 3 students, students with depressive symptoms and women. Medical schools should institute efforts to ensure that students’ HRQL and emotional support are maintained, particularly during critical phases of medical training.     

Embarking upon a medical career: psychological morbidity in first year medical students

This study was undertaken to measure the prevalence of psychological morbidity, and the nature and source of stress, in first year medical students. Two hundred and four first year medical students at a university in the north of England were sent a postal, self-report questionnaire. They were asked to complete the General Health Questionnaire (GHQ), the Stress Incident Record and to give details of their alcohol consumption. A total of 172 students (84·3%) replied. Thirty-six per cent of the students scored above the threshold of the GHQ, indicating probable psychological disturbance. There was no difference between men and women. Approximately half of the students described a stressful incident, the majority of which were related to medical training rather than to personal problems. Male students reported drinking significantly more alcohol than female students, but there was no relationship between levels of alcohol consumption and either psychological disturbance or reporting of stress.
The findings suggest that even at the preliminary stages of medical training, many students find aspects of the medical course very stressful. The psychological well-being of medical students needs to be more carefully addressed, and closer attention paid to the styles of medical teaching that may provoke avoidable distress.     

Health care reform as perceived by first year medical students

Our study objective was to evaluate the attitudes of first year medical students toward the health care system using a self administered questionnaire to all first year medical students at the medical schools in the University of California system. Of 631 students surveyed, 94% comleted the instrument. Students were asked about their attitudes toward and familiarity with concepts in health services, access to care, and managed care. Our findings indicated that most students were unfamiliar with concepts related to health services. Students were concerned about access to care; sixty-six percent of students favor a national health insurance plan. A majority of students supported allowing patients access to the current health care system regardless of the cost or utility of a medical test or procedure. Thirty-nine percent felt that rationing health care in any form (transplants, access to the intensive care unit, etc.) is contrary to the way medicine should be practiced. 72% felt that practicing physicians had a major responsibility to help reduce health care costs. When asked about specific changes intended to control health costs, students identified reform of medical malpractice system (63%) and increased spending on preventive health (60%) as the two proposals most likely to be effective. Students generally held negative attitudes toward managed care organizations; only 10% would chose to receive their care in HMOs. We conclude that first year medical students generally have little understanding of the health care system. Despite this, they hold strong opinions about access to care, managed care organizations and strategies intended to reduce health care spending. It is up to medical educators to find creative methods of introducing these content areas into an already bulging curriculum.Funds for this study were generously provided by the L.K. Whittier Foundation. Samuel A. Skootsky's salary was in part supported by Southern California Edison.     

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

Medical Education 2010 44 : 197–204 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 [) and also on early clinical skills assessments (. 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.     

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

Medical Education 2010: 44 : 699–705 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.