Comparative study of medical education as perceived by students at three Dutch universities

Objective. The aim of the present study was to identify the differences that may exist in professional satisfaction and skills (clinical patient management and psychosocial skills) in students and graduates from two traditional medical schools and their counterparts from a problem-based medical school in the Netherlands. Also their satisfaction for their training was investigated. Method. Questionnaires were designed containing items reflecting the earlier mentioned differences between the students. Following an initial pilot study, the questionnaire used in this study was constructed accordingly. Sample. The questionnaires were sent to 180 near and recent graduates of these three schools. Results. A total of 127 questionnaires were returned (response rate of 70.5%). The students of the PBL curriculum felt better prepared in psychosocial and interpersonal skills. They felt more satisfied with their training, but were less enthusiastic with the profession. The results also suggest that in their own opinion students and graduates from the three schools do not differ in clinical patient management skills acquired in medical school. Conclusion. A limitation of this study lies in the fact that results are based on actual self-assessment of the students. One must be aware that self-assessment does not always provide for objective information. However, since this limitation applied equally to respondents of all three medical schools, the differences between the schools can be considered indicative of the effects resulting from the different curricula.     

Variation by medical school in career choices of UK graduates of 1999 and 2000

OBJECTIVE: To report on how newly qualified doctors' specialty choices, and factors that influenced them, varied by medical school. DESIGN: Postal questionnaires. SETTING: United Kingdom. SUBJECTS: All doctors who graduated in the UK in 1999 and 2000. MAIN OUTCOME MEASURES: Choices of eventual career expressed 1 year after graduating, and factors influencing their choices. RESULTS: There were some significant differences between medical schools in the career choices made by their graduates. For example, the percentage of respondents who expressed the choice of general practice was significantly low among graduates of Oxford and Cambridge and high among graduates of Birmingham and Leicester. There was also significant variation between medical schools in choices for hospital medical and surgical specialties. There were significant differences, too, between medical schools in the extent to which career choices had been strongly influenced by graduates' inclinations before starting medical school and by their experience of their chosen specialty, particular teachers and departments at medical school. As well as the differences, however, there were also many similarities between the schools in graduates' career choices. DISCUSSION: Medical schools currently provide students with a broad training suited to any subsequent choice of specialty. We suggest that the similarities between schools in the career choices made by graduates are generally more striking than the differences. We raise the question of whether there should be any specialisation by individual schools to train students for careers in particular branches of medical practice.     

Choosing a career in general practice: the influence of medical schools

Summary. This paper reviews the literature on career choice to investigate the undergraduate influences on the preference of Australian graduates for a career in general practice. Although isolation of influencing factors is difficult, admission criteria and undergraduate curricula may influence career preference. As the institutional environment of medical schools is weighted towards scientific research and specialized medicine, medical students may be socialized into choosing non-generalist careers. Medical schools should consider broadening selection criteria and curriculum exposure to produce graduates with a broad range of career interests.     

Effects of conventional and problem-based learning on clinical and general competencies and career development

Objective  To test hypotheses regarding the longitudinal effects of problem-based learning (PBL) and conventional learning relating to students' appreciation of the curriculum, self-assessment of general competencies, summative assessment of clinical competence and indicators of career development.
Methods  The study group included 2 complete cohorts of graduates who were admitted to the medical curriculum in 1992 (conventional curriculum, n  =   175) and 1993 (PBL curriculum, n  =   169) at the Faculty of Medicine, University of Groningen, the Netherlands. Data were obtained from student records, graduates' self-ratings and a literature search. Gender and secondary school grade point average (GPA) scores were included as moderator variables. Data were analysed by a stepwise multiple and logistic regression analysis.
Results  Graduates of the PBL curriculum scored higher on self-rated competencies. Contrary to expectations, graduates of the PBL curriculum did not show more appreciation of their curriculum than graduates of the conventional curriculum and no differences were found on clinical competence. Graduates of the conventional curriculum needed less time to find a postgraduate training place. No differences were found for scientific activities such as reading scientific articles and publishing in peer- reviewed journals. Women performed better on clinical competence than did men. Grade point average did not affect any of the variables.
Conclusions  The results suggest that PBL affects self-rated competencies. These outcomes confirm earlier findings. However, clinical competence measures did not support this finding.     

The current state of medical education in Japan: a system under reform

CONTEXT: Not since just after World War II has there been as dramatic a change in the system of medical education in Japan as in the last several years. Medical school curricula are including more education that mimics clinical practice through problem-based learning, organ-based curricula and implementation of the objective structured clinical examination (OSCE). In response to criticism and concerns, the Japanese government has also implemented 2 major changes in the system of postgraduate medical education. First, a 2-year structured internship has been required of all medical school graduates; the first cohort to undertake this completed it in April 2006. Second, an internship matching system was adopted and first implemented in 2003. DISCUSSION: These reforms are leading to significant shifts in clinical education in Japan. Increasing numbers of medical graduates are entering residency programmes outside specialised university hospitals and core rotations place an increased emphasis on primary care. CONCLUSIONS: These changes in the training of young doctors suggest that the general clinical competency of doctors in Japan will improve in the coming years.     

An analysis of medical students' residency and specialty choices

The contemporary geographic maldistribution of physicians and shortages in some specialty areas is a persistent problem facing United States federal and state wide health planners. This paper attempts to illustrate some of the formal and informal processes of the selection of specialties and residency programs based on a survey of senior students of 37 selected American medical schools at the time of the National Residency Matching Program in 1982. Results of a factor analysis on influences on specialty choice produced two major clusters of medical students; those predominantly influenced in specialty choice by the faculty and other senior physicians (sponsorship), and those predominantly influenced by the social dimension of the physicians' role (social responsibility). These medical specialty choice orientations were also systematically related to either choice of specialty vs primary care medicine, to a life-style or status related choice of residency program, and to students' perceptions regarding a program's evaluation of a candidate. The results of the survey suggested that students who chose primary care were more apt to be influenced by sources outside of the medical school. These findings raise questions regarding the efficacy of medical school curriculum in motivating career choices in primary care. This is particularly important in view of the stated need to increase the proportion of medical school graduates choosing primary care careers.     

No 'connecting year' in the medical curriculum

The step from house-man to residency is a large one. The medical curricula at the universities of Leiden and Utrecht have started a project called the 'schakeljaar' (connecting year). Such a connecting year is intended to make the transition smoother and may have the added advantage that one can start the postgraduate training more quickly. However, there are some critical remarks that can be made here. First of all, there does not seem to be such a major difference between the doctor that one becomes during the connecting year and the currently common optional houseman or eldest houseman. Secondly, it is questionable whether one can really start the postgraduate training more quickly. The capacity of the postgraduate training programmes is limited. Thirdly, relatively little time can be saved in the basic medical curriculum.     

Academic career in medicine – requirements and conditions for successful advancement in Switzerland

Background  

Within the framework of a prospective cohort study of Swiss medical school graduates a sample of young physicians aspiring to an academic career were surveyed on their career support and barriers experienced up to their sixth year of postgraduate training.     

Medical specialists' choice of location: the role of geographical attachment in Norway.

The relation between current place of work (area of the country) and factors that might possibly represent doctors geographical attachments was studied in a sample of 322 Norwegian medical specialists. Location of hospital residency, age and geographical origin of spouse were associated with current location. Geographical attachment seems to influence doctors' locational choices from start of medical school until the end of their residency. The probability that a doctor shall locate in peripheral areas may increase from less than 10% to more than 50% if the doctor has the residency training in the periphery. Hence, favoring entrance to medical schools of students from the underserved areas, and location of graduate and postgraduate medical training in the underserved areas, as far as it is feasible while still maintaining medical standards, is suggested by the study.     

Abortion education in the medical curriculum: a survey of student attitudes

BACKGROUND: The purpose of this study was to evaluate student attitudes toward the inclusion of abortion education in the preclinical and clinical medical school curriculum. STUDY DESIGN: All students completing the OB-GYN rotation from May 2004 through January 2005 (n=118) were asked to complete a 21-item survey. Survey questions focused on students' attitudes about the appropriateness of abortion education, reasons for participation or nonparticipation in the abortion care experiences in the clinical curricula and the value of abortion education. RESULTS: One hundred students completed the survey for a response rate of 85%. Nearly all respondents indicated that abortion education was appropriate in the preclinical and clinical curricula (96%). Fifty-three percent of students participated in a clinical abortion care experience. The majority of these students rated it as valuable (84%) and would recommend it to a friend (73%). Most students who planned a career in Family Medicine and OB-GYN preferred the integration of abortion training into the residency curriculum (74%). CONCLUSIONS: Abortion education is acceptable and valued by medical students and should be integrated into the curricula of all medical schools.     

Does premedical academic background influence medical graduates' perceptions of their medical school or their subsequent career paths and decisions?

A survey of McMaster University's first six medical classes (1972-1977) has shown that neither completion of the science courses that are usually required for admission to other medical schools nor achievement of high grades in premedical studies has an important impact on graduates' perceptions of the medical curriculum or on their evaluation of their preparation for the first year of postgraduate training in comparison to other trainees. No influence of either premedical science background or grade point average was detected on career choices in relation to field of medicine entered, level of specialization, location and type of practice, or on factors influencing these choices.     

Examination performance and the future careers of Aberdeen medical graduates

School certificate attainment, performance at medical school, and early postgraduate career, were linked in a study of five cohorts of Aberdeen medical graduates. The results show a measure of correlation but it is argued that the time has come for long-term prospective research into the validity of selection of entrants to medical schools.     

Survey of the career experience and postgraduate training of the 1965 and 1970 graduates of the Scottish university medical schools

A survey of the career experience and postgraduate training of the 1965 and 1970 graduates of the Scottish university medical schools was carried out in 1975. The duration of training for the specialties of medicine and surgery and for obstetrics and gynaecology was in general longer than for anaesthetics, psychiatry and radiology; the implications of varying periods of training for postgraduate education are discussed. Attention is drawn to a number of factors which influenced career choice. The 1970 graduates who became principals spent longer in training for general practice than those of 1965. Some married women with children had difficulty in finding suitable part-time work; this may be a serious problem for those seeking accreditation of higher specialist training and for training for general practice. It was estimated that, of the British nationals, about 11% of the 1965 and 8% of the 1970 graduates had emigrated. General practice was the discipline most commonly chosen by doctors working overseas.     

Influence of training changes on the stability of specialty choices of UK medical graduates: surveys of the graduates of 2002 and 2008

ObjectivesTo explore the impact of Modernising Medical Careers (MMC) training on the stability of medical career choices in the UK.SettingUKParticipantsGraduates of 2002 and 2008 from all UK medical schools, 1 and 3 years postgraduation.DesignQuestionnaire surveys were conducted of 2002 and 2008 graduates from all UK medical schools 1 and 3 years post graduation.Results2008 graduates were a little more likely than graduates of 2002 to retain their year 1 choice in year 3 (77.3% vs. 73.3%; p = 0.002). Among 2008 graduates, the percentage retaining their year 1 choice varied between 42% (clinical oncology) and 79% (general practice). Enthusiasm for a specialty, student experience and inclinations before medical school were associated with choice retention; consideration of domestic circumstances and hours/working conditions were associated with changes of choice. 2008 graduates were more likely than 2002s to be influenced by enthusiasm for a specialty, self-appraisal of their skills, working hours and their domestic circumstances; and less likely to be influenced by their experience of jobs, a particular teacher/department or eventual financial prospects.ConclusionsPost-MMC, graduates were less likely to change their career choice and more likely to be motivated by personal factors and self-assessment of their suitability to a particular area of work.     

Development of an interactive bioterrorism and emerging infections curriculum for medical students and internal medicine residents

While awareness of bioterrorism threats and emerging infectious diseases has resulted in an increased sense of urgency to improve the knowledge base and response capability of physicians, few medical schools and residency programs have curricula in place to teach these concepts. Public health agencies are an essential component of a response to these types of emergencies. Public health education during medical school is usually limited to the non-clinical years. With collaboration from our local public health agency, the Emory University School of Medicine developed a curriculum in bioterrorism and emerging infections. By implementing this curriculum in the clinical years of medical school and residency programs, we seek to foster improved interactions between clinicians and their local public health agencies.     

Home, training and work: mobility of British doctors

This study examines the locations of family homes, medical schools and places of specialist training, and work of doctors qualifying from UK medical schools in 5 calendar years between 1974 and 1993. The contribution of each UK region to the medical workforce relative to its population is assessed and trends over time are examined. The relationship between place of family home and medical school attended is examined for 14,108 doctors. Career appointment location and its relationship to medical school and family home loc‐ation are examined for over 4000 doctors. For the qualifiers of 1983, an additional analysis incorporating place of training is included. Large differences were found in the percentage of medical students from local family homes attending each regional medical school. In some cases differences reflected local populations but other cases had no obvious cause. Over all cohorts studied, 38% of respondents attended a medical school in the region of their family home (32% of 1993 qualifiers), 42% held a career post in the same region as their medical school, and 38% held a career post in the same region as their family home. Among the qualifiers of 1983, 65% had a career post in the same region as their postgraduate training, 34% also attended medical school in the same region, and 19% also came from family homes in the same region. More women than men took up a career post in the same region as their postgraduate training. The relationships to family home and medical school did not differ by gender. Consultants appeared slightly less likely than GPs to have stayed within a region, but this difference was not statistically significant.     

Entry of US medical school graduates into family medicine residencies: 2010-2011 and 3-year summary

This is the 30th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family medicine residency programs. This retrospective analysis based on data reported to the AAFP from medical schools and family medicine residency programs shows approximately 8.0% of the 17,081 graduates of US medical schools between July 2009 and June 2010 were first-year family medicine residents in 2010, compared to 7.5% in 2009 and 8.2% in 2008. Medical school graduates from publicly funded medical schools were more likely to be first-year family medicine residents in October 2010 than were residents from privately funded schools (9.6% versus 5.4%). The Mountain and West North Central regions reported the highest percentage of medical school graduates who were first-year residents in family medicine programs in October 2010 (14.3% and 11.3%, respectively); the New England and Middle Atlantic regions reported the lowest percentages (5.6% and 5.3%, respectively). Approximately four in 10 of the medical school graduates (40.3%) entering a family medicine residency program as first-year residents entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the 3-year average percentage from each medical school of graduates entering family medicine residencies and the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family medicine residency programs in 2010.     

Career choices for paediatrics: national surveys of graduates of 1974-2002 from UK medical schools

BACKGROUND: Knowledge of UK doctors' career intentions and pathways is essential for understanding future workforce requirements. The aim of this study was to report career choices for and career progression in paediatrics in the UK. METHODS: Postal questionnaire surveys of qualifiers from all UK medical schools in nine qualification years since 1974. RESULTS: In total, 74% (24 621/33 412) and 73% (20 720/28 459) of doctors responded at 1 and 3 years after graduation. Choices for paediatrics 1 year after qualifying fell from 7.8% of 1974 graduates to 5.0% of 1983 graduates, increased to 7.2% of 1993 graduates, and since the level has remained fairly constant. Approximately twice the percentage of women graduates than men graduates indicated a long-term career choice for paediatrics. A total of 44% of those who chose paediatrics 1 year after graduation were working in it 10 years after qualifying. Experience of the subject as a student, and enthusiasm/commitment: what I really want to do, affected long-term career choices more for paediatrics than for other medical careers. CONCLUSIONS: The proportion of junior doctors wishing to become paediatricians has not changed much during the last 30 years. The planned increase in the number of medical school graduates is necessary to increase the number of UK-trained consultant paediatricians. Medical students who experience enthusiastic and stimulating training in paediatrics may be more likely to become paediatricians.     

Entry of US medical school graduates into family medicine residencies: 2004-2005 and 3-year summary

This is the 24th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family medicine residency programs. Approximately 9.2% of the 15,895 graduates of US medical schools between July 2003 and June 2004 were first-year family medicine residents in 2004, compared with 9.3% in 2003 and 10.3% in 2002. Medical school graduates from publicly funded medical schools were more likely to be first year family medicine residents in October 2004 than were residents from privately funded schools, 10.8% compared with 6.5%. The West North Central and the Mountain regions reported the highest percentage of medical school graduates who were first-year residents in family medicine programs in October 2004 at 14.9% and 12.8%, respectively; the New England and Middle Atlantic regions reported the lowest percentages at 6.6% and 5.2%, respectively. Nearly half of the medical school graduates (46.8%) entering a family medicine residency program as first-year residents in October 2004 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family medicine residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.     

Factors associated with rural doctors' intention to continue a rural career: a survey of 3072 doctors in Japan

Objective: To show the relationship between the personal and educational backgrounds of rural doctors and their intention to continue a rural career. Design: Nationwide postal survey. Setting: Public clinics or hospitals in municipalities that are classified as ‘rural’ by the national government. Subjects: A total of 4896 doctors working for 828 public clinics and hospitals. Measurements: A questionnaire was mailed. The questionnaire inquired about the subject's age, sex, hometown, exposure to rural practice in undergraduate education, postgraduate training, continuing medical education, current position and affiliation status with a medical school, as well as his or her intention to continue a rural career. Results: Response rate was 64%; 26% answered that they intended to continue a rural career. Postgraduate training in general internal medicine, general surgery, anaesthesiology, paediatrics and gastroenterology were positively related with the intention to continue a rural career (odds ratio = 2.045, 1.59, 1.30, 1.48, 1.38). Rural background, undergraduate exposure to rural practice, multispecialty‐rotation in postgraduate training and current administrative position had positive correlations with the intention to continue in logistic regression analysis (odds ratio = 1.80, 2.47, 1.54, 2.17). Affiliation with a medical school department was negatively related with the intention to continue (odds ratio = 0.45). Conclusion: In addition to the rural background of physicians, some undergraduate and postgraduate factors were independently associated with the intention to continue a rural career.