A Contract‐Based Training System for Rural Physicians: Follow‐Up of Jichi Medical University Graduates (1978‐2006)

ABSTRACT: Context: The number of studies on long‐term effects of rural medical education programs is limited. Personal factors that are associated with long‐term retention of physicians in rural areas are scarcely known. Purpose: The authors studied the outcomes of Jichi Medical University (JMU), whose mission is to produce rural doctors, and analyzed the characteristics of its graduates who engaged in rural practice even after their 9‐year obligation of rural practice. Method: A retrospective cohort study was conducted including 2,988 JMU students who graduated between 1978 and 2006. Baseline data were collected at matriculation and graduation. Workplace addresses were surveyed in 2000, 2004, and 2006. Follow‐up rates were 98.7%, 98.2%, and 98.0% respectively. Findings: After their obligation period, JMU graduates were 4 times more likely than non‐JMU graduates to work in rural areas. The higher proportion of JMU graduates in rural areas did not change significantly between 1994 and 2004. The rural recruitment rate of post‐obligation JMU graduates was somewhat lower than rates reported for top rural medical education programs in the United States. In multivariate analyses, rural upbringing and primary care specialty were positively associated with having a rural address in at least one post‐obligation study year (OR 1.89 [95% CI 1.27‐2.81]; and 7.63 [4.37‐13.34], respectively) and settlement (ie, having a rural address over multiple years) after the contract (1.90 [1.04‐3.48]; and 32.07 [4.43‐232.24], respectively). Graduation from a private high school had a negative association with recruitment (0.56 [0.33‐0.96]). Conclusions: JMU was successful in increasing the number and retention of rural physicians. Rural origin and primary care specialty have a positive impact on both recruitment and retention after the rural obligation.     

Factors associated with the academic success of first year Health Science students

The academic success of students is a priority for all universities. This study identifies factors associated with first year academic success (performance and retention) that can be used to improve the quality of the student learning experience. A retrospective cohort study was conducted with a census of all 381 full time students enrolled in the Bachelor of Health Science at The University of Western Australia since the inception of the course in the year 2000. Factors found to be associated with successful academic performance were high matriculation score, female sex, non-Indigenous status, attendance at a government secondary school, upfront payment of university fees and completion of secondary school English Literature. The most influential factor on first year academic performance was a high matriculation score. Retention into second year was found to be influenced by participation in the university mentor scheme, non-Indigenous status and first year university marks. The factor of most influence on student retention was first year university marks. Valuable information about the performance and retention of first year Bachelor of Health Science students is provided in this study which is relevant to the operational priorities of any university.     

MCAT Verbal Reasoning score: less predictive of medical school performance for English language learners

Medical Education 2012: 46 : 878–886 Context Medical College Admission Test (MCAT) scores are widely used as part of the decision‐making process for selecting candidates for admission to medical school. Applicants who learned English as a second language may be at a disadvantage when taking tests in their non‐native language. Preliminary research found significant differences between English language learners (ELLs), applicants who learned English after the age of 11 years, and non‐ELL examinees on the Verbal Reasoning (VR) sub‐test of the MCAT. The purpose of this study was to determine if relationships between VR sub‐test scores and measures of medical school performance differed between ELL and non‐ELL students. Methods Scores on the MCAT VR sub‐test and student performance outcomes (grades, examination scores, and markers of distinction and difficulty) were extracted from University of California San Diego School of Medicine admissions files and the Association of American Medical Colleges database for 924 students who matriculated in 1998–2005 (graduation years 2002–2009). Regression models were fitted to determine whether MCAT VR sub‐test scores predicted medical school performance similarly for ELLs and non‐ELLs. Results For several outcomes, including pre‐clerkship grades, academic distinction, US Medical Licensing Examination Step 2 Clinical Knowledge scores and two clerkship shelf examinations, ELL status significantly affects the ability of the VR score to predict performance. Higher correlations between VR score and medical school performance emerged for non‐ELL students than for ELL students for each of these outcomes. Conclusions The MCAT VR score should be used with discretion when assessing ELL applicants for admission to medical school.     

Lessons learned from 15 years of non‐grades‐based selection for medical school

Context

Thirty years ago, it was suggested in the Edinburgh Declaration that medical school applicants should be selected not only on academic, but also on non‐academic, attributes. The main rationale behind extending medical school selection procedures with the evaluation of (non‐academic) personal qualities is that this will lead to the selection of students who will perform better as a doctor than those who are selected on the basis of academic measures only. A second rationale is the expectation that this will lead to a representative health workforce as a result of reduced adverse impact. The aims of this paper are (i) to describe what can be learned about the use of selection criteria other than grades from over 15 years of Dutch experience and (ii) to summarise current knowledge on the issue of adverse impact in relation to non‐grades‐based selection.

Methods

A narrative review was undertaken of the (published) evidence that has resulted from non‐grades‐based school‐specific selection procedures in the Netherlands and from recent explorations of the effect of the use of non‐grades‐based selection criteria on student diversity.

Results

The Dutch evidence is grouped into five key themes: the effect of participation in voluntary selection procedures, the assessment of pre‐university extracurricular activities, the use of work samples, Dutch experiences with situational judgement tests and the effects of changing circumstances. This is followed by several lessons learned for medical schools that aim to increase their student diversity.

Conclusion

Over the last 30 years, important steps towards reliable and valid methods for measuring non‐academic abilities have been taken. The current paper describes several lessons that can be learned from the steps taken in the Dutch context. The importance of sharing evidence gathered around the globe and building on this evidence to reach our goal of predicting who will be a good doctor is acknowledged.     

Ethnic disparities in undergraduate pre-clinical and clinical performance

Medical Education 2012: 46: 575–585 Context Research from numerous medical schools has shown that students from ethnic minorities underperform compared with those from the ethnic majority. However, little is known about why this underperformance occurs and whether there are performance differences among ethnic minority groups. Objectives This study aimed to investigate underperformance across ethnic minority groups in undergraduate pre‐clinical and clinical training. Methods A longitudinal prospective cohort study of progress on a 6‐year undergraduate medical course was conducted in a Dutch medical school. Participants included 1661 Dutch and 696 non‐Dutch students who entered the course over a consecutive 6‐year period (2002–2007). Main outcome measures were performance in Year 1 and in the pre‐clinical and clinical courses. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by logistic regression analysis for ethnic subgroups (Surinamese/Antillean, Turkish/Moroccan/African, Asian, Western) compared with Dutch students, adjusted for age, gender, pre‐university grade point average (pu‐GPA), additional socio‐demographic variables (first‐generation immigrant, urban background, first‐generation university student, first language, medical doctor as parent) and previous performance at medical school. Results Compared with Dutch students, Surinamese and Antillean students specifically underperformed in the Year 1 course (pass rate: 37% versus 64%; adjusted OR 0.40, 95% CI 0.27–0.60) and the pre‐clinical course (pass rate: 19% versus 41%; adjusted OR 0.57, 95% CI 0.35–0.93). On the clinical course all non‐Dutch subgroups were less likely than Dutch students to receive a grade of ≥ 8.0 (at least three of five grades: 54–77% versus 88%; adjusted ORs: 0.17–0.45). Conclusions Strong ethnic disparities exist in medical school performance even after adjusting for age, gender, pu‐GPA and socio‐demographic variables. More subjective grading cannot be ruled out as a cause of lower grades in clinical training, but other possible explanations should be studied further to mitigate the disparities.     

Faking good: self-enhancement in medical school applicants

Medical Education 2012: 46 : 485–490 Objectives The problem of dissimulation by applicants when self‐report tests of personality are used for job selection has received considerable attention in non‐medical contexts. Personality testing is not yet widely used in medical student selection, but this may change in the light of recent research demonstrating significant relationships between personality and performance in medical school. This study therefore aimed to assess the extent of self‐enhancement in a sample of medical school applicants. Methods A within‐subjects design compared personality test scores collected in 2007 for 83 newly enrolled medical students with scores for the same students obtained on the same personality test administered during the selection process 4 months previously. Five factors of personality were measured using the International Personality Item Pool and mean differences in scores were assessed using paired t‐tests. Results At the time of selection, the personality scores of successful applicants were similar to those of candidates who were not accepted (n = 271). Once selected, the medical students achieved significantly lower scores on four of the five personality factors (conscientiousness, extroversion, openness to experience, agreeableness) and higher scores on the fifth factor (neuroticism). Of the selected students, 62.7% appeared to have ‘faked good’ on at least one of the five factors measured. Conclusions Applicants to medical school are likely to dissimulate when completing self‐report tests of personality used for selection. The authors review the evidence as to whether such dissimulation reduces construct and predictive validity and summarise methods used to reduce self‐enhancement in applicant samples.     

Equity in interviews: do personal characteristics impact on admission interview scores?

Medical Education 2010: 44: 1077–1083 Context Research indicates that some social groups are disadvantaged by medical school selection systems. The stage(s) of a selection process at which this occurs is unknown, but at interview, when applicant and interviewer are face‐to‐face, there is potential for social bias to occur. Methods We performed a detailed audit of the interview process for a single‐entry year to a large UK medical school. Our audit included investigating the personal characteristics of both interviewees and interviewers to find out whether any of these factors, including the degree of social matching between individual pairs of interviewees and interviewers, influenced the interview scores awarded. Results A total of 320 interviewers interviewed 734 applicants, providing complete data for 2007 interviewer–interviewee interactions. The reliability of the interview process was estimated using generalisability theory at 0.82–0.87. For both interviewers and interviewees, gender, ethnic background, socio‐economic group and type of school attended had no influence on the interview scores awarded or achieved. Staff and student interviewer marks did not differ significantly. Although numbers in each group of staff interviewers were too small for formal statistical analysis, there were no obvious differences in marks awarded between different medical specialties or between interviewers with varying amounts of interviewing experience. Conclusions Our data provide reassurance that the interview does not seem to be the stage of selection at which some social groups are disadvantaged. These results support the continued involvement of senior medical students in the interview process. Despite the lack of evidence that an interview is useful for predicting future academic or clinical success, most medical schools continue to use interviews as a fundamental component of their selection process. Our study has shown that at least this arguably misplaced reliance upon interviewing is not introducing further social bias into the selection system.     

Increasing tuition fees in a country with two different models of medical education

Medical Education 2010: 44: 577–586 Context Since the early 1990s, medical school tuition fees have increased substantially in all regions of Canada except Quebec. This provides a natural opportunity to examine the effect of tuition fee increases on medical student demographics, indebtedness and financial stress. Methods We conducted a national survey of medical students in 2007. We compared results for Quebec students with results for students studying in other parts of the country. We also compared results for 2007 medical students with results for medical students who had completed a similar survey in 2001 and with data for the general population. For the 2007 cohort, we also identified predictors of anticipated debt at the time of medical school graduation. Results A total of 7795 students responded to either the 2001 (n = 3871) or 2007 (n = 3924) survey. Median anticipated debt increased from $40 000 in 2001 to $71 000 in 2007 (Canadian dollars). Medical students in Quebec were more likely to have grown up in a lower‐income neighbourhood (odds ratio [OR] = 1.22, 95% confidence interval [CI] 1.03–1.44), were less likely to report significant financial stress (OR = 0.43, 95% CI 0.37–0.50) and reported a lower median anticipated debt than medical students in the rest of Canada ($30 000 versus $90 000; p < 0.001). Across Canada, factors associated with increased debt at the time of graduation were higher tuition fees, lower parental income, non‐Chinese ethnicity, higher debt at entry to medical school, smaller non‐repayable financial grants, longer pre‐medical education and higher non‐tuition expenses. Conclusions Quebec medical students differ from their counterparts in the rest of Canada in several notable ways. In particular, medical student debt has increased more and is greater in the rest of Canada than in Quebec. Our findings have implications for doctor human resources planning in Canada.     

Applying multimedia design principles enhances learning in medical education

Medical Education 2011: 45 : 818–826 Context The Association of American Medical Colleges’ Institute for Improving Medical Education’s report entitled ‘Effective Use of Educational Technology’ called on researchers to study the effectiveness of multimedia design principles. These principles were empirically shown to result in superior learning when used with college students in laboratory studies, but have not been studied with undergraduate medical students as participants. Methods A pre‐test/post‐test control group design was used, in which the traditional‐learning group received a lecture on shock using traditionally designed slides and the modified‐design group received the same lecture using slides modified in accord with Mayer’s principles of multimedia design. Participants included Year 3 medical students at a private, midwestern medical school progressing through their surgery clerkship during the academic year 2009–2010. The medical school divides students into four groups; each group attends the surgery clerkship during one of the four quarters of the academic year. Students in the second and third quarters served as the modified‐design group (n = 91) and students in the fourth‐quarter clerkship served as the traditional‐design group (n = 39). Results Both student cohorts had similar levels of pre‐lecture knowledge. Both groups showed significant improvements in retention (p < 0.0001), transfer (p < 0.05) and total scores (p < 0.0001) between the pre‐ and post‐tests. Repeated‐measures anova analysis showed statistically significant greater improvements in retention (F = 10.2, p = 0.0016) and total scores (F = 7.13, p = 0.0081) for those students instructed using principles of multimedia design compared with those instructed using the traditional design. Conclusions Multimedia design principles are easy to implement and result in improved short‐term retention among medical students, but empirical research is still needed to determine how these principles affect transfer of learning. Further research on applying the principles of multimedia design to medical education is needed to verify the impact it has on the long‐term learning of medical students, as well as its impact on other forms of multimedia instructional programmes used in the education of medical students.     

Effects of comprehensive educational reforms on academic success in a diverse student body

Medical Education 2010: 44 : 1232–1240 Context Calls for medical curriculum reform and increased student diversity in the USA have seen mixed success: performance outcomes following curriculum revisions have been inconsistent and national matriculation of under‐represented minority (URM) students has not met aspirations. Published innovations in curricula, academic support and pipeline programmes usually describe isolated interventions that fail to affect curriculum‐level outcomes. Methods United States Medical Licensing Examination (USMLE) Step 1 performance and graduation rates were analysed for three classes of medical students before (matriculated 1995–1997, n = 517) and after (matriculated 2003–2005, n = 597) implementing broad‐based reforms in our education system. The changes in pipeline recruitment and preparation programmes, instructional methods, assessment systems, academic support and board preparation were based on sound educational principles and best practices. Results Post‐reform classes were diverse with respect to ethnicity (25.8% URM students), gender (51.8% female), and Medical College Admissions Test (MCAT) score (range 20–40; 24.1% scored ≤ 25). Mean ± standard deviation MCAT scores were minimally changed (from 27.2 ± 4.7 to 27.8 ± 3.6). The Step 1 failure rate decreased by 69.3% and mean score increased by 14.0 points (effect size: d = 0.67) overall. Improvements were greater among women (failure rate decreased by 78.9%, mean score increased by 15.6 points; d = 0.76) and URM students (failure rate decreased by 76.5%, mean score increased by 14.6 points; d = 0.74), especially African‐American students (failure rate decreased by 93.6%, mean score increased by 20.8 points; d = 1.12). Step 1 scores increased across the entire MCAT range. Four‐ and 5‐year graduation rates increased by 7.1% and 5.8%, respectively. Conclusions The effect sizes in these performance improvements surpassed those previously reported for isolated interventions in curriculum and student support. This success is likely to have resulted from the broad‐based, mutually reinforcing nature of reforms in multiple components of the education system. The results suggest that a narrow reductionist view of educational programme reform is less likely to result in improved educational outcomes than a system perspective that addresses the coordinated functioning of multiple aspects of the academic enterprise.     

Impact of student ethnicity and patient‐centredness on communication skills performance

Medical Education 2010: 44 : 653–661 Objectives The development of patient‐centred attitudes by health care providers is critical to improving health care quality. A prior study showed that medical students with more patient‐centred attitudes scored higher in communication skills as judged by standardised patients (SPs) than students with less patient‐centred attitudes. We designed this multicentre study to examine the relationships among students’ demographic characteristics, patient‐centredness and communication scores on an SP examination. Methods Early Year 4 medical students at three US schools completed a 12‐item survey during an SP examination. Survey items addressed demographics (gender, ethnicity, primary childhood language) and patient‐centredness. Factor analysis on the patient‐centredness items defined specific patient‐centred attitudes. We used multiple regression analysis incorporating demographic characteristics, school and patient‐centredness items and examined the effect of these variables on the outcome variable of communication score. Results A total of 351 students took the SP examination and 329 (94%) completed the patient‐centredness questionnaire. Responses indicated generally high patient‐centredness. Student ethnicity and medical school were significantly associated with communication scores; gender and primary childhood language were not. Two attitudinal factors were identified: patient perspective and impersonal attitude. Multiple regression analysis revealed that school and scores on the impersonal factor were associated with communication scores. The effect size was modest. Conclusions In a medical student SP examination, modest differences in communication scores based on ethnicity were observed and can be partially explained by student attitudes regarding patient‐centredness. Curricular interventions to enhance clinical experiences, teaching and feedback are needed to address key elements of a patient‐centred approach to care.     

Demographic and socio-economic associations with academic attainment (UCAS tariff scores) in applicants to medical school

BACKGROUND: In the United Kingdom medical students are selected predominantly on their academic merit. Their academic achievement marks are equated via the tariff point score structure administered by the Universities and Colleges Admissions Service (UCAS). We studied the applicant databases for 1998-2003 for one English medical school to determine the factors that predict high tariff point scores. METHODS: Complete demographic data and relative socio-economic status, educational institution attended and tariff point score was available for 8997 UK applicants aged 21 years or younger to the 5-year Bachelor of Medicine/Bachelor of Surgery (BM BS) course at Nottingham University medical school (and partially complete data for a further 1891 applicants). The data were subjected to standard univariate and multivariate analyses and to path analysis. RESULTS: In these samples, the independent predictors of a high tariff point score were being younger and male. The effect sizes were small, although significant. Higher tariff point scores were achieved by those from households less materially disadvantaged. Ethnicity was also a predictor with white, Chinese and those of mixed ethnic origin achieving higher tariff point scores than those from other groups. Finally, the type of school attended predicted academic achievement with applicants from further education colleges, independent schools and grant-maintained schools achieving higher tariff point scores. CONCLUSION: Notwithstanding the relatively homogeneous (predominantly young, white, high academic achievers) applicant pool to a single UK medical school we identified consistent significant predictors of high tariff point scores. As high tariff point scores are still the major entry criterion to UK medical schools, our findings will be of value in informing policy decisions concerning 'widening access' schemes being established at government request.     

The influence of admissions variables on first year medical school performance: a study from Newcastle University, Australia

AIMS: This study examined the relationship between the performance of first year medical students at the University of Newcastle, Australia, and admission variables: previous educational experience, and entry classification (standard -- academic or composite, Aboriginal and Torres Strait Islander, or overseas), age and gender. METHODS: Admission and demographic information was obtained for students who entered first year medicine at Newcastle between the years 1994 and 1997 inclusive. Academic performance was measured according to results of first assessment ('satisfactory' vs. 'not satisfactory') and the final assessment of the first year ('satisfactory' vs. 'not satisfactory'). Logistic regression was used to examine the relationship between predictor variables and outcomes. RESULTS: Assessment and admissions information was obtained for 278 students, 98% of all students who entered the medical course between 1994 and 1997. Regression analysis of first assessment indicated that Aboriginal and Torres Strait Islander and overseas students were significantly more likely to be 'not satisfactory' than all other students (RR=3.1,95% CI: 1.4. - 6 7 and RR=1.5, 95% CI: 1.2-1.8, respectively). Analysis of final assessment indicated these two student groups were also significantly more likely to be 'not satisfactory' than all other students (RR=4.5, 95% CI: 1.4-13.5 and RR=3.5, 95% CI: 1.2-10.8, respectively). At first assessment, students entering via the standard academic pathway and older students were less likely to be 'not satisfactory' (RR=0.6, 95% CI: 0.5-0.7 and RR=0.8, 95% CI: 0.7-0.9, respectively). However both these differences were not evident at final assessment. There were no significant relationships between performance in first year and the remaining variables. CONCLUSIONS: Aboriginal and Torres Strait Islander, and overseas medical students had academic difficulties in the first year of the course, suggesting the need for extra course support. The result may reflect the educational and other obstacles these students must overcome in order to enter and progress through their medical degree. More research is warranted to explore the extent to which these differences persist throughout the medical degree.     

Entry to medical school: an audit of traditional selection requirements

The major focus in the selection of entrants for medical school has traditionally been on academic achievement in school-leaving examinations in which certain science subjects are a requirement. A longitudinal study of 413 successful applicants was undertaken to determine the relationship of these admission criteria to subsequent performance. The findings supports a correlation between overall marks in the school-leaving examination and the annual Grade Point Averages. Those students in the top quartile for marks showed a significant advantage in terms of achievement but only in the preclinical years. Despite the significant correlations no predictions could be made on the basis of overall marks. No correlation was found with levels of clinical competence during the ward clerkships or with the interdisciplinary objective structured clinical examination (OSCE) in the final examination. Marks in individual school-leaving examination subjects correlated with performance during different parts of the course but only those entrants in the top quartile for marks in physics and biology showed an advantage through to the clinical years. English marks were the least correlated and failed to confer an advantage in any year of the course. None of the correlations between school-leaving marks and grades in medical school exceeded 0.4. The predictive value of school-leaving examination marks therefore accounted for only 16% of the variance in subsequent examinations. Selection of medical students on the basis of academic criteria alone is inadequate and should be accompanied by assessment of personal qualities. This School no longer uses school-leaving marks as the primary selection instrument. Measurement of personal qualities, motivation and life experiences by structured interviews is combined with intellectual ability to rank applicants. Correlational or predictive studies cannot of themselves decide which individual subjects should be prerequisites. However, the failure of any one subject to demonstrate greater correlation or prediction tends to support the study of a broader range of subjects by potential applicants.     

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.     

A randomised controlled trial of the effects of mindfulness practice on medical student stress levels

Medical Education 2011: 45 : 381–388 Objective This study aimed to determine whether the practice of mindfulness reduces the level of stress experienced by senior medical students. Methods We carried out a multicentre, single‐blinded, randomised controlled trial with intention‐to‐treat analysis in three clinical schools attached to the University of Tasmania, Hobart, Tasmania. Participants included 66 medical students in their final 2 years of study in 2009. Participants were block‐randomised to either an intervention or a usual care control group. The intervention used an audio CD of guided mindfulness practice designed and produced for this trial. Participants were advised to use the intervention daily over the 8 weeks of the trial. All participants completed two self‐report questionnaires, at baseline and at 8 weeks, respectively. The intervention group also completed a questionnaire at 16 weeks to provide follow‐up data. The primary outcome measure was the difference over time in scores on the Perceived Stress Scale (PSS). The secondary outcome measure referred to differences over time in scores on the subscales of the Depression, Anxiety and Stress Scale (DASS). Results Mean baseline scores on the PSS and the stress component of the DASS were 15.7 (maximal score of 40) and 13.2 (maximal score of 42), respectively, both of which exceed scores in age‐matched normative control data. Using multivariable analysis, participants in the intervention group demonstrated significant reductions in scores on the PSS (? 3.44, 95% confidence interval [CI] ? 6.20 to ? 0.68; p < 0.05) and the anxiety component of the DASS (? 2.82, 95% CI ? 4.99 to ? 0.64; p < 0.05). A borderline significant effect was demonstrated on the stress component of the DASS (? 3.69, 95% CI ? 7.38 to 0.01; p = 0.05). Follow‐up at 8 weeks post‐trial revealed that the effect was maintained. Conclusions Mindfulness practice reduced stress and anxiety in senior medical students. Stress is prevalent in medical students and can have adverse effects on both student health and patients. A simple, self‐administered, evidence‐based intervention now exists to manage stress in this at‐risk population and should be widely utilised.     

Emotional intelligence in medical students: does it correlate with selection measures?

Context Much attention and emphasis are placed on the selection of medical students. Although selection measures have been validated in the literature, it is not yet known whether high scores at selection are indicative of high levels of interpersonal aptitude. Emotional intelligence (EI) is reported to be a predictor of the interpersonal and communications skills medical schools are looking for in applicants. Objectives This study describes EI scores in medical students and explores correlations between EI and selection scores at the University of Western Australia. Methods Senior medical students from a 6‐year undergraduate curriculum completed the online MSCEIT^® (Mayer–Salovey–Caruso Emotional Intelligence Test) survey. Scores for EI were described and correlations between EI and Undergraduate Medicine and Health Sciences Admission Test (UMAT), Interview and Tertiary Entrance Rank (TER) scores were analysed. Results Mean scores of the 177 respondents (58%) reflected the normal distribution of scores (mean 98, standard deviation [SD] 15.0) in the general population. Males had higher EI scores than females and Asian students demonstrated higher EI Total and branch scores than White students. The highest and lowest EI scores were obtained for the branches Understanding Emotions (mean 110, SD 19.0) and Perceiving Emotions (mean 94, SD 15.6), respectively. No significant correlations were found between EI Total or EI branch scores and any of the selection scores (UMAT, TER and Interview). Discussion This study offers information that can be used to compare the EI scores of medical students with those of other health professionals. No relationship was identified between cognition (measured by the UMAT) and skill (measured by the MSCEIT^®) in the interpersonal domain and EI. Further studies are required to explore whether UMAT Section 2 is measuring EI, if there are associations between EI and academic performance and if EI can be used to predict the performance of junior doctors.     

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.     

An equivalence study of interview platform: Does videoconference technology impact medical school acceptance rates of different groups?

Web-based interviewing may be an effective element of a medical school’s larger approach to promotion of holistic review, as recommended by the Association of American Medical Colleges, by facilitating the feasibility of including rural and community physicians in the interview process. Only 10% of medical schools offer videoconference interviews to applicants and little is known about the impact of this interview modality on the admissions process. This study investigated the impact of overall acceptance rates using videoconference interviews and face-to-face interviews in the medical school selection process using an equivalence trial design. The University of New Mexico School of Medicine integrated a videoconferencing interview option for community and rural physician interviewers in a pseudo-random fashion during the 2014–2016 admissions cycles. Logistic regression was conducted to examine whether videoconference interviews impacted acceptance rates or the characteristics of accepted students. Demographic, admissions and diversity factors were analyzed that included applicant age, MCAT score, cumulative GPA, gender, underrepresented in medicine, socioeconomic status and geographic residency. Data from 752 interviews were analyzed. Adjusted rates of acceptance for face-to-face (37.0%; 95% CI 28.2, 46.7%) and videoconference (36.1%; 95% CI 17.8, 59.5%) interviews were within an a priori ± 5% margin of equivalence. Both interview conditions yielded highly diverse groups of admitted students. Having a higher medical college admission test score, grade point average, and self-identifying as disadvantaged increased odds of admission in both interview modalities. Integration of the videoconference interview did not impact the overall acceptance of a highly diverse and qualified group of applicants, and allowed rural and community physicians to participate in the medical school interview process as well as allowed campus faculty and medical student committee members to interview remotely.     

Cost‐Effectiveness of a School‐Based Obesity Prevention Program

BACKGROUND: A school‐based obesity prevention study (Medical College of Georgia FitKid Project) started in the fall of 2003 in 18 elementary schools. Half of the schools were randomized to an after‐school program that included moderate‐to‐vigorous physical activity, healthy snacks, homework assistance, and academic enrichment. All third graders were invited to enroll. The objective of this study was to assess the cost‐effectiveness (CE) of the first‐year intervention. METHODS: Standard CE analysis methods and a societal perspective were used. Program delivery costs incurred during the first‐year intervention and the usual after‐school care costs that would occur in the absence of the intervention were estimated (in 2003 dollars). Net intervention costs were calculated by subtracting the usual after‐school care costs from the intervention costs. The effectiveness of the intervention was measured as percent body fat (%BF) reduction compared with a control condition. The CE was assessed as the net intervention cost divided by the effectiveness of the intervention. RESULTS: The intervention costs totaled $174,070, $558/student, or $956/student who attended ≥40% of the intervention sessions. The usual after‐school care costs were estimated at $639/student. Students who attended ≥40% of the intervention reduced %BF by 0.76% (95% confidence interval: ?1.42 to ?0.09) at an additional cost of $317/student. CONCLUSIONS: Subjects who attended ≥40% of the intervention achieved a significant reduction in %BF at a relatively low cost. School‐based obesity prevention programs of this type are likely to be a cost‐effective use of public funds and warrant careful consideration by policy makers and program planners.