Sexual and gender-related harassment in medical education and research training: results from a Swedish survey

OBJECTIVE: The aims of this study were to establish the level of perceived sexual and gender-related harassment in undergraduate and doctoral studies, in which environment the events occurred, which categories of persons had committed the harassment, and other aspects of sexual harassment at the Faculty of Medicine, Gothenburg University. METHODS: A questionnaire was distributed to all registered male and female undergraduate students (n= 605) and doctoral students (n=743) by mail to their home addresses. RESULTS: The response rate was 62% (840/1348). Of the total study population, 59% (495/840) of respondents reported at least one experience of derogatory jokes and comments, 54% (454/840) of respondents reported at least one experience of gender-related discrimination, and 22% (187/840) of respondents reported at least one incident of sexual harassment. More severe types of sexual harassment were reported by 9% (79/840) of respondents. Women, and especially undergraduate women, were more often exposed to all kinds of harassment than were men. Lecturers/professors, doctors and co-students were the categories most often identified as the harassers. The harassment mostly occurred during lectures, clinical work and coffee breaks. The most common types of self-perceived mistreatment were derogatory jokes and comments. CONCLUSION: This survey shows that sexual harassment happens to both men and women, although it is more commonly experienced by female undergraduate and doctoral students, and that it occurs in both the university and hospital environments. Universities should develop action plans to prevent such events. Students and teachers should be well informed about appropriate measures to take in situations where harassment is known or suspected to occur.     

An assessment of academic performance and personality

This study examines whether personality profiles, using personality factors, or clusters of personality factors, are associated with academic success. One hundred and forty medical students of the University of Wales College of Medicine were invited to complete a personality questionnaire (Cattell 16 PF) as they sat their final examinations in June 1988. A total of 129 usable forms were obtained. The students were divided into four groups dependent on their academic performance, which had been monitored throughout the course. The majority (62%) had no academic problems, but 16 (12%) students had serious difficulties, which entailed delaying qualification by at least 6 months. There was no relationship between the scores obtained for the students' first attempt at A-level and their subsequent medical school academic performance. However, students who obtained a degree either before or during their medical course were significantly less likely to have academic problems. Academic success was not associated with any of Cattell's personality factors. This was true of previously reported groups of factors associated with the poor student performance, and regardless of first or second order factors. We conclude that this personality profile is unlikely to be helpful in selecting future intakes of medical students, although a prospective study would be required for a definite answer to this question.     

Adaptive and maladaptive perfectionism in medical students: a longitudinal investigation

OBJECTIVES: The personality of medical students may have an important impact on both their academic performance and emotional adjustment during medical school. There has been little systematic study of the impact of perfectionism on medical students. The present study sought to compare the perfectionism profile of medical students with that of a general arts student group and to examine the relationship among perfectionism, distress symptoms and academic expectations and satisfaction. DESIGN: Medical students (n=96) and arts students (n=289) completed a baseline assessment including two multidimensional perfectionism scales. The medical students also completed measures of distress symptoms, personality (neuroticism, conscientiousness) and questions about their perceptions of their academic performance. Of the medical students, 58 completed a second set of questionnaires 6 months later (time 2). SUBJECTS: First-, second- and third year medical students and first-year arts students. RESULTS: In comparison with arts students, the perfectionism profile of medical students showed higher personal standards, lower doubts about actions and lower maladaptive perfectionism scores. In the medical students adaptive perfectionism (achievement striving) was significantly correlated with baseline academic performance expectations and conscientiousness and was predictive of dissatisfaction with academic performance at time 2. Maladaptive perfectionism (excessive evaluative concerns) was significantly correlated with baseline distress symptoms and neuroticism and was predictive of symptoms of depression and hopelessness at time 2. CONCLUSIONS: Perfectionism in medical students differs systematically from perfectionism in general arts students. Distinguishing adaptive and maladaptive aspects of perfectionism is important in understanding the cross-sectional and longitudinal implications of perfectionism for medical students.     

Formative assessment of the consultation performance of medical students in the setting of general practice using a modified version of the leicester assessment package

OBJECTIVE: To evaluate the use of a modified version of the Leicester Assessment Package (LAP) in the formative assessment of the consultation performance of medical students with particular reference to validity, inter-assessor reliability, acceptability, feasibility and educational impact. DESIGN: 180 third and fourth year Leicester medical students were directly observed consulting with six general practice patients and independently assessed by a pair of assessors. A total of 70 practice and 16 departmental assessors took part. Performance scores were subjected to generalizability analysis and students' views of the assessment were gathered by questionnaire. RESULTS: Four of the five categories of consultation performance (Interviewing and history taking, Patient management, Problem solving and Behaviour and relationship with patients) were assessed in over 99% of consultations and Physical examination was assessed in 94%. Seventy-six percent of assessors reported that the case mix was 'satisfactory' and 20% that it was 'borderline'; 85% of students believed it to have been satisfactory. Generalizability analysis indicates that two independent assessors assessing the performance of students across six consultations would achieve a reliability of 0.94 in making pass or fail decisions. Ninety-eight percent of students perceived that their particular strengths and weaknesses were correctly identified, 99% that they were given specific advice on how to improve their performance and 98% believed that the feedback they had received would have long-term benefit. CONCLUSIONS: The modified version of the LAP is valid, reliable and feasible in formative assessment of the consultation performance of medical students. Furthermore, almost all students found the process fair and believed it was likely to lead to improvements in their consultation performance. This approach may also be applicable to regulatory assessment as it accurately identifies students at the pass/fail margin.     

Introducing medical students to medical informatics

Summary. Medical informatics ( MI ) has been introduced to medical students in several countries. Before outlining a course plan it was necessary to conduct a survey on students' computer literacy. A questionnaire was designed for students, focusing on knowledge and previous computer experience. The questions reproduced a similar questionnaire submitted to medical students from North Carolina University in Chapel Hill ( NCU ). From the results it is clear that although almost 80% of students used computers, less than 30% used general purpose applications, and utilization of computer-aided search of databases or use in the laboratory was exceptional. Men reported more computer experience than women in each area investigated by our questionnaire but this did not appear to be related to academic performance, age or course. Our main objectives when planning an MI course were to give students a general overview of the medical applications of computers and instruct them in the use of computers in future medical practice. As our medical school uses both Apple Macintosh and IBM compatibles, we decided to provide students with basic knowledge of both. The programme was structured with a mix of theoretico-practical lectures and personalized practical sessions in the computer laboratory. As well as providing a basic overview of medical informatics, the course and computer laboratory were intended to encourage other areas of medicine to incorporate the computer into their teaching programmes.     

Students, tutors and relationships: the ingredients of a successful student support scheme

BACKGROUND: Medical students suffer from stress and psychological morbidity. Much of this stress is related to uncertainty about course work and workload. Although several student support systems are on offer at various medical schools, few have been shown to meet the needs of students. OBJECTIVE: To evaluate one student support scheme and determine the factors which are essential for success. METHOD: A total of 144 second- and third-year medical students were randomly selected at the University of Dundee. They were asked to complete questionnaires regarding contact with their personal tutors, frequency of meetings, activities during meetings, opinions on how to improve the system and how satisfied they were with the present system. In addition 28 tutors were also asked to complete a questionnaire which matched as far as possible that for students. Qualitative data was collected from semi-structured interviews, free-text responses from questionnaires, email communications with student group representatives and telephone interviews. RESULTS: The scheme was rated as successful or very successful by 25 (18.4%) students and five (29.4%) tutors. A high success rating was associated with regular and frequent meetings, with tutors actively seeking their students and taking part in social as well as academic activities. CONCLUSIONS: The relationship that is formed between students and tutors is the most important factor contributing to the success of the scheme. Taking part in social activities encourages the relationship to develop, whilst addressing academic problems helps to meet the needs of students. Those students who fail exams appear to have the same needs as those who pass.     

What do medical students read and why? A survey of medical students in Newcastle‐upon‐Tyne,England

OBJECTIVES: There is increasing interest in the role of medical humanities within the undergraduate curriculum, but we know little about medical students' views on this or about their reading habits. Our study explored the reading habits of medical students, and their attitudes towards literature and the introduction of humanities into the curriculum. DESIGN: Self-completion questionnaire survey. SETTING: Newcastle University and Medical School. SUBJECTS: All first-, second- and third-year undergraduate medical students (384), biology students (151) and a random sample of law students (137) were sent a self-completion questionnaire to assess reading levels, attitudes towards literature and the medical humanities (medical students) and the perceived benefits of reading. RESULTS: Medical students read widely beyond their course and articulate a range of benefits from this, including: increasing awareness of life outside their experience; introspection or inspiration; emotional responses; and stimulation of an interest in reading or literature. Of the medical students, 40% (103/258) read one or more fiction books per month, but 75% (193) read fewer non-curricular books since starting university, largely because of time pressures, work, study or academic pressures and restricted access to books. A total of 77% (194) thought that medical humanities should definitely or possibly be offered in the curriculum, but of these 73% (141) thought it should be optional and 89% (172) that it should not be examined. CONCLUSIONS: Medical students read literature for a variety of very positive and valued reasons, but have found leisure reading harder to maintain since starting university. They support inclusion of the humanities in medical education, but have mixed views on how this should be done.     

The quality of student-tutor interactions in the clinical learning environment

We surveyed 403 students in their clinical years for their perceptions of the quality of clinical clerkships. Between 42.6 and 67.0% of tutorials were said to contain positive factors such as a relaxed teaching atmosphere, enthusiasm, a good selection of patients and adequate preparation. Negative features in 18.2-37.2% of tutorials included unreasonable expectations, conflicting information, late arrival, early departure, failure to show up and the display of anger, a patronizing attitude, favouritism or ridicule. While two-thirds of tutors were regarded as friendly and helpful, the remaining one-third were perceived as unconcerned, discouraging, derogatory or hostile. Overall, only half the clinical tutors were rated as effective teachers; more specifically in medicine and psychiatry, less than one-third of consultants were regarded as effective teachers, as compared with some two-thirds of consultants in obstetrics and gynaecology and paediatrics who were so regarded. Almost two-thirds of the students had predominantly positive reactions to interactions with their tutors, in terms of being motivated to learn, enthused about the subject and having their self-confidence increased. Some one-quarter had negative reactions such as indifference, depression, anger, embarrassment and fearfulness. However, the impact of student-tutor interactions was mainly confined to the students' academic well-being, with little effect on their personal-social lives. Finally, one-third of students had experienced at least some form of mistreatment by their tutors, including gender, appearance, religious and racial discrimination, unfair grading and public humiliation. These findings suggest that the clinical clerkship may not be providing an optimal learning environment for medical students.     

Medical faculty as humanistic physicians and teachers: the perceptions of students at innovative and traditional medical schools

BACKGROUND AND OBJECTIVES: The training of caring physicians represents an important goal of medical education. Little is known however, on whether medical faculty constitute good role models for teaching humanistic skills to medical students. In this study, we examined to what extent medical students at innovative and traditional schools perceived their teachers as humanistic physicians and teachers. We also explored whether pre-clinical and clinical students shared the same perceptions. METHODS: A mail survey was conducted in Canada of all second-year students and senior clerks at one innovative medical school (problem-based learning (PBL), patient-centred, community-oriented) and three traditional medical schools. Students were asked to what extent they agreed or disagreed that the majority of their teachers behaved as humanistic physicians and teachers; 10 statements were used. Overall, 65% of the 1039 students returned the questionnaire. RESULTS: Over 25% of second-year students and 40% of senior clerks did not agree that their teachers behaved as humanistic caregivers with patients or were good role models in teaching the doctor-patient relationship. More than half of second-year students and senior clerks did not agree that their teachers valued human contact with them or were supportive of students who had difficulties. There were few differences in the way medical students at innovative and traditional schools perceived their teachers' humanistic qualities. At the pre-clinical level however, there were more students from the innovative school than from the traditional schools (around 60% vs. 40%, P < 0.005) who agreed that their teachers valued human contact with them and were supportive of students. CONCLUSION: Our results indicate that the PBL curriculum fosters better teacher-student relationships during the pre-clinical years. They also suggest that an unacceptably large number of medical students are taught by physicians who seem to lack compassion and caring in their interactions with patients. This study questions the adequacy of medical faculty as role models for the acquisition of caring competence by medical students.     

Academic misconduct among medical students in a post-communist country

AIM: To assess the prevalence of, attitudes towards and willingness to report different forms of academic dishonesty among medical students in a post-communist transitional country. METHODS: An anonymous, self-administered questionnaire was distributed to medical students in Years 2-6 at the Zagreb University School of Medicine; 827 (70%) valid questionnaires were returned and analysed. RESULTS: Most of the students (94%) admitted cheating at least once during their studies. The most frequent type of misconduct was 'signing in an absent student on a class attendance list' (89.1%), and the least frequent 'paying for passing an examination' (0.7%). The number of committed types of misconduct out of 11 listed types increased from Year 2 (median 2) to Year 6 (median 4). Cheating behaviours could be clustered into 4 groups based on self-reported cheating, perceived prevalence of cheating, attitude towards cheating, and willingness to report cheating. The clustered behaviours that most students admitted to were perceived as the most frequent, more approved of and less likely to be reported. The strongest predictors of dishonest behaviour were attitude, perception of peer group behaviour and study year. Almost half (44%) the students said they would never report any form of cheating. CONCLUSION: Academic misconduct is widespread among medical students at the largest medical school in Croatia and its prevalence is greater than that reported for developed countries. This may be related to social and cultural factors specific to a country in the midst of a post-communist transition to a market economy, and calls for measures to be instigated at an institutional level to educate against and prevent such behaviour.     

A prospective analysis of stress and academic performance in the first two years of medical school

AIM: This study provides prospective, longitudinal data on the relationship between stress-related measures and academic performance during the first two years of medical school. METHODS: First year medical students (n = 121) were surveyed prior to beginning classes (wave 1), and again 8 months later (wave 2). Personality variables predisposing to distress (optimism and trait anxiety), stress response (depression and state anxiety), and stress management strategies were assessed at wave 1 and wave 2. Pre-medical academic scores, and grades at the end of five assessment periods over the course of the first 2 years of medical school were also obtained. RESULTS AND CONCLUSIONS: As expected, pre-medical-school academic performance strongly predicted performance in medical school. Academic performance before and during medical school was negatively related to reported stress levels. On bivariate correlations, there were numerous significant relationships between stress reported at waves 1 and 2, and medical school academic performance assessed after these measures. In addition there were modest negative correlations between self-reported coping strategies of 'humour' and 'wishful thinking', and consequent academic performance. However, the predictive value of stress and its management on prospective academic performance was much decreased once pre-medical-school performance was statistically controlled.     

Towards the identification of student learning problems: the development of a diagnostic inventory

An understanding of how students approach their learning has important implications for medical education. Of particular interest is the fact that the approach students use in their study has a significant impact on both the quality of the learning and their academic success. It would clearly be of value to identify students whose approach to learning was predictive of unsatisfactory performance. This paper describes the initial development of two versions of an inventory (questionnaire) which was designed to aid in the diagnosis of student learning problems. Preliminary information is given on the reliability and validity of these instruments. Factor analyses support the underlying design. Correlation of subscales with academic performance has provided encouraging evidence of the potential of these inventories in identifying students with specific learning or study problems.     

Computer awareness among medical students: a survey

The objective of the study was to assess the attitude of Edinburgh University medical students towards computers and to evaluate the effects of changes in the curriculum and intercalated BSc towards computer knowledge. During March to November 1995 a questionnaire was distributed in lectures, seminars and tutorials to all Edinburgh University medical students. Overall, 65% of students returned the questionnaire, divided equally between both genders. Only 2% of students had not used a computer in the previous year. The most frequent application used was E-mail and the most frequent site, the Greenfield suite micro lab, within the medical school. The average score for self-perceived computer knowledge on a scale of 0–10 was 4.19. This score was significantly higher for the students who own a computer and who have an intercalated BSc honours degree as well as the pre-clinical students compared to the clinical students. There is also a strong correlation between computer use and doing a second year special option module. With regards to attitude towards computers, 86% of students agreed that computer skills will be beneficial to them in their future career and 62% of all students wanted a structured course in computer use as part of the MB ChB course. There has been a general increase in computer literacy amongst the medical students in Edinburgh. This is specially so for the pre-clinical students who have had the brunt of the changes in the curriculum. The tendency for both the lower knowledge and use by the clinical students can, in part, be due to the accessibility of computers to these students.     

Voluntary active euthanasia and doctor-assisted suicide: knowledge and attitudes of Dutch medical students

The objective of the study was to gain insight into the knowledge of and attitudes towards voluntary active euthanasia and doctor-assisted suicide (EEDAS) of Dutch medical students, and to determine whether knowledge and attitudes change after a 1–day informative conference about EDAS. Data were collected by means of two self-administered questionnaires. Questionnaire 1 had to be completed before the start of the conference and questionnaire 2 after the conference. In both questionnaires, students were asked by means of two open-ended questions to define euthanasia and doctor-assisted suicide. They were also asked to indicate which of eight statements met with the requirements for prudent practice. Finally, the students were asked to what extent they agreed or disagreed with each of seven statements about attitudes towards EDAS. To determine if a selection occurred among students who returned both questionnaires, their background characteristics, and knowledge and attitudes towards EDAS were compared with those who returned only the first questionnaire. Forty-seven students returned only the first questionnaire, while both questionnaires were returned by 137 students. No differences were found between students who returned both questionnaires and those who returned only the first questionnaire with regard to age, religion, knowledge of and attitudes towards EDAS. Students' knowledge of the definitions of EDAS and the requirements for prudent practice improved significantly. Students' reactions to the statements on attitudes towards EDAS showed that a large majority had a fairly positive attitude towards EDAS. There was no significant difference before and after the conference. Male students and students with a religion were more opposed to EDAS than female students and students without a religion. The fact that the students' knowledge of EDAS improved after a 1–day conference does not imply sufficient understanding of the issue. Because EDAS is allowed only under strict conditions in the Netherlands, medical students require special training. Only then will they be equipped to deal with requests for EDAS during their future careers.     

Sexual harassment during clinical clerkships in Dutch medical schools

Context  Sexual harassment of medical students has been the focus of many international studies. Prevalence rates from 18% to over 60% have been reported. However, a Dutch study at Nijmegen Medical School found the prevalence rate to be lower (13.3% in the total group; 20% among female students only).
Objectives  We aimed to identify whether Nijmegen constitutes a positive sample of Dutch medical schools or whether incidents of sexual harassment are less prevalent in the Netherlands than elsewhere, and to establish if and how these experiences impact the professional lives of students.
Methods  Students received a semi-structured questionnaire containing questions about their experiences of sexual harassment during clerkships. The questions referred to students' reactions to any incidents, the possible consequences for their wellbeing or professional functioning and the way cases of sexual harassment were handled.
Results  The prevalence of sexual harassment was significantly higher in Utrecht than in Nijmegen. In both studies rates were relatively low compared with international data. Nevertheless, 1 in 3–5 Dutch female medical students had experienced unwelcome sexual attention from patients, colleagues or supervisors. Three of 10 students who had experienced such an incident stated that it had a negative impact on their functioning afterwards.
Conclusions  Prevalence rates of sexual harassment in medical schools in the Netherlands are low compared with international rates. However, the number of women students who experience sexual harassment is still 1 in 3–5. The occurrence of and ways to deal with these incidents should be important topics in the training of medical students and supervisors.     

Information technology in medical education: a nationwide project on the opportunities of the new technology

CONTEXT: The aim of the national "IT Culture in Medical Education" project in Finland is to enhance the opportunities new technology may provide for medical education. The project focuses on attitudes towards information technology (IT) and on its current use among teachers and students. METHOD: This survey was part of a Finnish nationwide project in medical education. Data were collected by means of a questionnaire designed to gather information about IT use in medical education, sent to teachers and students. The questions were 5-point Likert-type. The participants were medical teachers (n=196) and medical students (n=392) at two medical schools. RESULTS: In both universities, it appeared that medical teachers and students had a very positive attitude toward the advances in modern technology. In addition to the favourable attitudes, computer-related technology was also widely applied. Teachers, however, used information technology more in their research work than in teaching. CONCLUSIONS: The results pose challenges to medical education and underline the importance of educational and psychological knowledge in combination with new technical skills.     

The attitudes of 'tomorrow's doctors' towards mental illness and psychiatry: changes during the final undergraduate year

AIMS: To compare the efficacy of two teaching styles, didactic teaching and problem based learning, in producing enduring change in final-year medical students' attitudes towards psychiatry and mental illness. METHOD: A 1-year follow-up questionnaire survey of two groups of medical students taught psychiatry in their fourth-year training by two different methods. One-year follow-up scores were compared with pre-attachment and post-attachment scores in the fourth year. RESULTS: 70 (68%) students completed both questionnaires at follow-up. The follow-up scores were significantly lower compared with both the fourth-year pre-attachment and post-attachment scores, suggesting that the positive change in attitudes following psychiatric training in the fourth year significantly decayed during the final year. The two teaching methods did not differ in the magnitude of this reduction. CONCLUSIONS: The positive change that occurs in medical students' attitude towards psychiatry, psychiatrists and mental illness after their fourth-year psychiatric training is transient and decays over the final year.     

Effect of legislative changes in drug promotion on medical students: questionnaire survey

Objective The aim of this follow‐up study was to examine whether the legislative changes that took place in Finland in 2004 had an impact on the interactions between pharmaceutical companies and medical students. According to a previous survey, information provided by pharmaceutical companies represented one of the most important sources of information on pharmaceutical products for medical students and students frequently attended promotional events. Methods The authors collected the survey data using questionnaires distributed to medical students in Finland’s five medical departments in spring 2005. A total of 1523 students (44% of all medical students in Finland) responded to the questionnaire. Results were compared with the findings of a previous study conducted in 2000. Results We found a dramatic drop in how often students attended promotions given by pharmaceutical company representatives (PCRs), with 17% versus 68% of students in the clinical phase of study attending at least twice a month (P < 0.001). Other educational events organised by pharmaceutical companies were attended by 3% versus 22% of clinical students (P < 0.001). In addition, presentations by PCRs and industry‐sponsored educational events were not regarded as such important sources of information as they had been earlier and the perceived influence of promotion on future prescribing habits had decreased (12% versus 25% indicated that promotion influences prescribing; P < 0.001). Almost two‐thirds of the students indicated that basic medical education should provide them with more efficient tools for critical assessment of the claims made by pharmaceutical marketing departments. Conclusions Legislative reform has decreased the amount of contact between the pharmaceutical industry and medical students and diminished the role of industry‐sponsored promotion as a source of information on pharmaceutical products.     

Attitudes toward mental illness in medical students: does personal and professional experience with mental illness make a difference?

PURPOSE: Medical students may be susceptible to emotional difficulties because of the high levels of both academic and interpersonal stress associated with their training. This study examined attitudes toward mental illness in medical students. It was expected that people who had experience of mental illness, either in their personal lives or through their professional experience, would have more positive attitudes toward students with mental health problems than would people who had not had such experience. METHOD: Faculty and staff employed by a large American university medical centre completed a questionnaire package including several measures designed to assess specific attitudes toward medical students with emotional problems. Data were also collected on the degree to which specific mental disorders were thought to interfere with the performance of medical students. RESULTS: In general, prior experience with mental illness, either through personal or professional activities, was associated with more positive attitudes about students with mental illness. However, the pattern of findings was complex. CONCLUSION: Future research should examine the extent to which specific mental illnesses actually affect the performance of medical students.