Contribution of medical student research to the MedlineTM-indexed publications of a German medical faculty

Medical students in Germany have to write a research thesis to acquire the title of medical doctor. This study evaluates the contribution of student research to the Medline?-indexed publications of a German medical faculty. A 1993–1995 Medline?-publication list, on which medical students among authors should be marked, was sent to medical faculty staff of the University of Würzburg, Germany (n = 238). Faculty members responded (106, 45%), 66 were working at a clinic, 26 at a clinic-associated institute and 14 at a basic science institute. Between 1993 and 1995, 1128 Medline?-indexed papers were published by these faculty members, who on average supervised 4·5 medical students (n = 477). Medical students were among the authors of 316 (28%) and were the first authors of 88 papers (7·8%). For 66% of medical students their research resulted in a Medline?-indexed publication. Medical student research activity can significantly influence the published output of a medical faculty.     

Exploring the underperformance of male and minority ethnic medical students in first year clinical examinations

Evidence shows that medical students from Minority Ethnic (ME) backgrounds and male medical students underperform in undergraduate examinations. Our study confirmed these findings in first year clinical (year 3) medical students, and further explored this disparity in performance. We conducted a series of meta-analyses to measure the effects of sex and ethnic group on the written examination and Objective Structured Clinical Examination (OSCE) scores of three groups of year 3 medical students at two London UK medical schools (n = 1,051; 46.0% male; 48.7% White). Male and ME students scored lower on written and OSCE assessments. Both assessments were statistically significantly correlated (mean r = 0.45) and therefore the effects of sex and ethnic group were measured on each exam after being adjusted for the effect of the other. Although sex and ethnic differences remained on the OSCE when adjusted for written performance, these differences disappeared on the written when it was adjusted for OSCE performance. These findings may reflect a relative deficit in practical clinical knowledge in male and ME year 3 students. Results were unlikely to be due to examiner bias, as the machine-marked unadjusted written exam results showed significant sex and ethnic differences.     

Smoking behaviour and attitudes among Australian medical students

Teaching about tobacco and related diseases is essential in the undergraduate medical course in order for students to gain knowledge about smoking and how to intervene with patients who smoke. The objective of the study was to assess students'smoking-related behaviour, knowledge and attitudes towards tobacco, and perceptions of their future role as doctors. Data were collected from two consecutive years of year 1 and year 5 medical students at the University of New South Wales, Sydney. A total of 594 (79%) of students across the 2 years completed the survey: 90% of year 1 students, and 69% of year 5 students. The daily smoking rate among the total medical students was 2.9%: 11.8% in year 1 (2.3% daily, 9.5% occasional) and 13.7% in year 5 (3.3% daily, 10.4% occasional). There were significantly more male than female smokers in year 5 (P < 0.05). The overall smoking rates for males in years 1 and 5 were 12.4% and 19.3%, and the smoking rates for females were 11.2% and 8%. Knowledge about the causal role of tobacco in the development of specific diseases improved significantly from year 1 to year 5 (P < 0.001). Nevertheless, in year 5 there remained a lack of knowledge about the relationship of smoking and some diseases. Fifty-seven per cent of students thought that their current knowledge was sufficient to counsel smokers, with year 5 students (89%) being far more positive than year 1 students (34%) (P < 0.001). Teaching medical students about smoking-related diseases and a patient-centred smoking cessation intervention results in an increase in knowledge, as well as positive perceptions about their future role in intervening with smokers.     

The teaching of medicine at the University Centre for Health Sciences Yaounde,Cameroon: its concordance with the Edinburgh Declaration on Medical Education

Summary. The University Centre for Health Sciences (UCHS) or as it is referred to in French ‘Centre Universitaire des Sciences de la Santé’ (CUSS), became functional in 1969 with the enrolment of the first group of students. The objective of this training programme was to produce a scientifically sound, multipurpose doctor who would be fully operational in a rural setting with minimal equipment and supplies ( Monekosso 1970, 1972 ). The graduate had to be able to adapt readily to new situations and improvise whenever possible, calling for a high degree of competence and initiative. The training strategies adopted by UCHS in 1969 which met this requirement were later found to be in close concordance with the tenets of the World Conference on Medical Education held in Edinburgh in 1988, the Edinburgh Declaration. While some of the terminology may not have been worked out at the time, the programme developed embraced some new concepts hitherto untried or undeveloped:

• — the problem-solving approach in the first to the sixth year;
• — an integrated teaching approach during the first to sixth year of medical training;
• — an integrated medicine internship in district hospitals in the sixth year;
• — a community-based training approach throughout the training;
• — team training of three different health professionals;
• — competency-based training;
• — health services linked research;
• — health services linked training ( Monekosso & Quenum 1978 ).

The concordance of this programme to the Edinburgh Declaration is of great interest in realizing the World Federation for Medical Education programme and implementing the Edinburgh Declaration. The involvement of the three innovative medical schools in the planning stage of the curriculum explains this concordance.     

Perceptions of family planning and abortion education at a faith-based medical school

Background

Because of religious beliefs against contraception and abortion, family planning education is limited at faith-based institutions. The purpose of this study was to assess medical students' satisfaction with family planning education at a faith-based medical school.

Study Design

A self-administered anonymous questionnaire was designed and distributed to all second- and fourth-year students (n=273) at a faith-based medical school during the 2008–2009 academic year. The questionnaire included items on adequacy of and preference for amount and content of family planning preclinical education and clinical training.

Results

A total of 220 students completed the questionnaire for a response rate of 80.6%. The majority of respondents described the preclinical education as inadequate and preferred increased content on contraception (73.9%), sterilization (68.6%) and abortion (65.2%). The majority of fourth-year students reported appropriate contraceptive clinical training (69.0%), but inadequate sterilization training (54.8%) and abortion training (71.4%) during their third-year OB/GYN clerkship. Approximately half of fourth-year students (51.8%) desired clinical abortion training.

Conclusion

The majority of students enrolled at a faith-based medical school rated their current family planning education as inadequate and desired additional opportunities.     

Minding the gap between communication skills simulation and authentic experience

Context

Concurrent exposure to simulated and authentic experiences during undergraduate medical education is increasing. The impact of gaps or differences between contemporaneous experiences has not been adequately considered. We address two questions. How do new undergraduate medical students understand contemporaneous interactions with simulated and authentic patients? How and why do student perceptions of differences between simulated and authentic patient interactions shape their learning?

Methods

We conducted an interpretative thematic secondary analysis of research data comprising individual interviews (n = 23), focus groups (three groups, n = 16), and discussion groups (four groups, n = 26) with participants drawn from two different year cohorts of Year 1 medical students. These methods generated data from 48 different participants, of whom 17 provided longitudinal data. In addition, data from routinely collected written evaluations of three whole Year 1 cohorts (response rates ≥ 88%, n = 378) were incorporated into our secondary analysis dataset. The primary studies and our secondary analysis were conducted in a single UK medical school with an integrated curriculum.

Results

Our analysis identified that students generate knowledge and meaning from their simulated and authentic experiences relative to each other and that the resultant learning differs in quality according to meaning created by comparing and contrasting contemporaneous experiences. Three themes were identified that clarify how and why the contrasting of differences is an important process for learning outcomes. These are preparedness, responsibility for safety, and perceptions of a gap between theory and practice.

Conclusions

We propose a conceptual framework generated by reframing common metaphors that refer to the concept of the gap to develop educational strategies that might maximise useful learning from perceived differences. Educators need to ‘mind’ gaps in collaboration with students if synergistic learning is to be constructed from contemporaneous exposure to simulated and authentic patient interactions. The strategies need to be tested in practice by teachers and learners for utility. Further research is needed to understand gaps in other contexts.

     

Teachers in general practice: a comparative study

Thirty-nine randomly selected general practitioners in the Cambridgeshire Health Area were surveyed in an attempt to determine whether there were prior differences between those practitioners who choose to become involved with undergraduate medical students and those who choose not to.
Teachers were found to have graduated more recently, subscribe to more journals and were more likely to use medical libraries than non-teachers.
All the solo practitioners in the study and two of the four practitioners in two-man groups belonged to a subgroup of non-teachers who had never had students and did not want students in the future. This subgroup also subscribed to fewer journals than the other groups, bought fewer textbooks and used medical libraries less.
The only prior differences between teachers and non-teachers that have been demonstrated are year of graduation and type of practice. Other differences could well be attributed to the influence of the students themselves. Studies are needed to clarify this issue, especially as it relates to continuing medical education.     

Videotaped vs traditional lectures for medical students

Closed-circuit television (CCTV) provides medical departments with alternatives in instructional formats. Concern, however, has been voiced about teaching via TV because the medium itself might cause inattention. This study investigated whether TV will lower the test scores of medical students. Sixty-one students were randomly divided into two groups. The lecture (control) group received the information via traditional lectures, including use of 2”× 2” transparencies. The video group received concurrently the same information via CCTV. Multiple-choice examinations were given after each of the six sessions. The cumulative mean scores were similar: lecture group = 87.56%, video group = 87.99%, i.e., no significant difference (P=0.77). To detect attitudinal differences toward the two formats, the students were surveyed at the end of the series and intragroup agreement on specific questions was calculated. The students rated the lecture format more highly. In response to the question ‘Did the audiovisual materials used by the instructor aid your learning?’, the mean rating from the lecture group was 7.37 (scale of 0–9) compared to a mean rating of 5.93 from the video group (P< 0.0003).     

Medical students' attitude towards psychiatry: a ten-year comparison†

Medical students' interest in and attitudes toward psychiatry, both as a field of education and as a medical specialty, have been explored by a number of investigators. The present study compares two series of investigations completed at the McGill University teaching hospitals over a ten year span and involving third year medical students in 1968–69 (n=59) and in 1978–79 (n=168). The findings of these two studies are evaluated in two parts: (1) comparison of attitudes toward psychiatry before and after clinical training in 1978–79. (2) comparison of the results obtained in 1969 with those in 1979. The results of the comparison showed that students currently put more emphasis on the clinical aspects of psychiatric training and less on the theoretical and research aspects of psychiatry. Thirty-two percent of students in 1979 found psychotherapy to be the most useful treatment modality as compared with only 10 percent in 1969. Findings reflecting the usefulness of organic therapies in psychiatry remained fairly consistent, but behaviour therapy was found to be less useful by students in 1979 than in 1969. In the 1969 survey, 2 per cent of the third year students indicated an interest in psychiatry as a future career as compared with 3.3 per cent in 1979. The implications of these findings are discussed in relation to the psychiatric training programmes in medical schools.     

Impact of teacher training: a shift toward problem-solving orientation

This study explores the effect of World Health Organization (WHO) sponsored teacher-training activities conducted by the medical education department located at Pahlavi University School of Medicine in Shiraz, Iran.
The first study was conducted in 1974, before the influence of organized teacher-training activities at Pahlavi University. From that study it was concluded that class standing, based upon examinations given in 1968–1973, was dependent upon ability to recall information.
The present study, conducted in 1976 after the influence of organized teacher training, revealed that the basis for the determination of class standing, based upon examinations given in 1971–1976, was shifting from ability to recall information to problem-solving competencies.
The tangible changes identified by this study were assumed to be related to several variables such as the heightened awareness and skill among the medical teachers, students' demand for relevancy and their familiarity with the new testing method, particularly the PMP, and perhaps some other variables. However, no attempt was made to draw causality between teacher-training activities had the position in class. Due to the fact that teacher-training has been the most prominent activity since 1972, it was assumed that the significant changes in this study could be related to such efforts.     

Where should special attention be paid in undergraduate medical education? Two surveys among Finnish doctors

The study focuses on Finnish doctors' views of their undergraduate medical education. In 1988, a study (Junior Physician 88 Study) involving all the doctors registered during the years 1977–1986 in Finland (n = 5208 ) was carried out. A questionnaire was sent to a random sample of 2632 doctors, and after two mailings 1745 questionnaires (66.3%) were returned. A total of 1334 gave at least one answer to the question: ‘Where should special attention be paid in undergraduate medical education?’ Five years later, in 1993, another study (Physician 93 Study) involving all medical doctors registered in Finland during the years 1982–1991 (n = 4671 ) was carried out. The same questionnaire was sent to a random sample of 2332 doctors, and after two reminders 1818 questionnaires (78.0%) were returned, and 1228 doctors also answered the open-ended question. Content analysis was used to analyse the answers qualitatively and quantitatively. About 90% of the answers could be classified into two main categories: practical skills and evaluation of subjects. The most common proposal for the improvement of undergraduate medical education was that the practical skills needed in general practice should be taught. More education in administration and health economics was also desired. Respondents said that preclinical and clinical studies should be more closely integrated. In answers to the open question, the course in public health was strongly criticized for being too theoretical. Learning of the core knowledge for medical practice was considered essential.     

Predicting stress in first year medical students: a longitudinal study

While there is ample documentation that medical training is stressful, less is known about predictive variables that might identify students who have the most difficulty in managing stress during medical training. Depression and anxiety in first year medical students were investigated in a longitudinal design. One-hundred and twenty-one medical students (81% of the class) were surveyed. The first survey took place immediately prior to the beginning of medical training (wave 1); the second survey was approximately 8 months after the beginning of classes (wave 2). Medical students who began their first year with relatively low ‘A'level grades, high ratings of state anxiety and depression, high trait anxiety and low dispositional optimism, and reliance on avoidant coping strategies were found to be at higher risk for developing depression and anxiety symptoms at wave 2. Students reported increased concern about curriculum and environment, personal competence and endurance, and time to have a life outside medical school at wave 2, compared to their reports at wave 1. Increase in concerns correlated with an increase in depression and anxiety. At both surveys, use of avoidant coping strategies resulted in increased depression and anxiety; at wave 2, active coping and positive reinterpretation resulted in decreased depression and anxiety. These findings suggest characteristics of vulnerable students who might be identified early in their first year and provided with additional support. Educating students to expect an increase in concerns about environment and personal ability to manage the academic load might make these concerns less overwhelming. In addition, information about effective coping strategies (i.e. active coping efforts) and ineffective means of dealing with stress (avoidant coping efforts) might be helpful in preventing distress.     

Hand hygiene in medical students: performance, education and knowledge

Background

Despite several guidelines on hand hygiene (HH), compliance especially in physicians is reported to be low which has huge implications for healthcare-associated infections. To evaluate performance of HH, influence of teaching and influence of monitoring the results in medical students, we conducted an observational study.

Methods

Performance of hand disinfection was evaluated in first (N = 28), third (N = 193) and fifth (N = 45) year medical students using fluorescent hand disinfectant. The influence of teaching and information about result control was assessed. The students perception of the impact of HH was also evaluated by a questionnaire.

Results

Presence of disinfectant gaps was observed significantly more often in first year medical students compared to third year ones (82% vs, 60%; p = 0.02). In additional, > 3 gaps were seen significantly more often in first year medical students compared to fifth year students (36% vs. 9%; p = 0.007). Both information about teaching and monitoring the results improved outcome significantly. For example, gaps were present in 92% without information and without teaching, in 70% (RR: 1.3 (1.0–1.6); p = 0.003) with information about result control only, and in only 18% (5.1 (3.0–8.5); p = 0.0001) after teaching. Notably, the medical students ascribed HH to be of a great importance regardless of their level of education.

Conclusions

Performance of HH could be improved by practical training as evidenced by best HH performance being documented immediately after teaching and a training effect during the course of medical studies was also observed. Thus, we suggest implementing regular education and practical training on HH from early on in the medical studies curricula to improve overall quality of patient care. regular education and practical training on HH from early on in the medical studies curricula to improve overall quality of patient care.     

Disease prevention and health promotion: a study of medical students and teachers

All students at the Royal Free Hospital School of Medicine (n = 508 ) were surveyed on their self-reported smoking and drinking habits, attitudes to disease prevention and health promotion in general, attitudes towards the teaching of disease prevention and health promotion, and their perception of what was taught at the beginning of the 1993–1994 academic year (response rate 75.2%). The teaching staff (n = 271 ) were also surveyed on their attitudes towards the teaching of disease prevention and health promotion, and their perception of what was taught (response rate 74.2%). Seventeen per cent of the students reported they were current smokers and 81% drank alcohol. Four factors were extracted from the responses to the items on disease prevention and health promotion in general and these represented the importance of health, a patient-centred approach, patient responsibility and a doctor-centred approach. Clinical students and those who were older were more likely to have a ‘patient-centred’ approach to disease prevention and health promotion. Sixty per cent of clinical and 44% of pre-clinical teachers aimed to teach about disease prevention and health promotion. The topics reported by students as most likely to have been taught in detail are smoking and health, alcohol and health, immunization, and breast and cervical screening. However, all these topics were reported as having been taught in detail by less than 50% of the students. The majority of students and teachers believe that teaching about disease prevention and health promotion should be integrated into all years of the curriculum and all clinical firms. Teachers were significantly less likely than students to believe that students should learn more about disease prevention and health promotion, and that learning about prevention is as important as learning about diagnosis and treatment. We believe that, in order to build on the positive features highlighted in this study, agreed aims and objectives should be developed and teaching about disease prevention and health promotion should be integrated both horizontally and vertically throughout the curriculum.     

Medical students proposing questions for their own written final examination: evaluation of an educational project

BACKGROUND: In order to emphasise learning more than control, from autumn 2000 we have invited medical students to propose questions for their own written examination in family medicine. One out of three student's proposals was guaranteed to be a part of their coming written examination, possibly somewhat modified. AIM: To evaluate how sixth year medical students experienced the project, and to what extent their performance in the examination was influenced. PARTICIPANTS: Sixth year medical students. MAIN OUTCOME MEASURES: The project was evaluated using (i) marks in examination; (ii) scores on self-administered questionnaires; and (iii) students' free text evaluation. RESULTS: Fifty-seven of 64 (89%) students taking their examination in autumn 2000, and 56 of 59 (95%) students taking the exam in spring 2001, responded. In autumn 2000, 34 (60%) students reported that the project had changed their learning strategies. During spring 2001, 46 of 56 students participated in producing questions, using a mean of 2.6 hours on the work. Students got 5-7% higher marks on their own questions on a scale ranging from 1 to 12. The students' free text evaluation showed that they had prepared especially thoroughly for the topics proposed by the students. They found it comforting to know at least one of the questions in the examination, and the students' questions were found relevant for general practice. CONCLUSION: Encouraging students to write questions for their own examination makes them feel more confident during the examination period, and may increase their reflective learning, without seriously limiting topics studied or violating the control function of the examination.     

A factor analytic study of branching patient management problems

This study was undertaken to determine the factor analytic structure of patient management problems (PMPs) and to determine whether such factors are stable for different groups taking the same examination and for the same group over time. Two examinations were administered to a group of medical students, the first during their junior year and the second during their senior year. The second examination was also administered to a second class of students during their junior year. Factor analyses results indicated there are two components to medical problem-solving as measured by PMPs-data gathering and management. Both factors were stable over groups and over time.     

Implications of HIV infection and AIDS for medical education

Summary: What implications on medical schools have HIV infection and AIDS, as the schools reshape their curricula to meet the General Medical Council's new requirements? ( General Medical Council 1993 ). A recent Institute of Medical Ethics’ (IME) enquiry suggests:

• 1 that each medical school should have a specific policy to coordinate teaching on HIV infection and AIDS, and to maximize students' clinical contact with patients who have the virus; and
• 2 that medical students should be encouraged to develop self-awareness and skills in communication and ethics.

     

Gender differences in the results of the final medical examination at University College Dublin

OBJECTIVES: In 1984 females made up 45% of medical undergraduates in Ireland. By 1996 this proportion had increased to 57%. This study examines gender differences in performance at final medical examinations, with a view to ascertaining the impact of the change in proportion of females attending medical school. DESIGN: Final year examination results of medical students over a 5-year period (1992-96) were obtained from the broadsheets of University College Dublin (UCD) examinations office. The results of 557 students (females n=277; males=280) were analysed for all final year examinations (n=5). SETTING: University College Dublin. SUBJECTS: Final year medical students. RESULTS: Overall females were found to have performed better than their male counterparts. They were more likely to achieve an honours grade and had a similar or lower likelihood of passing or failing. Gender differences in performance were most marked in paediatrics (P < 0.01), psychiatry (P < 0.01) and obstetrics and gynaecology (P=0.01), females being more successful in each case. CONCLUSIONS: The success of females and their increased numbers at undergraduate level are not reflected at senior registrar and consultant level. As medical manpower becomes more of an issue the lack of women, particularly in certain specialties, and the possible reasons for this need to be addressed.