The Impact of Role Models on Medical Students

How do German medical students perceive role models during clinical placements ("Famulatur")? An empirical study

BACKGROUND

Studies have demonstrated the importance of role models in medical education. Medical students in Germany participate in clinical placements ("Famulatur") that last 4 months in total and represent the first real-world setting where students encounter possible role models in their clinical education. These placements are an extracurricular activity, however, and regarded as the "black box" of medical education. This study aimed to evaluate whether and how students experience role models during clinical placements, the qualities associated with potential role models and whether role model-related learning gains are relevant.

METHODS

We recruited 96 students (mean age: 23.83 years; 75% female) in their 5th to 9th semesters at the Faculty of Medicine at the University of Ulm, Germany, who were participating in a clinical placement between July and October 2015. Participants completed a questionnaire at the beginning of a 5-day working week to record sociodemographic and other information and another one at the end of the week to assess various aspects of their experiences. On each of the 5 days, they completed a structured questionnaire to record their perceived role models and self-assessed learning gains.

RESULTS

Role models and role modelling play an important role in clinical placements. The positive function of medical staff as role models predominated (88.4%) across all specialties. Junior doctors were the most frequently perceived role models (28.5%), followed by consultants (25.1%) and nursing staff (22.4%). The most commonly perceived positive quality was the interaction with students (16.5%), followed by team behaviour (13.6%), interaction with patients (13.6%) and professional expertise (13.4%). Students also had various kinds of learning gains such as knowledge or skills.

CONCLUSIONS

Although these clinical placements are extracurricular activities in Germany and their content is not regulated, they are home to a relevant amount of role modelling. Students experience the various medical professions in different roles and in a range of tasks and interactions. Defining basic learning objectives could help to increase the relevance of these placements for the medical curriculum in Germany and transfer the associated learning gains from the hidden to the open curriculum.

What influence do courses at medical school and personal experience have on interest in practicing family medicine? - Results of a student survey in Hessia

Aim: Against the background of an impending shortage of family practitioners, it is important to investigate the factors influencing the choice to become one. The aim of this study was to identify factors that encourage medical students to choose to practice family medicine. Method: Using a questionnaire, students in the fourth and fifth years of their studies in the Federal State of Hesse were asked about the factors that had influenced their choice of medical specialty and their experience of courses in family medicine. Predictors of an interest in practicing family medicine were calculated using multiple logistic regression. Results: 361 questionnaires were returned, representing a response rate of 70.9%. Confirmation of personal strengths, an interest in the field, and practical experience of the subject generally turned out to be important factors influencing the choice of medical specialty. 49.3% of students expressed an interest in practicing family medicine. A link existed between an interest in working as a family doctor and the opportunity to take over an existing practice, experience of medicine in rural areas, and an appreciation of the conditions of work. With regard to education at medical school, positive experiences during a clinical traineeship in family medicine and positive role models among teachers of general practice were identified as predictors. Conclusion: Almost half the medical students were open to the idea of practicing family medicine. Experience of medicine in rural areas and positive experiences of courses in general practice were linked to an increased interest in working as a family doctor. To promote this interest, it may be a promising approach to increase opportunities to collect experience of medicine in rural areas, and to encourage highly motivated teaching practices.

First Year Medical Student Peer Nominations of Professionalism: A Methodological Detective Story about Making Sense of Non-Sense

This article explores the assessment of professionalism within a cohort of medical students during a sequential 13-week medical school histology and anatomy course. Across seven data points, students were asked to identify a professionalism role model from amongst their peers and to score Likert-structured rationales for their decision. Based on density scores, an initial social network analysis identified six peer-nomination "stars." However, analysis of these stars revealed considerable variability and random-like "noise" in both the nomination and explanation data sets. Subsequent analyses of both data sets explored the possibility of underlying patterns in this noise using tests of reliability, principal components factor analysis, and fixed-effects regression analysis. These explorations revealed the presence of two dimensions (professional vs. supportive) in how students sought to explain their nomination decisions. Although data variability remained quite high, significantly less variability was present in the professional than in the supportive dimension, suggesting that academic helpfulness rationales are both empirically distinct and more mutable than rationales grounded in professionalism-related factors. In addition, data showed that the greater the stability in one's choice of a professionalism role model nomination over the T1-T7 data periods, the more stable one's reasons for that nomination-both for professionalism and supportive dimensions. Results indicate that while peer assessment of professionalism by first-year medical students may not be very reliable, students can differentiate between more personal and professional factors, even at this early stage in their professional development. Formal instruction within the pre-clinical curriculum should recognize and address this distinction. Anat Sci Educ. © 2018 American Association of Anatomists.

What influence do courses at medical school and personal experience have on interest in practicing family medicine? - Results of a student survey in Hessia

Aim: Against the background of an impending shortage of family practitioners, it is important to investigate the factors influencing the choice to become one. The aim of this study was to identify factors that encourage medical students to choose to practice family medicine. Method: Using a questionnaire, students in the fourth and fifth years of their studies in the Federal State of Hesse were asked about the factors that had influenced their choice of medical specialty and their experience of courses in family medicine. Predictors of an interest in practicing family medicine were calculated using multiple logistic regression. Results: 361 questionnaires were returned, representing a response rate of 70.9%. Confirmation of personal strengths, an interest in the field, and practical experience of the subject generally turned out to be important factors influencing the choice of medical specialty. 49.3% of students expressed an interest in practicing family medicine. A link existed between an interest in working as a family doctor and the opportunity to take over an existing practice, experience of medicine in rural areas, and an appreciation of the conditions of work. With regard to education at medical school, positive experiences during a clinical traineeship in family medicine and positive role models among teachers of general practice were identified as predictors. Conclusion: Almost half the medical students were open to the idea of practicing family medicine. Experience of medicine in rural areas and positive experiences of courses in general practice were linked to an increased interest in working as a family doctor. To promote this interest, it may be a promising approach to increase opportunities to collect experience of medicine in rural areas, and to encourage highly motivated teaching practices.

Perceptions of occupational therapy students and clinical tutors on the attributes of a good role model

BACKGROUND

Occupational therapy students learn in different environments, where role modelling takes place. Nevertheless, little is known about student and tutors perceptions on model´s characteristics.

OBJECTIVES

The aims of this study were to investigate the perceptions of occupational therapy students on the most important attributes of role models and to confront their views with those of clinical tutors.

METHODS

A sample of 61 students completed a structured, standardized online questionnaire. Ten clinical tutors regarded by students as good models underwent a semi-structured individual interview. Data were analyzed quantitatively and qualitatively (thematic content analysis).

RESULTS

The most important attributes of a good role model according to student perception were: good relationship with patients, integrity and ethical behaviour, respectful relationships with colleagues, patient management skills, commitment to personal and professional growth and enthusiasm for the profession. Clinical tutors believed that they were nominated as good role models because they demonstrated empathy towards patients, good relationships with students and enthusiasm for their profession.

CONCLUSIONS AND SIGNIFICANCE

Perceptions of occupational therapy students and clinical tutors about role models characteristics were similar. Identification of attributes of good role models may inform teacher training and faculty development in occupational therapy.

Dietetics students' experiences of dietetics workforce preparation and preparedness: a systematic review and qualitative synthesis

BACKGROUND

Dietetics students are a widely researched group. As emerging dietitians, they can provide valuable insights to inform how dietetics education programmes may be enhanced to meet contemporary healthcare needs. This review aimed to systematically synthesise dietetics students' experiences of dietetics workforce preparation.

METHODS

MEDLINE, CINAHL, Embase, PsycINFO, ERIC, Informit and ProQuest Dissertations and Theses Global were searched to identify research published until June 2017. Studies investigating dietetics students' experiences of dietetics workforce preparation, and employing qualitative data collection and analysis methods were included. Data analysis was guided by thematic synthesis, where themes were constructed through an iterative and inductive process. Study quality was appraised using the RATS Qualitative Research Review Guidelines.

RESULTS

From the 3301 records identified, five studies met the inclusion criteria and the views of 120 dietetics students from two countries over a 9-year period were synthesised. The overarching theme of 'navigating through the ups and downs' was underpinned by four main themes: enduring hurdles; reconciling expectations; transforming self; and making and breaking connections. Quality appraisal results rated selection bias as being inadequate/inappropriate across all studies.

CONCLUSIONS

Dietetics students undertake a transformational journey through dietetics education. They are inspired by seeing what is possible through meaningful encounters with practitioners in diverse settings. However, they are challenged by competitive environments and perceived ideals that are embedded in the profession. Strategies that focus on exposing dietetics students to inspirational practitioners, increasing and celebrating diversity in academic/placement settings, and incentivising collaboration across dietetics education, could act as catalysts to enhance the experience of future dietetics students and the nutrition-related health of those they will serve.

Qualitative study of medical students' experiences of a psychiatric attachment

Aims and method

This study utilised qualitative methods to explore medical students' experiences of a clinical attachment in psychiatry and examine the impact of these on career intentions. Fifteen 4th-year students from the University of Bristol were interviewed and their responses analysed.

Results

Four key themes of role models, difference, stigma and career choice emerged from the analysis. Role models could be more influential than the specialty when choosing career options. Many students experienced psychiatry as being different to other specialties. For some this was a reason not to pursue psychiatry as a career but for others it was a positive aspect of the specialty. Stigma arose from a variety of sources, notably from medical students themselves.

Clinical implications

These findings are relevant given the current recruitment problems in psychiatry and need to be considered in the planning and delivery of undergraduate medical education.

Socialization, Indifference, and Convenience: Exploring the Uptake of Influenza Vaccine Among Medical Students and Early Career Doctors

The Chief Medical Officer recommends that all health care workers receive an influenza vaccination annually. High vaccination coverage is believed to be the best protection against the spread of influenza within a hospital, although uptake by health care workers remains low. We conducted semistructured interviews with seven medical students and nine early career doctors, to explore the factors informing their influenza vaccination decision making. Data collection and analysis took place iteratively, until theoretical saturation was achieved, and a thematic analysis was performed. Socialization was important although its effects were attenuated by participants' previous experiences and a lack of clarity around the risks and benefits of vaccination. Many participants did not have strong intentions regarding vaccination. There was considerable disparity between an individual's opinion of the vaccine, their intentions, and their vaccination status. The indifference demonstrated here suggests few are strongly opposed to the vaccination-there is potential to increase vaccination coverage.

Medical Student Experiences on Consultation-Liaison Psychiatry Rotations: A Nationwide Survey

BACKGROUND

Consultation-liaison (C-L) psychiatry clerkship rotations may improve medical students' understanding of psychiatric principles relevant to the settings in which they will ultimately practice. This study aimed to characterize students' experiences on C-L rotations.

METHODS

This cross-sectional survey study, sponsored by the Academy of Psychosomatic Medicine Subcommittee on Medical Student Education, was conducted at 5 US medical schools between 2012 and 2016. After the C-L rotation, students completed a voluntary 17-item survey.

RESULTS

A total of 235 surveys were collected (mean response rate = 92%). The most frequently endorsed benefit of C-L was learning to manage psychiatric disorders in the context of medical illness (89%). The most frequently endorsed drawback was inconsistent/excessively variable workload (40%). Overall, 82% of respondents recommended C-L to other students; 80% reported that the ideal clerkship would include exposure to both C-L and inpatient psychiatry. Overall, 38% reported that their C-L experience increased their interest in psychiatry as a career. Effect of C-L on interest in psychiatry did not differ by study site, age, sex, clerkship length, or time spent on C-L. Respondents who noted more positive role-modeling on C-L compared to other clerkship rotations were more likely to report increased interest in a psychiatry career (odds ratio = 2.70).

CONCLUSIONS

Most medical students perceive C-L rotations favorably. Positive role modeling may increase their consideration of psychiatry specialization. The findings that C-L rotation length did not correlate with attitudes and that most students preferred exposure to both inpatient and C-L psychiatry suggest that C-L exposure can beneficially be integrated into core clerkships containing other elements.

A nationwide, resident-led teaching programme for medical students in Singapore: SingHealth Student Internship Programme Bootcamp

INTRODUCTION

This study aimed to describe the planning, development and evaluation of the success of the first nationwide, resident-led, large-group teaching programme for medical students - the Singapore Health Services Student Internship Programme (SIP) Bootcamp.

METHODS

This was an initial feasibility study evaluating a half-day teaching boot camp initiated, developed and conducted by the resident educators. A three-month preparation period was required to set up an education subcommittee, liaise with medical student leaders, recruit resident educators, meet all the stakeholders and conduct the boot camp. During the SIP Bootcamp, resident educators conducted clinical case presentations using a question-and-answer format. Audience participation was strongly encouraged. A 15-item questionnaire was distributed to assess the participants' learning experience and the resident educators' teaching performance using a five-point Likert scale.

RESULTS

Overall, 94.8% (n = 110) of the 116 respondents agreed that the teaching sessions were of high quality and content was relevant to their training. The resident educators appeared well-informed (96.6%, n = 112) and enthusiastic about their respective topics (98.3%, n = 114). However, a few students (9.5%, n = 11) felt that the audio-visual aids and handouts could be improved to better aid their learning process.

CONCLUSION

This teaching boot camp for medical students was the first of its kind in Singapore and feedback from medical students showed that it was well-received. Further research using different teaching methods, including small-group discussions and surgical practical sessions by resident educators from different specialties, would be of great value to students.

Enrichment activities in the medical school psychiatry programme - could this be a key to engaging medical students in psychiatry? A study from a high secure forensic psychiatric UK hospital

BACKGROUND

The majority of research studies on medical student attitudes toward psychiatry focus on influencing factors and the medical school experience. This study evaluates the effectiveness of a one-day visit to a high secure forensic psychiatric unit on medical students' attitudes towards psychiatry and also assesses career intentions and the factors influencing these.

METHOD

Change in attitudes and career intention were measured by administering a questionnaire, which included the 30-item Attitudes Toward Psychiatry (ATP-30) survey, at the start (time 1) and end (time 2) of the one-day visit. Qualitative data on factors influencing career choice was also gathered.

RESULTS

Evaluation of 284 responses revealed a significant increase in positive attitude towards psychiatry from time 1 to time 2 in the sample as a whole. The most influential factor on consideration of psychiatry as a career across all groups was the medical school clinical placement. For those that tended away from choosing psychiatry as a career, patient prognosis was important.

CONCLUSIONS

Poor recruitment in psychiatry in the UK is already established which will doubtless be compounded by controversies surrounding the proposed new junior doctors' contract. Now more than ever, the need to inspire and motivate those at medical school encountering psychiatry is crucial. Our findings add to the body of evidence that the medical school clinical attachment is fundamental in shaping attitudes. However, these results also show that a well-planned visit to a specialised psychiatric unit outside of traditional placements can have a significant impact on students' attitudes toward psychiatry and mental illness in general. There is limited literature in the UK on enrichment activities within the psychiatry medical school curriculum. We propose that developing opportunities for enrichment activities within psychiatry could increase the scope of how we engage students in this fascinating field of medicine.

The clinically excellent primary care physician: examples from the published literature

Clinical excellence is the ultimate goal in patient care. Exactly what the clinically excellent primary care physician (PCP) looks like and her characteristics have not been explicitly described. This manuscript serves to illustrate clinical excellence in primary care, using primarily case reports exemplifying physicians delivering holistic and patient-centred care to their patients. With an ever increasing demand for accessible and accountable health care, an understanding of the qualities desirable in primary care providers is now especially relevant.A literature review was conducted to identify compelling stories showing how excellent PCPs care for their patients. In the 2397 published works reviewed, we were able to find case reports and studies that exemplified every domain of the description of clinical excellence proposed and published by the Miller Coulson Academy of Clinical Excellence (MCACE). After reviewing these reports, the authors felt that the domains of excellence, as described by the MCACE, are practically applicable and relevant for primary care physicians. It is our hope that this paper prompts readers to reflect on clinical excellence in primary care.

Experiences in disaster-related mental health relief work: An exploratory model for the interprofessional training of psychological relief workers

The purpose of this study was to begin to generate an exploratory model of the disaster-related mental health education process associated with the training experiences of psychological relief workers active during the Sichuan earthquake in China. The data consisted of semi-structured interviews with 20 psychological relief workers from four different professions (social workers, psychiatric nurses, psychiatrists, and counsellors) regarding their experiences in training and ideas for improvement. The model explains the need to use a people-centred community interprofessional education approach, which focuses on role-modelling of the trainer, caring for relief workers, paying attention to the needs of the trainee, and building systematic interprofessional education strategies. The proposed model identifies areas for the comprehensive training of relief workers and aims to address the importance of people-centred mental health service provisions, ensure intentional and strategic training of relief workers using interprofessional concepts and strategies, and use culturally attuned and community-informed strategies in mental health training practices.

Supervisor leadership in relation to resident job satisfaction

BACKGROUND

Research from outside the medical field shows that leadership behaviours influence job satisfaction. Whether the same is true for the medical training setting needs to be explored. The aim of this study was to investigate the influence of residents' overall appreciation of their supervisor's leadership and observation of specific supervisor leadership behaviours on job satisfaction.

METHODS

We invited residents (N = 117) to rate how often they observed certain task and relation-oriented leadership behaviours in their supervisor and overall appreciation of their supervisor's leadership. Furthermore, they rated their satisfaction with 13 different aspects of their jobs on a 10-point scale. Using exploratory factor analysis we identified four factors covering different types of job satisfaction aspects: personal growth, autonomy, affective, and instrumental job satisfaction aspects. Influence of overall appreciation for supervisor leadership and observation of certain leadership behaviours on these job satisfaction factors were analysed using multiple regression analyses.

RESULTS

The affective aspects of job satisfaction were positively influenced by overall appreciation of leadership (B = 0.792, p = 0.017), observation of specific instructions (B = 0.972, p = 0.008) and two-way communication (B = 1.376, p = 0.008) and negatively by mutual decision-making (B = -1.285, p = 0.007). No effects were found for the other three factors of job satisfaction.

CONCLUSIONS

We recommend that supervisors become more aware of whether and how their behaviours influence residents' job satisfaction. Especially providing specific instructions and using two-way communication seem important to help residents deal with their insecurities and to offer them support.

G, Azucas-Peralta R, Barrezueta-Fernandez J, Cerna-Urrutia L, DaSilva-DeAbreu A, Mondragón-Cardona A, Moya G, Valverde-Solano CD, Theodorus-Villar R, Vizárraga-León M, Red-LIRHUS. Differences on Primary Care Labor Perceptions in Medical Students from 11 Latin American Countries

BACKGROUND

The shortage in Latin-American Primary Care (PC) workforce may be due to negative perceptions about it. These perceptions might be probably influenced by particular features of health systems and academic environments, thus varying between countries.

METHODS

Observational, analytic and cross-sectional multicountry study that evaluated 9,561 first and fifth-year medical students from 63 medical schools of 11 Latin American countries through a survey. Perceptions on PC work was evaluated through a previously validated scale. Tertiles of the scores were created in order to compare the different countries. Crude and adjusted prevalence ratios were calculated using simple and multiple Poisson regression with robust variance.

RESULTS

Approximately 53% of subjects were female; mean age was 20.4±2.9 years; 35.5% were fifth-year students. Statistically significant differences were found between the study subjects' country, using Peru as reference. Students from Chile, Colombia, Mexico and Paraguay perceived PC work more positively, while those from Ecuador showed a less favorable position. No differences were found among perceptions of Bolivian, Salvadoran, Honduran and Venezuelan students when compared to their Peruvian peers.

CONCLUSIONS

Perceptions of PC among medical students from Latin America vary according to country. Considering such differences can be of major importance for potential local specific interventions.

Effects of undergraduate medical students' individual attributes on perceptions of encounters with positive and negative role models

BACKGROUND

The use of role models (RMs) is a successful educational strategy. In formal training and other settings during undergraduate education, students have the opportunity to recognize numerous traits and behaviors of their RMs, such as teaching skills, professionalism in the clinical setting, and personal qualities. Encountering both positive and negative RMs allows medical students to learn a variety of professional norms and values. This learning process is likely influenced by a student's developmental status, which itself is related to that student's personal attributes and experiences. The purpose of this study was to examine graduating medical students' perceptions of their RM encounters and their learning processes, and how these perceptions and processes are affected by their own personal attributes.

METHODS

Sixth-year medical students were asked to complete questionnaires in 2013 and 2014 regarding encounters with positive or negative RMs, in terms of patient relationships, clinical expertise, teaching ability, and other factors, during clinical training and other situations. Associations between gender, age, admission status, and recognition of self-achievement and joy of learning in relation to RM encounters were then analyzed.

RESULTS

Among 115 students (75 males, 40 females) who completed the questionnaires, 113 (98.3 %) and 85 (73.9 %) reported encountering positive and negative RMs, respectively. The majority of students reported encountering both positive and negative RMs in terms of relationships with patients, humanity, and teaching ability, and fewer negative RMs in terms of clinical expertise and contributions to the community. Older students, males, and those who had passed an entrance examination for bachelors reported encountering more negative RMs in terms of relationships with patients, humanity, and teaching ability than younger students, females, and general admission students. These results suggested an association between positive and negative RM encounters and recognition of self-achievement and joy of learning in formal clinical training.

CONCLUSIONS

Most medical students encountered both positive and negative RMs during undergraduate medical education. These findings suggest that encounters with not only positive, but also negative RMs might facilitate student learning. Therefore, personal development appears to affect student perception of RMs.

Defining Clinical Excellence in Adult Infectious Disease Practice

Excellence in clinical care should be recognized and rewarded. A recent paradigm defined clinical excellence through seven key domains. This work examines ID clinical excellence in these domains, and in doing so highlights the important skill sets of ID physicians.

Clinical excellence should be recognized, particularly in the current climate that appropriately prioritizes relationship-centered care. In order to develop a recognition model, a definition of clinical excellence must be created and agreed upon. A paradigm recently suggested by C. Christmas describes clinical excellence through the following domains: diagnostic acumen, professionalism and humanism, communication and interpersonal skills, skillful negotiation of the healthcare system, knowledge, taking a scholarly approach to clinical practice, and having passion for clinical medicine. This work references examples of infectious disease (ID) clinical excellence across Christmas' domains and, in doing so, both examines how the definition of clinical excellence applies to ID practice and highlights the importance of ID physicians. Emphasizing such aspirational standards may not only inspire trainees and practicing physicians to pursue their own fulfilling clinical ID careers, it may also encourage health systems to fully value outstanding ID physicians who labor tirelessly to provide patients with exceptional care.

Excellence in Intensive Care Medicine

OBJECTIVE

Excellence is an important goal for all physicians. Unfortunately, it is hard to define, evaluate, and achieve. To provide a concise interpretive review of excellence in intensive care medicine, with a focus on those key characteristics that excellent physicians possess but are seldom discussed.

DATA SOURCES

Electronic search of the PubMed database using the search terms "excellence," "role models," "compassion," "commitment," "dedication," and "passion."

STUDY SELECTION

Publications or studies of excellence, role models, compassion, commitment, dedication, and passion. Two reviewers evaluated each term.

DATA EXTRACTION

Publications or studies were abstracted independently and in duplicate.

DATA SYNTHESIS

Excellence in critical care can be achieved through deliberate practice, feedback, and effective evaluation. Excellence embodies numerous characteristics, which include compassion, commitment, and passion.

CONCLUSIONS

Awareness of the fundamental characteristics of excellence can help young students and doctors determine what they should strive for to become excellent physicians as well as encourage experienced doctors to rekindle the spark that initially motivated them to become physicians.

[Surgery as specialization for female physicians: Results from course evaluations and alumni studies at MHH]

BACKGROUND

There is a lack of young surgeons in Germany. In order to provide a successful learning environment in medical education and to attract more physicians, training concepts need to be regularly controlled.

MATERIAL AND METHODS

Evaluation results compiled over several years from the Hanover Medical School (MHH) were analyzed for gender-related differences. In addition to overall satisfaction with practical training items were included that consider aspects of interaction between students and instructors. Furthermore, alumni studies provided data on the postgraduate specialty choice made by MHH students.

OBJECTIVES

Surgical training is integrated into medical education as block training periods of various durations. Against the background of an increased percentage of women in medicine this article analyzed whether surgery is evaluated differently between female and male medical students with respect to their experiences in clinical teaching.

RESULTS

Evaluations of clinical training in surgery demonstrated that female and male medical students do not differ substantially with respect to the teaching quality; however, young female physicians choose surgery as a professional option less frequently than men.

CONCLUSION

A systematic review of clinical training evaluations is crucial to identify weaknesses of current curricula. More empirical data from other faculties can induce discussions about the attractiveness of surgery as a profession.

Medical Students' Perceptions of Clinical Teachers as Role Model

Introduction

Role models facilitate student learning and assists in the development of professional identity. However, social organization and cultural values influence the choice of role models. Considering that the social organization and cultural values in South East Asia are different from other countries, it is important to know whether this affects the characteristics medical students look for in their role models in these societies.

Methods

A 32 item questionnaire was developed and self-administered to undergraduate medical students. Participants rated the characteristics on a three point scale (0 = not important, 1 = mildly important, 2 = very important). One way ANOVA and student's t-test were used to compare the groups.

Results

A total of 349 (65.23%) distributed questionnaires were returned. The highest ranked themes were teaching and facilitating learning, patient care and continuing professional development followed by communication and professionalism. Safe environment and guiding personal and professional development was indicated least important. Differences were also observed between scores obtained by males and females.

Conclusion

Globally there are attributes which are perceived as essential for role models, while others are considered desirable. An understanding of the attributes which are essential and desirable for role models can help medical educators devise strategies which can reinforce those attributes within their institutions.

Social dominance theory and medical specialty choice

Understanding how medical students select their specialty is a fundamental issue for public health and educational policy makers. One of the factors that students take into account is a specialty's prestige which hinges partly on its focus on technique rather than whole person. We examine the potential of a psychological framework, social dominance theory, to explain why some students, and not others, are drawn to more prestigious, technique-oriented specialties, based on their desire for hierarchy. We conducted a cross-sectional study among medical students at Institution X (N = 359). We examined the link between medical students' characteristics i.e. social dominance orientation (SDO), gender, age, and their career intention. We also examined level of medical students' SDO at different stages of the curriculum. SDO scores were significantly associated with technique-oriented career intentions (OR 1.56; 95 % CI [1.18, 2.06]; p = 0.001). The effect was independent of gender. Medical students' SDO scores were significantly higher in later stages of the medical curriculum (F = 6.79; p = 0. 001). SDO is a significant predictor of medical students' career intention. SDO scores are higher in students during the clinical phase of the curriculum. Medical socialization, involving the internalization of implicit and explicit norms, particularly in hospital settings, is likely to underpin our findings. This theory illuminates consistent findings in the literature on specialty prestige and the influence of medical school on career choice.

Family Medicine Department Chairs' Opinions Regarding Scope of Practice

PURPOSE

Family physicians are trained broadly to provide the majority of health care across multiple settings; however, their scope of practice has narrowed. Department chairs' role modeling of a broad scope of practice may set the tone for faculty and trainees.

METHOD

In 2013, the authors surveyed family medicine department chairs about their scope of practice, personal and department characteristics, and attitudes and beliefs about scope of practice and role modeling. They used descriptive statistics and bivariate analyses to test for associations between scope of practice, personal and department characteristics, and attitudes and beliefs. They created a Scope of Practice Index by summing the number of services each respondent provided to compare scope of practice across chairs.

RESULTS

Of 146 chairs, 88 responded (60.3% response rate); 85 were included in the final analysis. Sixty-five (77.4%) respondents were male; 73 (86.9%) were 51 years or older. Respondents spent a mean of 19.7% of their time in direct patient care and had a mean Scope of Practice Index of 11.9. Fifty-three (62.4%) disagreed that the scope of practice of family medicine was too broad for practicing physicians to keep up in all areas, and 56 (65.9%) believed that faculty should role model the full scope of practice to learners. Responses generally did not vary by respondents' personal scope of practice.

CONCLUSIONS

Family medicine department chairs believe that role modeling a broad scope of practice increases students' interest in family medicine and encourages residency graduates to provide a wide range of services.

The Motivational Theory of Role Modeling: How Role Models Influence Role Aspirants’ Goals

Role models are often suggested as a way of motivating individuals to set and achieve ambitious goals, especially for members of stigmatized groups in achievement settings. Yet, the literature on role models tends not to draw on the motivational literature to explain how role models may help role aspirants achieve these outcomes. In this paper, we introduce role aspirants and their motivational processes into an understanding of role modeling by drawing on expectancy–value theories of motivation to bring together the disparate literatures on role models to form a cohesive theoretical framework. We first integrate different definitions of role models into a new conceptualization where we propose that role models serve 3 distinct functions in which they influence goals and motivation: acting as behavioral models, representing the possible, and being inspirational. We then build a theoretical framework for understanding not only when, but also how, role models can effectively influence motivation and goals. This new theoretical framework, the Motivational Theory of Role Modeling, highlights ways in which the power of role models can be harnessed to increase role aspirants’ motivation, reinforce their existing goals, and facilitate their adoption of new goals.

Role-Modeling Cost-Conscious Care--A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

BACKGROUND

Little is known about how well faculty at teaching hospitals role-model behaviors consistent with cost-conscious care.

OBJECTIVE

We aimed to evaluate whether residents and program directors report that faculty at their program consistently role-model cost-conscious care, and whether the presence of a formal residency curriculum in cost-conscious care impacted responses.

DESIGN

Cost-conscious care surveys were administered to internal medicine residents during the 2012 Internal Medicine In-Training Examination and to program directors during the 2012 Association of Program Directors in Internal Medicine Annual Survey. Respondents stated whether or not they agreed that faculty in their program consistently role-model cost-conscious care. To evaluate a more comprehensive assessment of faculty behaviors, resident responses were matched with those of the director of their residency program. A multivariate logistic regression model was fit to the outcome variable, to identify predictors of responses that faculty do consistently role-model cost-conscious care from residency program, resident, and program director characteristics.

PARTICIPANTS

Responses from 12,623 residents (58.4 % of total sample) and 253 program directors (68.4 %) from internal medicine residency programs in the United States were included.

MAIN MEASURES

The primary outcome measure was responses to questionnaires on faculty role-modeling cost-conscious care.

KEY RESULTS

Among all responses in the final sample, 6,816 (54.0 %) residents and 121 (47.8 %) program directors reported that faculty in their program consistently role-model cost-conscious care. Among paired responses of residents and their program director, the proportion that both reported that faculty do consistently role-modeled cost-conscious care was 23.0 % for programs with a formal residency curriculum in cost-conscious care, 26.3 % for programs working on a curriculum, and 23.7 % for programs without a curriculum. In the adjusted model, the presence of a formal curriculum in cost-conscious care did not have a significant impact on survey responses (odds ratio [OR], 1.04; 95 % Confidence Interval [CI], 0.52-2.06; p value [p] = 0.91).

CONCLUSIONS

Responses from residents and program directors indicate that faculty at US teaching hospitals were not consistently role-modeling cost-conscious care. The presence of a formal residency curriculum in cost-conscious care did not impact responses. Future efforts should focus on placing more emphasis on faculty development and on combining curricular improvements with institutional interventions to adapt the training environment.

Medical Specialty Choice and Related Factors of Brazilian Medical Students and Recent Doctors

BACKGROUND

Choosing a medical specialty is an important, complex, and not fully understood process. The present study investigated the factors that are related to choosing and rejecting medical specialties in a group of students and recent medical doctors.

METHODOLOGY AND FINDINGS

A cross-sectional survey of 1,223 medical students and doctors was performed in Brazil in 2012. A standardized literature-based questionnaire was applied that gathered preferable or rejected specialties, and asked questions about extracurricular experiences and the influence of 14 factors on a Likert-type scale from 0 to 4. Specialties were grouped according to lifestyle categories: controllable and uncontrollable, which were subdivided into primary care, internal medicine, and surgical specialties. Notably, the time period of rejection was usually earlier than the time period of intended choice (p < 0.0001, χ(2) = 107.2). The choice mainly occurred during the internship period in medical school (n = 466; 38.7%). An overall large frequency of participation in extracurricular activities was observed (n = 1,184; 95.8%), which were highly associated with the respective medical area. Orthopedic surgery had the highest correlation with participation in specialty-specific organized groups (OR = 59.9, 95% CI = 21.6-166.3) and psychiatry was correlated with participation in research groups (OR = 18.0, 95% CI = 9.0-36.2). With regard to influential factors in controllable lifestyle specialties, "financial reason" (mean score ± standard deviation: 2.8 ± 1.0; median = 3) and "personal time" (3.1 ± 1.3; median = 4) were important factors. In primary care, these factors were less important (1.7 ± 1.3 and 1.7 ± 1.5, respectively; median = 2 for both), and higher scores were observed for "curricular internship" (3.2 ± 1.1, median = 4) and "social commitment" (2.6 ± 1.3, median = 3).

CONCLUSION

The present findings provide important insights into developing strategies to stimulate interest in specialties based on the needs of the Brazilian healthcare system.

The Johns Hopkins learning environment scale: measuring medical students' perceptions of the processes supporting professional formation

PURPOSE

To construct a new measure to assess students' perceptions of the medical school learning environment (LE).

METHOD

In 2012, students at Johns Hopkins University School of Medicine completed a survey containing 32 LE items. Additional questions asked about overall perception of the LE, personal growth, and recommending the school to a friend. Validity evidence for content, response process, internal structure, and relation to other variables was collected for interpretation of scores.

RESULTS

Of 465 students surveyed, 377 (81%) completed all LE items. Exploratory factor analysis yielded the 28-item Johns Hopkins Learning Environment Scale (JHLES) with seven factors/subscales: community of peers, faculty relationships, academic climate, meaningful engagement, mentoring, inclusion and safety, and physical space. Students' overall JHLES scores ranged from 51 to 139, of a possible 28 to 140, with a mean (SD) of 107 (15). Overall scores and most subscale scores did not differ significantly by gender or racial/ethnic background, but did differ significantly by overall perception of the LE (P ≤ .001) and increased incrementally as overall perception improved. Overall JHLES scores were significantly higher for students with higher personal growth scores and students who would recommend the school (both P < .001). Subscale scores for all seven factors increased with improved overall perception of the LE (all P ≤ .005).

CONCLUSIONS

The JHLES is a new measure to assess students' perceptions of the medical school LE, with supporting validity evidence and content describing the social, relational, and academic processes of medical school that support students' professional formation.

The influence of academic discourses on medical students' identification with the discipline of family medicine

PURPOSE

To understand the influence of academic discourses about family medicine on medical students' professional identity construction during undergraduate training.

METHOD

The authors used a multiple case study research design involving international medical schools, one each from Canada, France, Spain, and the United Kingdom (UK). The authors completed the fieldwork between 2007 and 2009 by conducting 18 focus groups (with 132 students) and 67 semistructured interviews with educators and by gathering pertinent institutional documents. They carried out discursive thematic analyses of the verbatim transcripts and then performed within- and cross-case analyses.

RESULTS

The most striking finding was the diverging responses between those at the UK school and those at the other schools. In the UK case, family medicine was recognized as a prestigious academic discipline; students and faculty praised the knowledge and skills of family physicians, and students more often indicated their intent to pursue family medicine. In the other cases, family medicine was not well regarded by students or faculty. This was expressed overtly or through a paradoxical academic discourse that stressed the importance of family medicine to the health care system while decrying its lack of innovative technology and the large workload-to-income ratio. Students at these schools were less likely to consider family medicine.

CONCLUSIONS

These results stress the influence of academic discourses on medical students' ability to identify with the practice of family medicine. Educators must consider processes of professional identity formation during undergraduate medical training as they develop and reform medical education.

Medical student experience in surgery influences their career choices: a systematic review of the literature

OBJECTIVES

Student experiences during surgical rotations may dictate interest in future surgical careers. The objective of this study was to systematically examine the effect of surgical experience (SE) on student attitudes toward surgical careers and also to identify variables influencing the educational value of SE.

METHODS

A systematic review of the available literature was conducted by 2 independent researchers searching Medline, EMBASE, Google Scholar, and Cochrane databases, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses recommendations. Studies assessing SE during the students' surgical rotations were identified. The quality of the included studies was assessed using a validated quality index. Factors affecting student surgical rotation experience and perceptions of surgical careers were recorded.

RESULTS

Overall, 204 studies were identified; 20 unique studies met the inclusion criteria with a median cohort size of 169 (interquartile range: 107-262) respondents. Most were cross-sectional surveys (n = 16/20) and administered to clinical students (n = 16/20). All studies investigating the effect of SE on career choices (n = 8) found that positive experiences during the surgical placement were associated with an increased interest in surgical careers. The operating theater experience was identified as a defining feature of overall SE. Involvement in operative procedures, a welcoming environment, and avoidance of syncopal events positively influenced the SE, particularly in those who actively sought educational opportunities. Study limitations included single-center and single-year cohort designs (70%) with the use of nonvalidated research tools (95%).

CONCLUSIONS

A systematic review of the literature highlights a number of factors associated with a positive surgical rotation, which may lead to more students deciding to pursue a career in surgery. Understanding the factors that contribute to these decisions through multicenter studies using validated research tools may lead to more effective surgical rotations, ultimately improving the delivery of the surgical education.

Role modelling of clinical tutors: a focus group study among medical students

BACKGROUND

Role modelling by clinicians assists in development of medical students' professional competencies, values and attitudes. Three core characteristics of a positive role model include 1) clinical attributes, 2) teaching skills, and 3) personal qualities. This study was designed to explore medical students' perceptions of their bedside clinical tutors as role models during the first year of a medical program.

METHODS

The study was conducted with one cohort (n = 301) of students who had completed Year 1 of the Sydney Medical Program in 2013. A total of nine focus groups (n = 59) were conducted with medical students following completion of Year 1. Data were transcribed verbatim. Thematic analysis was used to code and categorise data into themes.

RESULTS

Students identified both positive and negative characteristics and behaviour displayed by their clinical tutors. Characteristics and behaviour that students would like to emulate as medical practitioners in the future included: 1) Clinical attributes: a good knowledge base; articulate history taking skills; the ability to explain and demonstrate skills at the appropriate level for students; and empathy, respect and genuine compassion for patients. 2) Teaching skills: development of a rapport with students; provision of time towards the growth of students academically and professionally; provision of a positive learning environment; an understanding of the student curriculum and assessment requirements; immediate and useful feedback; and provision of patient interaction. 3) Personal qualities: respectful interprofessional staff interactions; preparedness for tutorials; demonstration of a passion for teaching; and demonstration of a passion for their career choice.

CONCLUSION

Excellence in role modelling entails demonstration of excellent clinical care, teaching skills and personal characteristics. Our findings reinforce the important function of clinical bedside tutors as role models, which has implications for faculty development and recruitment.

Twelve Tips for teaching medical professionalism at all levels of medical education

Review of studies published in medical education journals over the last decade reveals that teaching medical professionalism is essential, yet challenging. According to a recent Best Evidence in Medical Education (BEME) guide, there is no consensus on a theoretical or practical model to integrate the teaching of professionalism into medical education. The aim of this article is to outline a practical manual for teaching professionalism at all levels of medical education. Drawing from research literature and author's experience, Twelve Tips are listed and organised in four clusters with relevance to (1) the context, (2) the teachers, (3) the curriculum, and (4) the networking. With a better understanding of the guiding educational principles for teaching medical professionalism, medical educators will be able to teach one of the most challenging constructs in medical education.

Specific disgust sensitivities differentially predict interest in careers of varying procedural-intensity among medical students

Mismatches between the needs of public health systems and student interests have led to renewed study on the factors predicting career specializations among medical students. While most work examines career and lifestyle values, emotional proclivities may be important; disgust sensitivity may help explain preferences for careers with greater and lesser degrees of procedural content. In the study, 294 students completed measures assessing: (1) demographics, (2) career interest or intention regarding emergency medicine, internal medicine, obstetrics/gynecology, and pediatric medicine, (3) traditional determinants of career intention/interest, and (4) core/bodily product, animal reminder, contamination, and sexual/moral disgust sensitivity. As predicted, logistic regressions controlling for demographics and traditional career predictors, showed that greater animal reminder disgust predicted reduced interest in emergency medicine but greater interest in pediatric medicine. Conversely, greater core/bodily product disgust predicted lower interest in obstetrics/gynecology and pediatric medicine; greater contamination and sexual/moral disgust both predicted increased odds of interest in internal medicine. Overall, specific disgust sensitivities were the best predictors of specialization intention in multivariate models. Specific disgust sensitivities appear to differentially deter and/or predispose self-selection into specific trajectories varying in procedural content. Such findings may permit the early identification of specialty fit and provide guidance in career counseling.

Role modeling in medical education: the importance of a reflective imitation

The medical literature almost uniformly addresses the positive aspects of role modeling. Still, some authors have questioned its educational value, a disagreement that is probably due to differing definitions of role modeling. If defined as demonstration of skills, provision of feedback, and emulation of specific professional behaviors, then role modeling is an important component of clinical training. However, if it is defined as a learner's unselective imitation of role models and uncritical adoption of the messages of the learning environment, then the benefits of role modeling should be weighed against its unintended harm.In this Perspective, the author argues that imitation of role models may initially help students adapt to the clinical environment. However, if sustained, imitation may perpetuate undesirable practices, such as doctor-centered patient interviewing, and unintended institutional norms, such as discrimination between private and public patients. The author suggests that the value of role modeling can be advanced not only by targeting role models and improving faculty performance but also by enhancing students' reflective assessment of their preceptors' behaviors, especially so that they can better discern those that are worth imitating. This student-centered approach may be accomplished by first, warning students against uncritically imitating preceptors who are perceived as role models; second, showing students that their preceptors share their doubts and uncertainties; third, gaining an insight into possible undesirable messages of the learning environment; and finally, developing policies for faculty recruitment and promotion that consider whether a clinical preceptor is a role model.

Being a mindful clinical teacher: can mindfulness enhance education in a clinical setting?

Mindfulness may be viewed as a vehicle to promote the healer's role in medicine. This role addresses the way in which a medical practitioner interacts with patients. The aim of this article is to highlight how mindful qualities may also enhance teaching in clinical settings. Challenges to being a mindful clinical teacher are presented along with creative ways to accommodate them. Residents play an important role in training medical students. Examples of how mindfulness influenced a psychiatric resident's teaching experiences are presented to illustrate the concepts discussed herein. The dimension of "being" in medicine, based on the humanist philosophy of Dr Karl Jaspers, is provided as a framework for this article.

Clinicians should be aware of their responsibilities as role models: a case report on the impact of poor role modeling

BACKGROUND

Role modeling is an important and valuable educational method. It is predominant throughout (under-)graduate medical education, and attributes of exemplary medical role models are manifold.

AIM

This article describes the impact of poor role modeling on medical students' professional and personal development on the basis of a singular incident at an associated teaching hospital. In addition, scientific literature studying the effect of and the reasons behind poor role modeling in undergraduate and graduate medical education is analyzed and discussed.

RESULTS

To maximize the educational potential of clinical role modeling, medical schools have to consider strategies both on the individual as well as on the institutional level. Several suggestions are offered on both levels.

DISCUSSION/CONCLUSION

Based on a case report of significantly poor role modeling, this article outlines strategies through which academic medical institutions may maximize the educational potential of role modeling and lastingly enhance teaching proficiency of clinical faculty.

Sex, role models, and specialty choices among graduates of US medical schools in 2006-2008

BACKGROUND

Undergraduate education studies have suggested instructor sex can influence female students to pursue a discipline. We sought to evaluate a similar hypothesis in medical students.

STUDY DESIGN

We obtained Association of American Medical Colleges (AAMC) data about the specialization of 2006-2008 graduates of US medical schools, the sex of their faculty and department chairs, and sex of residents in the residency programs in which they enrolled. We used logistic regression to examine associations between faculty and leadership sex and female students' pursuit of 5 surgical specialties along with 3 nonsurgical specialties for context. We used Wilcoxon rank-sum tests to evaluate whether women entered residency programs with a higher proportion of female residents.

RESULTS

In 2006-2008, US medical school graduates included 23,642 women. Women were substantially under-represented among residents in neurosurgery, orthopaedics, urology, otolaryngology, general surgery, and radiology; women constituted 47.4% of US graduates specializing in internal medicine and 74.9% in pediatrics. We found no significant associations between exposure to a female department chair and selection of that specialty and no consistent associations with the proportion of female full-time faculty. Compared with male students, female students entered residency programs in their chosen specialty that had significantly higher proportions of women residents in the year before their graduation.

CONCLUSIONS

Although we did not detect consistent significant associations between exposure to potential female faculty role models and specialty choice, we observed that female students were more likely than males to enter programs with higher proportions of female residents. Sex differences in students' specialization decisions merit additional investigation.

Career attitudes of first-year veterinary students before and after a required course on veterinary careers

Careers in Veterinary Medicine is a required, one-credit-hour course at the North Carolina State University College of Veterinary Medicine (NCSU-CVM), which meets once weekly during veterinary students' first semester. Lectures in this course are presented by one or more veterinarians representing diverse career areas. A voluntary, anonymous survey was distributed before the first class meeting in 2011 (PRE) and at the end of the semester (POST) to assess if students' career interests changed during the semester. The survey collected basic demographic data and students' preferences (on a Likert scale) for 17 veterinary career paths. Out of 63 students, 36 (57%) in the POST survey said that their career interests had changed during the semester, and 17 of the 26 students (65%) who gave a reason credited the careers course as one factor in reconsidering their career choice. Only 3 of the 17 career paths had statistically significant PRE/POST survey differences in Likert response frequency (equine practice, pathology, and wildlife medicine), but both informal discussions with students and responses to open-ended survey questions indicated that many students valued the introduction to unfamiliar veterinary career areas. Careers in Veterinary Medicine is a vital component of recent career-planning initiatives in the college, which will be especially important to veterinary students as they face continued changes in the profession, such as the increased debt load of the new graduate and the threat of veterinary workforce oversupply.

"Teaching is like nightshifts …": a focus group study on the teaching motivations of clinicians

BACKGROUND

To ensure the highest quality of education, medical schools have to be aware of factors that influence the motivation of teachers to perform their educational tasks. Although several studies have investigated motivations for teaching among community-based practitioners, there is little data available for hospital-based physicians.

PURPOSES

This study aimed to identify factors influencing hospital-based physicians' motivations to teach.

METHODS

We conducted 3 focus group discussions with 15 clinical teachers from the Medical Faculty at Hamburg University. Using a qualitative inductive approach, we extracted motivation-related factors from the transcripts of the audio-recorded discussions.

RESULTS

Three main multifaceted categories influencing the motivation of teachers were identified: the teachers themselves, the students, and the medical faculty as an organization. Participants showed individual sets of values and beliefs about their roles as teachers as well as personal notions of what comprises a "good" medical education. Their personal motives to teach comprised a range of factors from intrinsic, such as the joy of teaching itself, to more extrinsic motives, such as the perception of teaching as an occupational duty. Teachers were also influenced by the perceived values and beliefs of their students, as well as their perceived discipline and motivation. The curriculum organization and aspects of leadership, human resource development, and the evaluation system proved to be relevant factors as well, whereas extrinsic incentives had no reported impact.

CONCLUSIONS

Individual values, beliefs, and personal motives constitute the mental framework upon which teachers perceive and assess motivational aspects for their teaching. The interaction between these personal dispositions and faculty-specific organizational structures can significantly impair or enhance the motivation of teachers and should therefore be accounted for in program and faculty development.

Nursing, pharmacy, or medicine? Disgust sensitivity predicts career interest among trainee health professionals

Given global demand on health workforces, understanding student enrollment motivations are critical. Prior studies have concentrated on variation in career and lifestyle values; the current work evaluated the importance of disgust sensitivity in the prediction of health career interests. We argue that emotional proclivities may be important and that disgust sensitivity may help explain differential student interest in nursing, pharmacy, or medical careers. 303 first year students attending a required course in human behavior provided consent before completing questionnaires assessing: (1) demographics, (2) career intentions/interests, (3) traditional determinants of career intention/interest, and (4) dispositional disgust sensitivity. As expected, disgust sensitivity varied across the three majors, with those targeting medical careers being less sensitive than those interested in either nursing or pharmacy. As importantly, even when controlling for demographics and traditional career determinants, analyses showed that greater disgust sensitivity was associated with reduced odds of intended enrolment in pharmacy versus medicine or nursing but did not predict the distinction between nursing and medicine. The impact of disgust sensitivity on career interest was substantial and equivalent to established predictors of career intention. Disgust sensitivity may represent an important factor impacting the specific choices students make within the health professions, particular when students are choosing between careers involving greater and lesser degrees of exposure to the normative elicitors of disgust.

Does access to role models influence future career choice? Impact of psychiatry teaching on recently graduated doctors in the United Kingdom

OBJECTIVE

The authors determined who provides formal psychiatry teaching to newly-qualified doctors and whether the amount of such teaching correlates to a later career preference for psychiatry.

METHODS

Data were collected on the cohort starting work in 2010 until applying to a specialty training program 16 months later. Total hours of psychiatry teaching was compared with the number choosing a residency in the same specialty.

RESULTS

A total of 19 hospitals in northwest England provided teaching programs for their interns and first-year residents (U.K. foundation doctors); 15 provided information on doctors' later specialty choice. Only 2.3% of teaching was dedicated to psychiatry. Doctors led a higher proportion of medicine or surgery sessions (63%) than those on psychiatry (48%). Provision of psychiatry teaching was associated with entering psychiatry residency.

CONCLUSIONS

Hospitals providing the most formal psychiatry training have the highest proportions matriculating into a psychiatry residency.