Intercalated degrees, learning styles, and career preferences: prospective longitudinal study of UK medical students

Can score databanks help teaching?

Background

Basic courses in most medical schools assess students' performance by conferring scores. The objective of this work is to use a large score databank for the early identification of students with low performance and to identify course trends based on the mean of students' grades.

Methodology/Principal Findings

We studied scores from 2,398 medical students registered in courses over a period of 10 years. Students in the first semester were grouped into those whose ratings remained in the lower quartile in two or more courses (low-performance) and students who had up to one course in the lower quartile (high-performance). ROC curves were built, aimed at the identification of a cut-off average score in the first semesters that would be able to predict low performances in future semesters. Moreover, to follow the long-term pattern of each course, the mean of all scores conferred in a semester was compared to the overall course mean obtained by averaging 10 years of data. Individuals in the low-performance group had a higher risk of being in the lower quartile of at least one course in the second semester (relative risk 3.907; 95% CI: 3.378–4.519) and in the eighth semester (relative risk 2.873; 95% CI: 2.495–3.308). The prediction analysis revealed that an average score of 7.188 in the first semester could identify students that presented scores below the lower quartiles in both the second and eighth semesters (p<0.0001 for both AUC). When scores conferred by single courses were compared over time, three time-trend patterns emerged: low variation, upward trend and erratic pattern.

Conclusion/Significance

An early identification of students with low performance may be useful in promoting pedagogical strategies for these individuals. Evaluation of the time trend of scores conferred by courses may help departments monitoring changes in personnel and methodology that may affect a student's performance.

Why medical students choose not to carry out an intercalated BSc: a questionnaire study

BACKGROUND

At some medical schools, students can opt to undertake a 1 year intercalated degree, usually a BSc, in addition to their medical course. Over the last few years the numbers of students who have opted to undertake an intercalated degree have been steadily decreasing despite the advantages in securing foundation posts. The aim of this study was to find out why medical students opted not to take an intercalated degree.

METHODS

All 4th and 5th year medical students (n = 343) who had elected not to take an intercalated degree were personally handed a questionnaire.

RESULTS

293 completed questionnaires were returned (response rate 85%). The most common reason students opted not to intercalate was because they did not want to have another year of study (69.6%) or incur more debt (51.9%). Only 45 (15.3%) students said they had enough information to inform their decision: reported take up of information provision was poor.

CONCLUSIONS

Our findings indicate that the benefits of intercalating need to be better defined and presented to students in a way that they can make a more informed decision.

A mandatory intercalated degree programme: revitalising and enhancing academic and evidence-based medicine

BACKGROUND

Recruitment of medical graduates to research careers is declining. Expansion of medical knowledge necessitates all graduates be equipped to critically evaluate new information. To address these challenges, a mandatory intercalated degree programme was introduced as part of curriculum reform.

AIMS

To review the place on intercalated degrees, the methods available for learning about research and to analyse experience with a new university programme focusing on research.

METHODS

A literature review followed by the analysis of experience with eight cohorts of students who had completed the new programme.

RESULTS

A total of 1599 students completed the programme. Laboratory-based research was the most common choice followed by clinical research, population health, epidemiology, medical humanities and mental health. Also, 93% of students spent over 75% of their time undertaking research. Sixty-three students published their research, half as first authors. Students and coordinators support the programme. Learning about research during the postgraduate phase is variable and frequently left to individual choice.

CONCLUSION

Intercalating an additional degree focusing on research can achieve a number of learning objectives but demands a level of maturity, autonomy and preparedness, not uniformly present in students undertaking a mandatory intercalated programme. A more realistic goal is the development of 'research-mindedness' amongst all students.

A remedial intervention linked to a formative assessment is effective in terms of improving student performance in subsequent degree examinations

BACKGROUND

Intervention may help weaker medical students improve their performance. However, the effectiveness of remedial intervention is inconclusive due to small sample sizes in previous studies. We asked: is remedial intervention linked to a formative assessment effective in terms of improving student performance in subsequent degree examinations?

METHODS

This was a retrospective, observational study of anonymous databases of student assessment outcomes. Data were analysed for students due to graduate in the years 2005-2009 (n = 909). Exam performance was compared for students who received remediation versus those who did not. The main outcome measure was summative degree examination marks.

RESULTS

After adjusting for cohort, gender, overseas versus home funding, previous degree and previous performance in the corresponding baseline third year summative exam, students receiving a remedial intervention (after poor performance on a formative objective structured clinical examination and written exams mid-fourth year) were significantly more likely to obtain an improved mark on end-of-fourth year summative written (p = 0.005) and OSCE (p = 0.001) exams compared to those students who did not receive remediation.

CONCLUSION

A remedial intervention linked to poor assessment performance predicted improved performance in later examination. There is a need for prospective studies in order to identify the effective components of remedial interventions.

The importance of vocational and social aspects of approaches to learning for medical students

Having performed research using approaches to learning and studying inventories and become familiar with the concepts they purport to measure, the authors were concerned that existing inventories might not capture the full range of intentions and motivations for learning that exist within populations of medical students. We used semi-structured interviews to explore the approaches to learning of undergraduate medical students at two time points: in the academic setting (year 2) and subsequently in the clinical setting (year 3). A thematic index was created using a framework analysis approach with the data derived from the academic setting and subsequently applied to and developed by the data derived from the clinical setting. Some themes and sub-themes emerging from the analysis fitted well with the deep, surface and strategic approaches described previously in higher education. Others did not. In particular, the importance of the vocational and social aspects of learning was striking in this sample of students, in both academic and clinical settings, and these would be missed by the majority of existing inventories. This study confirms that existing conceptions of approaches to learning within the higher education literature do not account for the full range of intentions and motivations that exist within medical student populations.

An intercalated BSc degree is associated with higher marks in subsequent medical school examinations

BACKGROUND

To compare medical students on a modern MBChB programme who did an optional intercalated degree with their peers who did not intercalate; in particular, to monitor performance in subsequent undergraduate degree exams.

METHODS

This was a retrospective, observational study of anonymised databases of medical student assessment outcomes. Data were accessed for graduates, University of Aberdeen Medical School, Scotland, UK, from the years 2003 to 2007 (n = 861). The main outcome measure was marks for summative degree assessments taken after intercalating.

RESULTS

Of 861 medical students, 154 (17.9%) students did an intercalated degree. After adjustment for cohort, maturity, gender and baseline (3rd year) performance in matching exam type, having done an IC degree was significantly associated with attaining high (18-20) common assessment scale (CAS) marks in three of the six degree assessments occurring after the IC students rejoined the course: the 4th year written exam (p < 0.001), 4th year OSCE (p = 0.001) and the 5th year Elective project (p = 0.010).

CONCLUSION

Intercalating was associated with improved performance in Years 4 and 5 of the MBChB. This improved performance will further contribute to higher academic ranking for Foundation Year posts. Long-term follow-up is required to identify if doing an optional intercalated degree as part of a modern medical degree is associated with following a career in academic medicine.

Should applicants to Nottingham University Medical School study a non-science A-level? A cohort study

BACKGROUND

It has been suggested that studying non-science subjects at A-level should be compulsory for medical students. Our admissions criteria specify only Biology, Chemistry and one or more additional subjects. This study aimed to determine whether studying a non-science subject for A-level is an independent predictor of achievement on the undergraduate medical course.

METHODS

The subjects of this retrospective cohort study were 164 students from one entry-year group (October 2000), who progressed normally on the 5-year undergraduate medical course at Nottingham. Pre-admission academic and socio-demographic data and undergraduate course marks were obtained. T-test and hierarchical multiple linear regression analyses were undertaken to identify independent predictors of five course outcomes at different stages throughout the course.

RESULTS

There was no evidence that the choice of science or non-science as the third or fourth A-level subject had any influence on course performance. Demographic variables (age group, sex, and fee status) had some predictive value but ethnicity did not. Pre-clinical course performance was the strongest predictor in the clinical phases (pre-clinical Themes A&B (knowledge) predicted Clinical Knowledge, p < 0.001, and pre-clinical Themes C&D (skills) predicted Clinical Skills, p = or< 0.01).

CONCLUSION

This study of one year group at Nottingham Medical School provided no evidence that the admissions policy on A-level requirements should specify the choice of third or fourth subject.

Modernising medical careers and factors influencing career choices of medical students

This article details medical students' views towards future career choices and factors that may influence this choice. The role of gender in career choice and the importance of structured career advice and management is highlighted and discussed.

Graduates of different UK medical schools show substantial differences in performance on MRCP(UK) Part 1, Part 2 and PACES examinations

BACKGROUND

The UK General Medical Council has emphasized the lack of evidence on whether graduates from different UK medical schools perform differently in their clinical careers. Here we assess the performance of UK graduates who have taken MRCP(UK) Part 1 and Part 2, which are multiple-choice assessments, and PACES, an assessment using real and simulated patients of clinical examination skills and communication skills, and we explore the reasons for the differences between medical schools.

METHOD

We perform a retrospective analysis of the performance of 5827 doctors graduating in UK medical schools taking the Part 1, Part 2 or PACES for the first time between 2003/2 and 2005/3, and 22453 candidates taking Part 1 from 1989/1 to 2005/3.

RESULTS

Graduates of UK medical schools performed differently in the MRCP(UK) examination between 2003/2 and 2005/3. Part 1 and 2 performance of Oxford, Cambridge and Newcastle-upon-Tyne graduates was significantly better than average, and the performance of Liverpool, Dundee, Belfast and Aberdeen graduates was significantly worse than average. In the PACES (clinical) examination, Oxford graduates performed significantly above average, and Dundee, Liverpool and London graduates significantly below average. About 60% of medical school variance was explained by differences in pre-admission qualifications, although the remaining variance was still significant, with graduates from Leicester, Oxford, Birmingham, Newcastle-upon-Tyne and London overperforming at Part 1, and graduates from Southampton, Dundee, Aberdeen, Liverpool and Belfast underperforming relative to pre-admission qualifications. The ranking of schools at Part 1 in 2003/2 to 2005/3 correlated 0.723, 0.654, 0.618 and 0.493 with performance in 1999-2001, 1996-1998, 1993-1995 and 1989-1992, respectively.

CONCLUSION

Candidates from different UK medical schools perform differently in all three parts of the MRCP(UK) examination, with the ordering consistent across the parts of the exam and with the differences in Part 1 performance being consistent from 1989 to 2005. Although pre-admission qualifications explained some of the medical school variance, the remaining differences do not seem to result from career preference or other selection biases, and are presumed to result from unmeasured differences in ability at entry to the medical school or to differences between medical schools in teaching focus, content and approaches. Exploration of causal mechanisms would be enhanced by results from a national medical qualifying examination.

Attitudes to e-learning, learning style and achievement in learning neuroanatomy by medical students

BACKGROUND

Two main learning approaches adopted by students have been identified by research: deep (seeking for meaning motivated by interest in the subject matter) and surface (rote-learning motivated by fear of failure). There is evidence that learning approach is influenced by learning environment (e.g. Trigwell et al. 1999). Online courses pose the challenge of designing software that will encourage the more desirable approach to learning.

AIMS

The aims were to evaluate how successful an online course is at encouraging deep approach to learning, which factors might influence the approach adopted towards it, and whether the approach adopted is related to academic performance.

METHOD

Using 205 second-year pre-clinical medical students, we compared their approach to learning, as measured by Biggs et al. (2001) 2F-SPQ-R, for a computer-aided learning (CAL) course in Neuroanatomy with that for their studies in general. We then examined student attitudes towards the CAL course and the ratings of the course Web pages in terms of the learning approach they encourage (done by 18 independent raters).

RESULTS

The students reported using significantly less deep approach to learning for the CAL course. However, their approach for the course was not related to results on a neuroanatomy assessment based on it. Enjoyment of the course, assessment of the amount of information in it as appropriate, and ease of understanding the course were all associated with a deeper approach. The only agreement between the raters of the CAL course was for some pages that included patient case studies, which were unanimously given a very high deep rating. Assessment marks for questions referring to these pages were higher than for the rest of the assessment.

CONCLUSIONS

The study suggests that maximizing the use of clinical relevance should increase the interest and enjoyableness of the course and thereby aid deep learning and retention of information.

High-quality learning: harder to achieve than we think?

CONTEXT

High-quality learning in the context of medical education can be defined by current conceptions of a deep approach to learning and studying, in combination with metacognitive skills such as personal organisation and reflection on learning. Modern undergraduate education aims to provide an environment that will promote high-quality learning, but this is not as easy to achieve as it might at first seem. Part of the difficulty arises because it is student perceptions of the learning and assessment environment that determine the adopted approach to studying and these are notoriously hard to predict.

OBJECTIVE

To generate a detailed understanding of aspects that facilitate and inhibit high-quality learning within an innovative, undergraduate medical programme.

METHODS

We carried out semi-structured interviews with Year 2 undergraduate students.

RESULTS

Self-directed, problem-based and vocationally relevant activities appeared to promote high-quality learning. Unanticipated barriers to high-quality learning in this setting included a perceived lack of useful feedback on learning, the assessment of applied medical knowledge for a subset of underperforming students, anatomy as a curricular topic and the quantity of information to be assimilated in medicine.

CONCLUSIONS

Only by understanding the barriers as they are perceived by students can we design evidence-based modifications to curricula that are likely to be successful in promoting high-quality learning.

What is the educational impact of standards-based assessment in a medical degree?

CONTEXT

Many medical courses use standards-based assessment, usually reported by a restricted range of categories, but there is little evidence of its educational impact. This study aimed to evaluate the impact on medical student learning of changing to standards-based assessments reported by distinction, pass or fail.

METHODS

We carried out a prospectively planned before-and-after study within an undergraduate medical course using a questionnaire to compare motivation and approaches to the study, and a diary to compare the number of hours spent studying.

RESULTS

Questionnaire response rates were 607/752 (81%) before the change and 651/780 (83%) afterwards. Daily diary response rates were 1074/1478 (73%) before, and 1304/1844 (71%) after the change. Deep motive declined with class year during norm-referenced assessments but not with standards-based assessment (r = - 0.11 versus 0.01; P < 0.02). Deep strategy increased significantly under standards-based assessments in students in Years 2 and 3 (mean difference 0.64 [0.08-1.2]; P < 0.05) and Year 6 (mean difference 2.0 [0.03-3.9]; P < 0.05). Competitiveness scores declined as students progressed through the course in both cohorts. Students identified themselves as feeling more like a doctor after the change to standards-based assessments. Time spent studying was largely unchanged but the proportions of wanted discretionary study increased from 64% to 71% for students in Years 2 and 3, and from 65% to 70% for students in Years 4 and 5.

CONCLUSIONS

The changes were associated with beneficial effects on deep motive, deep strategy, professional identify and intrinsically motivated study. There were no changes in competitiveness and minimal changes in amount of time spent studying.

Medical student characteristics associated with time in study: is spending more time always a good thing?

BACKGROUND

Time in study may reflect motivation, but may also reflect inefficient study habits.

PURPOSE

To determine how time in study relates to motivation and study approaches.

METHODS

A total of 173 fourth- and fifth-year students in a six-year curriculum completed diaries over seven consecutive days. Time studying was correlated with motivation and approaches to study.

RESULTS

Time in study correlated with achieving motive, achieving strategy, deep strategy, motivation and planning/organisation. Deep motive correlated with time on assignments. Students who were less certain they wanted to work as a doctor undertook less study activity and spent less time with patients. Students who lacked confidence they would make a good doctor spent more time in non-timetabled discretionary study but also spent less time with patients.

CONCLUSION

A desire to achieve, certainty of career choice and lack of confidence are associated with time in study. Unconfident students divert their time away from patients.

Future directions in training veterinarians for careers in toxicological pathology in the United Kingdom

There is currently a global shortage of veterinary pathologists in all sectors of the discipline, and recruitment of toxicological pathologists is a particular problem for the pharmaceutical industry. Efforts to encourage veterinarians to consider alternative career paths to general practice must start at the undergraduate level, with provision of structured career guidance and strong role models from pathology and research disciplines. It is also imperative that both the importance of biomedical research and the role of animal models be clearly understood by both university staff and undergraduates. Traditionally, much post-graduate training in toxicological pathology is done "on the job" in the United Kingdom, but completion of a residency and/or PhD program is recognized as a good foundation for a career in industry and for successful completion of professional pathology examinations. New models of residency training in veterinary pathology must be considered in the United Kingdom to enable a more tailored approach to training toward specific career goals. A modular approach to residency training would allow core skills to be maintained, while additional training would target specific training requirements in toxicological pathology. Exposure to laboratory-animal pathology, toxicology, research methodology, and management skills would all be of benefit as an introduction to a career in toxicological pathology. However, long-term funding for UK residencies remains a problem that must be resolved if future recruitment needs in veterinary pathology are to be met.

Preparation for practice: how can medical schools better prepare PRHOs?

There is growing evidence that new PRHOs feel unprepared for their first post. This study compared three cohorts of graduates, the first from a traditional systems-based curriculum, the second from the same systems-based curriculum, who had also taken an intercalated degree, and the third from a PBL curriculum who had not intercalated. Subjective reports of confidence in clinical skills, anxiety and feelings of preparedness for practice were assessed using a previously published instrument. Graduates from the PBL curriculum who had not intercalated felt significantly better prepared, less anxious and more confident than equivalent graduates from the systems-based curriculum. Systems-based curriculum graduates who had taken an additional intercalated degree scored as highly in these criteria as the PBL graduates who had not intercalated. Despite these improvements, absolute levels of anxiety remained high and feelings of preparedness and confidence in clinical skills remained poor.

Greek medical students' career choices indicate strong tendency towards specialization and training abroad

The aim of the study was to investigate the career choices, location preferences and criteria among medical students in Greece. We applied a questionnaire-based analysis using a sample of 591 students of four out of seven Greek Medical Schools. The sample included students of all academic years. The vast majority of students wish to specialize (97.6%), while general practice gathered a very low percentage (1.7%). The scientific challenge (61.4%) and interaction with patients (60.6%) seem to be the major influencing factors for most of the students' specialty preferences, whilst less common variables influencing career choice are the high demand/supply ratio for certain health services (40.4%), the income potential (31.4%), the active tempo (26.2%) and prestige (15%). 70.3% of those asked consider the possibility of specializing abroad. The low concern of Greek medical students for general practice reveals today's drastic deficiency in Greek primary health care. Such a situation will escalate, unless targeted strategies to produce more general practitioners are adopted. Furthermore, the results reflect a lower education and organizing level urging students to specialize abroad. The National Health System (NHS) should be reformed towards a rationalistic distribution of the medical specialties and medical workforce.

Ambulatory teaching: do approaches to learning predict the site and preceptor characteristics valued by clerks and residents in the ambulatory setting?

BACKGROUND

In a study to determine the site and preceptor characteristics most valued by clerks and residents in the ambulatory setting we wished to confirm whether these would support effective learning. The deep approach to learning is thought to be more effective for learning than surface approaches. In this study we determined how the approaches to learning of clerks and residents predicted the valued site and preceptor characteristics in the ambulatory setting.

METHODS

Postal survey of all medical residents and clerks in training in Ontario determining the site and preceptor characteristics most valued in the ambulatory setting. Participants also completed the Workplace Learning questionnaire that includes 3 approaches to learning scales and 3 workplace climate scales. Multiple regression analysis was used to predict the preferred site and preceptor characteristics as the dependent variables by the average scores of the approaches to learning and perception of workplace climate scales as the independent variables.

RESULTS

There were 1642 respondents, yielding a 47.3% response rate. Factor analysis revealed 7 preceptor characteristics and 6 site characteristics valued in the ambulatory setting. The Deep approach to learning scale predicted all of the learners' preferred preceptor characteristics (beta = 0.076 to beta = 0.234, p < .001). Valuing preceptor Direction was more strongly associated with the Surface Rational approach (beta = .252, p < .001) and with the Surface Disorganized approach to learning (beta = .154, p < 001) than with the Deep approach. The Deep approach to learning scale predicted valued site characteristics of Office Management, Patient Logistics, Objectives and Preceptor Interaction (p < .001). The Surface Rational approach to learning predicted valuing Learning Resources and Clinic Set-up (beta = .09, p = .001; beta = .197, p < .001). The Surface Disorganized approach to learning weakly negatively predicted Patient Logistics (beta = -.082, p = .003) and positively the Learning Resources (beta = .088, p = .003). Climate factors were not strongly predictive for any studied characteristics. Role Modeling and Patient Logistics were predicted by Supportive Receptive climate (beta = .135, p < .001, beta = .118, p < .001).

CONCLUSION

Most site and preceptor characteristics valued by clerks and residents were predicted by their Deep approach to learning scores. Some characteristics reflecting the need for good organization and clear direction are predicted by learners' scores on less effective approaches to learning.

Are differences between graduates and undergraduates in a medical course due to age or prior degree?

BACKGROUND

The number of medical programmes targeted at graduates is increasing and there are reports of beneficial outcomes. However, many new graduate medical schools have simultaneously changed their admission criteria and curricula. This study aimed to determine whether there were differences between graduates and undergraduates on the same medical course and to establish which differences might be due to having a prior degree, the course itself or age at entry to medical school.

METHODS

A questionnaire-based survey was administered to all students in Years 2-5. It included the Study Process Questionnaire, the Achievement Motivation Profile and Likert scale questions on career.

RESULTS

Questionnaires were completed by 587 students (response rate 80.3%), of whom 143 had a prior degree. Whilst having a prior degree was associated with many outcomes, for most this disappeared, and the overall predictive ability of the model improved when age was included. Age at entry to medical school brought certainty and motivation about career choice, a prior degree had some effect on approaches to studying and co-operativeness, while the course itself had effects on most outcomes, some of which were positive and some negative.

CONCLUSION

Graduates bring a distinct quality to a course but many of these relate to a student's age. Older age at entry may be more important than having a prior degree.

Stress, burnout and doctors' attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates

BACKGROUND

The study investigated the extent to which approaches to work, workplace climate, stress, burnout and satisfaction with medicine as a career in doctors aged about thirty are predicted by measures of learning style and personality measured five to twelve years earlier when the doctors were applicants to medical school or were medical students.

METHODS

Prospective study of a large cohort of doctors. The participants were first studied when they applied to any of five UK medical schools in 1990. Postal questionnaires were sent to all doctors with a traceable address on the current or a previous Medical Register. The current questionnaire included measures of Approaches to Work, Workplace Climate, stress (General Health Questionnaire), burnout (Maslach Burnout Inventory), and satisfaction with medicine as a career and personality (Big Five). Previous questionnaires had included measures of learning style (Study Process Questionnaire) and personality.

RESULTS

Doctors' approaches to work were predicted by study habits and learning styles, both at application to medical school and in the final year. How doctors perceive their workplace climate and workload is predicted both by approaches to work and by measures of stress, burnout and satisfaction with medicine. These characteristics are partially predicted by trait measures of personality taken five years earlier. Stress, burnout and satisfaction also correlate with trait measures of personality taken five years earlier.

CONCLUSIONS

Differences in approach to work and perceived workplace climate seem mainly to reflect stable, long-term individual differences in doctors themselves, reflected in measures of personality and learning style.

Approaches to learning and studying in medical students: validation of a revised inventory and its relation to student characteristics and performance

INTRODUCTION

Inventories to quantify approaches to studying try to determine how students approach academic tasks. Medical curricula usually aim to promote a deep approach to studying, which is associated with academic success and which may predict desirable traits postqualification.

AIMS

This study aimed to validate a revised Approaches to Learning and Studying Inventory (ALSI) in medical students and to explore its relation to student characteristics and performance.

METHODS

Confirmatory factor analysis was used to validate the reported constructs in a sample of 128 Year 1 medical students. Models were developed to investigate the effect of age, graduate status and gender, and the relationships between approaches to studying and assessment outcomes.

RESULTS

The ALSI performed as anticipated in this population, thus validating its use in our sample, but a 4-factor solution had a better fit than the reported 5-factor one. Medical students scored highly on deep approach compared with other students in higher education. Graduate status and gender had significant effects on approach to studying and a deep approach was associated with higher academic scores.

CONCLUSIONS

The ALSI is valid for use in medical students and can uncover interesting relationships between approaches to studying and student characteristics. In addition, the ALSI has potential as a tool to predict student success, both academically and beyond qualification.

A levels and intelligence as predictors of medical careers in UK doctors: 20 year prospective study

OBJECTIVE

To assess whether A level grades (achievement) and intelligence (ability) predict doctors' careers.

DESIGN

Prospective cohort study with follow up after 20 years by postal questionnaire.

SETTING

A UK medical school in London.

PARTICIPANTS

511 doctors who had entered Westminster Medical School as clinical students between 1975 and 1982 were followed up in January 2002.

MAIN OUTCOME MEASURES

Time taken to reach different career grades in hospital or general practice, postgraduate qualifications obtained (membership/fellowships, diplomas, higher academic degrees), number of research publications, and measures of stress and burnout related to A level grades and intelligence (result of AH5 intelligence test) at entry to clinical school. General health questionnaire, Maslach burnout inventory, and questionnaire on satisfaction with career at follow up.

RESULTS

47 (9%) doctors were no longer on the Medical Register. They had lower A level grades than those who were still on the register (P < 0.001). A levels also predicted performance in undergraduate training, performance in postregistration house officer posts, and time to achieve membership qualifications (Cox regression, P < 0.001; b=0.376, SE=0.098, exp(b)=1.457). Intelligence did not independently predict dropping off the register, career outcome, or other measures. A levels did not predict diploma or higher academic qualifications, research publications, or stress or burnout. Diplomas, higher academic degrees, and research publications did, however, significantly correlate with personality measures.

CONCLUSIONS

Results of achievement tests, in this case A level grades, which are particularly used for selection of students in the United Kingdom, have long term predictive validity for undergraduate and postgraduate careers. In contrast, a test of ability or aptitude (AH5) was of little predictive validity for subsequent medical careers.

A levels and intelligence as predictors of medical careers in UK doctors: 20 year prospective study

OBJECTIVE

To assess whether A level grades (achievement) and intelligence (ability) predict doctors' careers.

DESIGN

Prospective cohort study with follow up after 20 years by postal questionnaire.

SETTING

A UK medical school in London.

PARTICIPANTS

511 doctors who had entered Westminster Medical School as clinical students between 1975 and 1982 were followed up in January 2002.

MAIN OUTCOME MEASURES

Time taken to reach different career grades in hospital or general practice, postgraduate qualifications obtained (membership/fellowships, diplomas, higher academic degrees), number of research publications, and measures of stress and burnout related to A level grades and intelligence (result of AH5 intelligence test) at entry to clinical school. General health questionnaire, Maslach burnout inventory, and questionnaire on satisfaction with career at follow up.

RESULTS

47 (9%) doctors were no longer on the Medical Register. They had lower A level grades than those who were still on the register (P < 0.001). A levels also predicted performance in undergraduate training, performance in postregistration house officer posts, and time to achieve membership qualifications (Cox regression, P < 0.001; b=0.376, SE=0.098, exp(b)=1.457). Intelligence did not independently predict dropping off the register, career outcome, or other measures. A levels did not predict diploma or higher academic qualifications, research publications, or stress or burnout. Diplomas, higher academic degrees, and research publications did, however, significantly correlate with personality measures.

CONCLUSIONS

Results of achievement tests, in this case A level grades, which are particularly used for selection of students in the United Kingdom, have long term predictive validity for undergraduate and postgraduate careers. In contrast, a test of ability or aptitude (AH5) was of little predictive validity for subsequent medical careers.

Pilot study of the roles of personality, references, and personal statements in relation to performance over the five years of a medical degree

OBJECTIVES

To compare the power of three traditional selection procedures (A levels, personal statements, and references) and one non-traditional selection procedure (personality) to predict performance over the five years of a medical degree.

DESIGN

Cohort study over five years.

SETTING

Nottingham medical school.

PARTICIPANTS

Entrants in 1995.

MAIN OUTCOME MEASURES

A level grades, amounts of information contained in teacher's reference and the student's personal statement, and personality scores examined in relation to 18 different assessments.

RESULTS

Information in the teacher's reference did not consistently predict performance. Information in the personal statement was predictive of clinical aspects of training, whereas A level grades primarily predicted preclinical performance. The personality domain of conscientiousness was consistently the best predictor across the course. A structural model indicated that conscientiousness was positively related to A level grades and preclinical performance but was negatively related to clinical grades.

CONCLUSION

A teacher's reference is of no practical use in predicting clinical performance of medical students, in contrast to the amount of information contained in the personal statement. Therefore, simple quantification of the personal statement should aid selection. Personality factors, in particular conscientiousness, need to be considered and integrated into selection procedures.

Postal survey of approaches to learning among Ontario physicians: implications for continuing medical education

OBJECTIVES

To understand the approaches to learning of practising physicians in their workplace and to assess the relation of these approaches to their motivation for, preferred methods of, and perceived barriers to continuing medical education.

DESIGN

Postal survey of 800 Ontario physicians.

PARTICIPANTS

373 physicians who responded.

MAIN OUTCOME MEASURES

Correlations of approaches to learning and perceptions of workplace climate with methods, motives, and barriers to continuing medical education.

RESULTS

Perceived heavy workload was significantly associated with the surface disorganised (r=0.463, P<0.01) and surface rational approach (r=0.135, P<0.05) to learning. The deep approach to learning was significantly correlated with a perception of choice-independence and a supportive-receptive climate at work (r=0.341 and 0.237, P<0.01). Physicians who adopt a deep approach to learning seem to be internally motivated to learn, whereas external motivation is associated with surface approaches to learning. Heavy workload and a surface disorganised approach to learning were correlated with every listed barrier to continuing medical education. The deep approach to learning was associated with independent learning activities and no barriers.

CONCLUSIONS

Perception of the workplace climate affects physicians' approaches to learning at work and their motivation for and perceived barriers to continuing medical education. Younger, rural, family physicians may be most vulnerable to feeling overworked and adopting less effective approaches to learning. Further work is required to determine if changing the workplace environment will help physicians learn more effectively.

The relationship between pre-registration house officers and their consultants

CONTEXT

Previous studies have drawn attention to the importance of the trainee/trainer relationship in determining job satisfaction and motivation to learn.

OBJECTIVES

To study the relationship between pre-registration house officers and their consultants through exploring an interpersonal exchange and the emotional context in which the exchange took place. To consider any association between the type of relationship implied and the trainee's attitude to their career.

DESIGN

Postal questionnaire covering a wide range of issues. This study focused on an open question about a significant or interesting exchange, followed by supplementary questions exploring the emotional context of the exchange.

SETTING

336 hospitals throughout the United Kingdom.

SUBJECTS

A cohort of doctors were followed from the time of their application to medical school, and studied towards the end of their pre-registration year (n=2456).

RESULTS

The response rate to the questionnaire was 58.4%. Responses were categorised as Support and supervision; Unreasonable behaviour; Consultant fallibility; Fair criticism and No exchange. Over half the responses described an interaction that made them feel positive. Trainees particularly appreciated positive feedback, clinical support, teaching, career advice, patronage, or social interaction. The importance of formal appraisal or review sessions in providing the setting for a positive exchange was confirmed. Positive interactions were associated with a positive view of medicine as a career. A minority described an interaction that was negative, involving unreasonable demands, criticism (whether perceived as fair or unfair), humiliation, or sexism. These were associated with a more negative view of medicine as a career, and of themselves as doctors.

How consultants, hospitals, trusts and deaneries affect pre-registration house officer posts: a multilevel model

OBJECTIVE

To examine variation in reported quality and working conditions of pre-registration house officer (PRHO) posts. To use multilevel modelling to determine how much of the variation was due to the effects of consultant firms, hospitals, trusts and deaneries, as well as variation at the level of the individual doctor.

DESIGN

Questionnaire survey of national sample of PRHOs at the end of the pre-registration year. Multilevel modelling was carried out using MLwiN.

SETTING

PRHOs working in UK approved medical and surgical posts in NHS hospitals from August 1996 to January 1999.

PARTICIPANTS

One thousand, four-hundred and thirty-five PRHOs who had previously been part of an extended cohort study of medical student selection and training. They reported on a total of 4926 posts, on 2721 identifiable consultant firms, in 336 hospitals, in 264 trusts and in 17 deaneries.

MAIN OUTCOME MEASURES

PRHOs' perceptions of the overall quality of all PRHO posts they had worked in, and working conditions in the current post.

RESULTS

Twenty percent of PRHO posts were described as excellent and 34% as very good, through to 6% reported as not very good, poor or bad. The overall rating of the post showed highly significant variation at the level of hospital/trust, and consultant firm. Other aspects of posts, such as working conditions showed variation at the level of deanery, trust, hospital and firms, with different patterns for the different measures. Assessments of stress in PRHOs (GHQ, burnout, response to uncertainty), and a desire to leave medicine, showed no variation at the level of deanery, trust, hospital or firm.

CONCLUSION

Some aspects of a PRHO post, in particular overall rated quality, but also many aspects of working conditions, show substantial variation at the level of hospital, trust and consultant firm, suggesting that differences reflect local variation in working practices and treatment of PRHOs, with the possibility of change and improvement. The lack of any variation at the level of deanery, trust, hospital or firm in stress of PRHOs suggests that these responses are idiosyncratic, individual responses by doctors themselves, rather than a general characteristic of posts, hospitals, trusts or deaneries.

Stressful incidents, stress and coping strategies in the pre-registration house officer year

CONTEXT

Previous studies have drawn attention to the stresses experienced by doctors in their first year.

OBJECTIVES

To gain a deeper understanding of the causes of stress in newly qualified doctors, how they cope, and what interventions might make the year less traumatic.

DESIGN

Postal questionnaire. This study focused on an open question asking about a stressful incident, the coping strategy used to deal with it, stressors in general and current levels of stress using the General Health Questionnaire.

SETTING

336 hospitals throughout the United Kingdom.

SUBJECTS

A cohort of doctors followed from the time of their application to medical school, studied towards the end of their pre-registration year (n=2456).

RESULTS

The response rate to the questionnaire was 58.4%. The incidents were categorised into the major groups Responsibility (33.6%), Interpersonal (29.7%), Overwork (17.0%), Death and disease (13.0%), and Self (6.7%). GHQ revealed psychological morbidity in 31% of respondents. Stress levels were highest in those reporting an incident about Responsibility or Self, lowest in those describing Death or disease. Stressors in general and preferred coping strategies differed between the groups.

CONCLUSION

The incidents suggested the following interventions to reduce stress: better supervision in the first few weeks in post, at night, and for medical problems on surgical wards; more attention to avoiding sleep deprivation; more time for discussion with colleagues at work; more personal time with friends and family. The choice of incident described was influenced by the personal characteristics of the respondent.

Changing face of medical curricula

The changing role of medicine in society and the growing expectations patients have of their doctors means that the content and delivery of medical curricula also have to change. The focus of health care has shifted from episodic care of individuals in hospitals to promotion of health in the community, and from paternalism and anecdotal care to negotiated management based on evidence of effectiveness and safety. Medical training is becoming more student centred, with an emphasis on active learning rather than on the passive acquisition of knowledge, and on the assessment of clinical competence rather than on the ability to retain and recall unrelated facts. Rigid educational programmes are giving way to more adaptable and flexible ones, in which student feedback and patient participation have increasingly important roles. The implementation of sustained innovation in medical education continues to present challenges, especially in terms of providing institutional and individual incentives. However, a continuously evolving, high quality medical education system is needed to assure the continued delivery of high quality medicine.

What happens to medical students who complete an honours year in public health and epidemiology?

BACKGROUND

Around one-third of medical students in the UK take an intercalated honours degree in addition to their basic undergraduate course. The honours year has been reported to have a major influence on subsequent career choice; honours students show greater interest in research and laboratory medicine careers and less in general practice and public health.1,2

AIMS

To examine the career choice of Nottingham medical students who completed an honours year in public health and epidemiology (including general practice).

METHODS

Postal questionnaire and telephone follow-up of a cohort of 266 students who entered the honours year in Public Health and Epidemiology between 1973 and 1993.

RESULTS

Career information was available on 203 students; 78% (195) of those are currently employed in medicine. 44% were working in general practice (expected 40-45%) and 8% in public health medicine (expected 2%). Overall 19% (expected 4-11%) had chosen academic careers including nine of the 15 choosing an academic career in public health. The majority (60%) reported that the honours year had influenced their career choice, while 55% reported that the year had increased their likelihood of choosing an academic career.

CONCLUSIONS

The honours year does encourage entry into academic and research careers in general and the type of honours year department strongly influences the subsequent choice of specialty.

The development of undergraduate curricula in surgery: I. General issues

Undergraduate surgical education is evolving in line with societal changes, the growth of information technology, developments in educational processes, and shifts in the health-care industry. The underlying principles include the establishment of a strong linkage between the objectives and content of curricula, the identification of core knowledge and appropriate attitudes, achieving competence in basic skills, the creation of greater integration, and the promotion of study in depth. The aim of the present paper was to provide surgeons with an overview of these developments.