Weighing the cost of educational inflation in undergraduate medical education

A value analysis of longitudinal integrated clerkships: consideration of costs and benefits

Longitudinal Integrated Clerkships (LICs) prioritise longitudinal relationships with faculty, patients, and place. Research shows that LICs benefit students and faculty, but most medical schools have limited LIC programmes. This is likely due to perceptions that LICs are more costly and complex than traditional block rotations (TBRs). The perceived cost versus evidence-based value related to clerkship education has not been examined in detail. Until recently, no 'All-LIC' medical school exemplars existed in the US, limiting the value of this model as well as the ability to examine relative cost and complexity. In this paper, we draw on our experience launching three 'All-LIC' medical schools in the United States - schools in which the entire clerkship class participates in a comprehensive clerkship-year LIC. We propose that the known benefits of LICs coupled with cost-mitigation strategies related to running an 'All LIC' model for core clinical clerkships, rather than block and LIC models simultaneously, results in a higher value for medical schools.

How much is enough?

In this editorial, the Editor-in-Chief considers the question of 'how much is enough?' in health professions education and health professions education research, and she explores some of the implications of how this perennial question might be answered.

Moving toward co-production: five ways to get a grip on collaborative implementation of Movement Behaviour curricula in undergraduate medical education

Several "calls to action" have imposed upon medical schools to include physical activity content in their overextended curricula. These efforts have often neither considered medical education stakeholders' views nor the full complexity of medical education, such as competency-based learning and educational inflation. With this external pressure for change, few medical schools have implemented physical activity curricula. Moreover, Canada's new 24-Hour Movement Guidelines focus on the continuum of movement behaviours (physical activity, sedentary behaviour, and sleep). Thus, a more integrated process to overcome the "black ice" of targeting all movement behaviours, medical education stakeholder engagement, and the overextended curriculum is needed. We argue for co-production in curriculum change and offer five strategies to integrate movement behaviour curricula that acknowledge the complexity of the medical education context, helping to overcome our "black ice." Our objectives were to investigate 24-Hour Movement Guideline content in the medical curriculum and develop an integrated process for competency-based curriculum renewal. Stakeholders were equal collaborators in a two-phased environmental scan of 24-Hour Movement Guideline content in the Queen's University School of Medicine. Findings and a working curriculum map highlight how new, competency-based content may be embedded in an effort to guide more relevant and feasible curriculum changes.

Profiling nursing students' dishonest behaviour: Classroom versus clinical settings

Background

While academic dishonesty among nursing students is becoming a global problem, the instruments used in studies on this topic are heterogeneous and, in many cases, not even validated. This makes it difficult or impossible to compare the findings on a global scale.

Objectives

To investigate the profile of Croatian nursing students’ dishonest behaviour in classroom and clinical settings and to examine the relationship between the incidence of dishonest behaviour in both settings.

Research design

A quantitative cross-sectional study using a Croatian online version of the Nursing Student Perceptions of Dishonesty Scale (overall Cronbach’s alpha 0.933).

Participants and research context

446 nursing students from a higher education institution in Croatia, EU, in the academic year 2020/21.

Ethical considerations

The study was approved by the relevant committee of the higher education institution.

Findings/results

Almost all participants (91.3%) performed dishonest behaviour on two or more occasions in the classroom and 32.5% did so in the clinical setting. The incidence of dishonest behaviour increased with the students’ year of BSc study (p = .008). All subscales of dishonest behaviour in the classroom were significantly and positively associated with dishonest behaviour in the clinical setting, except for the Not My Problem and Non-Compliance subscales.

Discussion

Based on these results, the following should be taken into consideration: 1) dishonest behaviour in the classroom is associated with dishonest behaviour in the clinical setting; 2) even the slightest occurrence of dishonest behaviour in the clinical setting can lead to fatal events.

Conclusions

The gradual increase in BSc nursing students’ dishonest behaviour with their year of study raises several questions regarding the development of ethical and moral values in this population. This raises the need for early and continuous exposure of students to ethical content from the beginning of their studies and support from competent educators.

Oncology and Radiation Oncology Awareness in Final Year Medical Students in Australia and New Zealand

This study aimed to determine final year students' core oncology and radiation oncology knowledge and attitudes about the quality of teaching in medical programmes delivered in Australia and New Zealand. Does the modern medical programme provide core oncology skills in this leading global cause of mortality and morbidity? An online survey was distributed between April and June 2018 and completed by 316 final year students across all 21 medical schools with final year cohorts in Australia and New Zealand. The survey examined teaching and clinical exposure, attitudes and core knowledge for oncology and radiation oncology. Several questions from a survey done of graduates in 2001 were repeated for comparison. We found that clinical exposure to oncology and its disciplines is low. Students rated oncology and haematology the worst taught medical specialties at medical school. Students reported the most confidence identifying when surgical management of cancer may be indicated and much lower levels of confidence identifying when systemic therapy and radiation therapy may be helpful. The majority of students had no formal course content on radiation therapy and more than one third of final year students erroneously believed that external beam radiation therapy turned patients radioactive. Exposure to oncology practice and the teaching of core oncology knowledge remains low for medical students in Australia and New Zealand. Many areas of oncology teaching and knowledge have worsened for medical students in Australia and New Zealand over the past 20 years. Well-established gaps in the core oncology knowledge of medical graduates must be urgently addressed given the increasing incidence of cancer and ongoing underutilisation of radiation therapy in particular.

Evaluating the Standardized Letter of Recommendation Form in Applicants to Orthopaedic Surgery Residency

INTRODUCTION

A standardized letter of recommendation (SLOR) form for orthopaedic surgery residency programs has recently been adopted for use, but it has not been scientifically evaluated. The purpose of this study is to investigate the usefulness of the SLOR form in the selection process.

METHODS

All SLOR forms submitted to our institution over a single application cycle were extracted and analyzed. The United States Medical Licensing Examination Step 1 scores, grades in clinical rotations, Alpha Omega Alpha status, and the number of publications were recorded for each applicant. Correlations were calculated with Spearman rho, and inter-rater reliability was evaluated by calculating intraclass correlation coefficients.

RESULTS

One thousand one hundred thirty-seven SLOR forms were analyzed for 513 applicants. There was substantial rank inflation with the SLOR form; the majority (92%) of applicants were rated as either ranked to match or in the top one-third of their rank list. Objective applicant factors such as grades and Step 1 scores demonstrated a very weak to nonexistent correlation with the summative rank (rho 0.07 to 0.13, P ≤ 0.012). Poor inter-rater reliability was observed with the intraclass correlation coefficient ranging from 0.22 to 0.33 (P < 0.001).

CONCLUSIONS

The usefulness of the SLOR form is limited by the very high ratings observed for all questions, and in particular, the final summative rank. Measures to reduce rank inflation must be implemented to improve the discriminant ability of the SLOR form, and if this cannot be accomplished, perhaps the form should be abandoned.

LEVEL OF EVIDENCE

Level III Retrospective.