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Verschuuren AEH, Tankink JB, Postma IR, Bergman KA, Goodarzi B, Feijen-de Jong EI, Erwich JJHM. Suboptimal factors in maternal and newborn care for refugees: Lessons learned from perinatal audits in the Netherlands. PLoS One 2024; 19:e0305764. [PMID: 38935661 PMCID: PMC11210813 DOI: 10.1371/journal.pone.0305764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/04/2024] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Refugees and their healthcare providers face numerous challenges in receiving and providing maternal and newborn care. Research exploring how these challenges are related to adverse perinatal and maternal outcomes is scarce. Therefore, this study aims to identify suboptimal factors in maternal and newborn care for asylum-seeking and refugee women and assess to what extent these factors may contribute to adverse pregnancy outcomes in the Netherlands. METHODS We conducted a retrospective analysis of national perinatal audit data from 2017 to 2019. Our analysis encompassed cases with adverse perinatal and maternal outcomes in women with a refugee background (n = 53). Suboptimal factors in care were identified and categorized according to Binder et al.'s Three Delays Model, and the extent to which they contributed to the adverse outcome was evaluated. RESULTS We identified 29 suboptimal factors, of which seven were related to care-seeking, six to the accessibility of services, and 16 to the quality of care. All 53 cases contained suboptimal factors, and in 67.9% of cases, at least one of these factors most likely or probably contributed to the adverse perinatal or maternal outcome. CONCLUSION The number of suboptimal factors identified in this study and the extent to which they contributed to adverse perinatal and maternal outcomes among refugee women is alarming. The wide range of suboptimal factors identified provides considerable scope for improvement of maternal and newborn care for refugee populations. These findings also highlight the importance of including refugee women in perinatal audits as it is essential for healthcare providers to better understand the factors associated with adverse outcomes to improve the quality of care. Adjustments to improve care for refugees could include culturally sensitive education for healthcare providers, increased workforce diversity, minimizing the relocation of asylum seekers, and permanent reimbursement of professional interpreter costs.
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Affiliation(s)
- A. E. H. Verschuuren
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
| | - J. B. Tankink
- Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Rotterdam, The Netherlands
| | - I. R. Postma
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, the Netherlands
| | - K. A. Bergman
- Department of Paediatrics Beatrix Children’s Hospital, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
| | - B. Goodarzi
- Department of Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Primary Care and Longterm Care, University Medical Center Groningen & University of Groningen, Groningen, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
| | - E. I. Feijen-de Jong
- Department of Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
- Department of Primary Care and Longterm Care, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Groningen, the Netherlands
| | - J. J. H. M. Erwich
- Department of Obstetrics and Gynecology, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
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Edgar AK, Tai J, Bearman M. Inclusivity in health professional education: how can virtual simulation foster attitudes of inclusion? Adv Simul (Lond) 2024; 9:15. [PMID: 38693571 PMCID: PMC11061899 DOI: 10.1186/s41077-024-00290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
Disparities in accessing quality healthcare persist among diverse populations. Health professional education should therefore promote more diversity in the health workforce, by fostering attitudes of inclusion. This paper outlines the potential of virtual simulation (VS), as one method in a system of health professional education, to promote inclusion and diversity. We conceptualise how VS can allow learners to experience an alternative to what HPE currently is by drawing on two social justice theorists, Paulo Freire, and Nancy Fraser and their ideas about 'voice' and 'representation'. We present two principles for VS design and implementation: (1) giving voice to learners has the power to transform; and (2) representation in VS builds inclusion. We provide practical means of building voice and representation into VS learning activities, followed by an example. Purposeful and thoughtful integration of these principles paves the way for a more diverse and inclusive healthcare workforce.
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Affiliation(s)
- Amanda K Edgar
- Deakin Learning Futures, Deakin University, Melbourne, Australia.
- School of Education, Faculty of Arts and Education, Deakin University, Geelong, Australia.
| | - Joanna Tai
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Australia
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Mulder L, Wouters A, Akwiwu EU, Koster AS, Ravesloot JH, Peerdeman SM, Salih M, Croiset G, Kusurkar RA. Diversity in the pathway from medical student to specialist in the Netherlands: a retrospective cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100749. [PMID: 37860636 PMCID: PMC10583163 DOI: 10.1016/j.lanepe.2023.100749] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Abstract
Background Medical specialist workforces are not representative of the society they serve, partially due to loss of diversity in the path from student to specialist. We investigated which demographic characteristics of bachelor students of medicine (BSM) are associated with becoming a physician and (particular type of) medical specialist; and whether this suggests 'cloning' (reproduction of sameness) of the existing workforce. Methods We used a retrospective cohort design, based on Statistics Netherlands data of all first-year BSM in 2002-2004 in The Netherlands (N = 4503). We used logistic regression to analyze the impact of sex, migration background, urbanity of residence, parental income and assets categories, and having healthcare professional parents, on being registered as physician or medical specialist in 2021. We compared our results to the national pool of physicians (N = 76,845) and medical specialists (N = 49,956) to identify cloning patterns based on Essed's cultural cloning theory. Findings Female students had higher odds of becoming a physician (OR 1.87 [1.53-2.28], p < 0.001). Physicians with a migration background other than Turkish, Moroccan, Surinamese, Dutch Caribbean or Indonesian (TMSDI) had lower odds of becoming a specialist (OR 0.55 [0.43-0.71], p < 0.001). This was not significant for TMSDI physicians (OR 0.74 [0.54-1.03], p = 0.073). We found a cloning pattern with regard to sex and migration background. Nationwide, physicians with a Turkish or Moroccan migration background, and female physicians with other migration backgrounds, are least likely to be a medical specialist. Interpretation In light of equity in healthcare systems, we recommend that every recruitment body increases the representativeness of their particular specialist workforce. Funding ODISSEI.
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Affiliation(s)
- Lianne Mulder
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, the Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, the Netherlands
| | - Anouk Wouters
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, the Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, the Netherlands
| | - Eddymurphy U. Akwiwu
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Andries S. Koster
- Department of Pharmaceutical Sciences, Utrecht University, David de Wied Building, Universiteitsweg 99, Utrecht, the Netherlands
| | - Jan Hindrik Ravesloot
- Amsterdam UMC Location University of Amsterdam, Faculty of Medicine, Department of Medical Biology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Saskia M. Peerdeman
- Amsterdam UMC Location University of Amsterdam, Department Neurosurgery, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Faculty of Medicine, Teaching and Learning Centre, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Mahdi Salih
- Erasmus MC, Division of Nephrology and Transplantation, Department of Internal Medicine, Dr. Molewaterplein 40, Rotterdam, The Netherlands
| | - Gerda Croiset
- University Medical Center Groningen, Wenckebach Institute for Education and Training, Hanzeplein 1, Groningen, the Netherlands
| | - Rashmi A. Kusurkar
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, the Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
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Mulder L, Akwiwu EU, Twisk JWR, Koster AS, Ravesloot JH, Croiset G, Kusurkar RA, Wouters A. Inequality of opportunity in selection procedures limits diversity in higher education: An intersectional study of Dutch selective higher education programs. PLoS One 2023; 18:e0292805. [PMID: 37831714 PMCID: PMC10575509 DOI: 10.1371/journal.pone.0292805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Selection for higher education (HE) programs may hinder equal opportunities for applicants and thereby reduce student diversity and representativeness. However, variables which could play a role in inequality of opportunity are often studied separately from each other. Therefore, this retrospective cohort study conducts an innovative intersectional analysis of the inequality of opportunity in admissions to selective HE programs. Using a combination of multivariable logistic regression analyses and descriptive statistics, we aimed to investigate 1) the representativeness of student populations of selective HE programs, as compared to both the applicant pool and the demographics of the age cohort; 2) the demographic background variables which are associated with an applicant's odds of admission; and 3) the intersectional acceptance rates of applicants with all, some or none of the background characteristics positively associated with odds of admission. The study focused on all selective HE programs (n = 96) in The Netherlands in 2019 and 2020, using Studielink applicant data (N = 85,839) and Statistics Netherlands microdata of ten background characteristics. The results show that student diversity in selective HE programs is limited, partly due to the widespread inequality of opportunity in the selection procedures, and partly due to self-selection. Out of all ten variables, migration background was most often (negatively) associated with the odds of receiving an offer of admission. The intersectional analyses provide detailed insight into how (dis)advantage has different effects for different groups. We therefore recommend the implementation of equitable admissions procedures which take intersectionality into account.
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Affiliation(s)
- Lianne Mulder
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eddymurphy U. Akwiwu
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Jos W. R. Twisk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Andries S. Koster
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jan Hindrik Ravesloot
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gerda Croiset
- Wenckebach Institute for Education and Training, University Medical Center Groningen, Groningen, The Netherlands
| | - Rashmi A. Kusurkar
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Anouk Wouters
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Fikrat-Wevers S, Stegers-Jager KM, Afonso PM, Koster AS, Van Gestel RA, Groenier M, Ravesloot JH, Wouters A, Van Den Broek WW, Woltman AM. Selection tools and student diversity in health professions education: a multi-site study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1027-1052. [PMID: 36653557 PMCID: PMC9848043 DOI: 10.1007/s10459-022-10204-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/29/2022] [Indexed: 06/16/2023]
Abstract
Student diversity in health professions education (HPE) can be affected by selection procedures. Little is known about how different selection tools impact student diversity across programs using different combinations of traditional and broadened selection criteria. The present multi-site study examined the chances in selection of subgroups of applicants to HPE undergraduate programs with distinctive selection procedures, and their performance on corresponding selection tools. Probability of selection of subgroups (based on gender, migration background, prior education, parental education) of applicants (N = 1935) to five selection procedures of corresponding Dutch HPE undergraduate programs was estimated using multilevel logistic regression. Multilevel linear regression was used to analyze performance on four tools: prior-education grade point average (pe-GPA), biomedical knowledge test, curriculum-sampling test, and curriculum vitae (CV). First-generation Western immigrants and applicants with a foreign education background were significantly less likely to be selected than applicants without a migration background and with pre-university education. These effects did not vary across programs. More variability in effects was found between different selection tools. Compared to women, men performed significantly poorer on CVs, while they had higher scores on biomedical knowledge tests. Applicants with a non-Western migration background scored lower on curriculum-sampling tests. First-generation Western immigrants had lower CV-scores. First-generation university applicants had significantly lower pe-GPAs. There was a variety in effects for applicants with different alternative forms of prior education. For curriculum-sampling tests and CVs, effects varied across programs. Our findings highlight the need for continuous evaluation, identifying best practices within existing tools, and applying alternative tools.
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Affiliation(s)
- S Fikrat-Wevers
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-207, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - K M Stegers-Jager
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-207, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - P M Afonso
- Department of Biostatistics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A S Koster
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - R A Van Gestel
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - M Groenier
- Technical Medical Centre, Technical Medicine, University of Twente, Enschede, The Netherlands
| | - J H Ravesloot
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Wouters
- Faculty of Medicine VU, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - W W Van Den Broek
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-207, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - A M Woltman
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-207, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Suzuki Y, Tsunekawa K, Takeda Y, Cleland J, Saiki T. Impact of medical students' socioeconomic backgrounds on medical school application, admission and migration in Japan: a web-based survey. BMJ Open 2023; 13:e073559. [PMID: 37669839 PMCID: PMC10481750 DOI: 10.1136/bmjopen-2023-073559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES The aim of this study was to clarify and compare the socioeconomic backgrounds of medical students with those of other health professions and non-health faculty students in an era of increasing inequity in Japanese society. DESIGN This was a quantitative nationwide study. Data were collected by a cross-sectional web-based anonymous questionnaire. SETTING Data from years 3 and 4 medical, health professions and non-health faculty students across Japan were collected in 2021. PARTICIPANTS Participants were 1991 students from medical schools, 224 from dental, 419 from pharmacy, 326 from nursing, 144 from other health professions and 207 from non-health faculties. RESULTS The proportion of high-income families (>18 million yen: ca. US$140 000) among medical students was 25.6%, higher than that of pharmacy (8.7%) and nursing students (4.1%) (p<0.01). One-third of medical students had a physician parent, more common than in non-medical students (p<0.01). Students who only applied to public medical schools and a regional quota 'Chiiki-waku' students with scholarship had lower family income and physician parents compared with those who applied to private medical schools (p<0.01), but they still had higher physician parents compared with non-medical students (p<0.01). Logistic regression revealed that having a physician parent (p<0.01), aspiring to the present profession during elementary school (p<0.01) and private upper secondary school graduation (p<0.01) predicted the likelihood of studying medicine. There were regional differences of backgrounds among medical students, and 80% of medical students with urban backgrounds intended to work in urban localities after graduation. CONCLUSIONS This study provides evidence that medical students in Japan hail from urban and higher income classes and physicians' families. This finding has implications for the health workforce maldistribution in Japan. Widening the diversity of medical students is essential for solving physician workforce issues and meeting broad healthcare needs.
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Affiliation(s)
- Yasuyuki Suzuki
- Medical Education Development Center, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Koji Tsunekawa
- Medical Education Development Center, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Yuko Takeda
- Department of Medical Education, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Jennifer Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Singapore
| | - Takuya Saiki
- Medical Education Development Center, Graduate School of Medicine, Gifu University, Gifu, Japan
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You Y, Wang W, Cleland J. Does medical education reform change who is selected? A national cross-sectional survey from China. BMJ Open 2023; 13:e070239. [PMID: 37567746 PMCID: PMC10423783 DOI: 10.1136/bmjopen-2022-070239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES Approximately 10 years ago, China introduced an education plan to improve the overall quality of medical education and to better serve the population's health needs. Many medical schools were then recognised and financed by China's Ministry of Education to develop and operationalise new pilot programmes (PPs) aligned with this plan. These ran in parallel with the traditional programmes (TPs). One way to achieve the plan's first aim, improving the quality of medical education, is to select academically stronger candidates. We, thus, examined and compared who were selected into PPs and TPs. DESIGN Cross-sectional study. SETTING Data were collected from 123 medical schools across China via the 2021 China Medical Student Survey. PARTICIPANTS Participants were undergraduate clinical medicine students across all year groups. PRIMARY AND SECONDARY OUTCOME MEASURES Medical school selection was via the National College Entrance Examination (NCEE). Medical students' NCEE performance and their sociodemographics were used as the primary and secondary outcome measures. Mann-Whitney or χ2 tests were used to compare the means between educational programmes (PPs vs TPs) and various selection outcomes. Multilevel mixed-effects regressions were employed to account for school idiosyncratic selection results. RESULTS Of the 204 817 respondents, 194 163 (94.8%) were in a TP and 10 654 (5.2%) a PP. PP respondents (median=75.2, IQR=69.5-78.8) had significantly higher NCEE scores than their TP counterparts (median=73.9, IQR=68.5-78.7). Holding constant their NCEE score, PP respondents were significantly more likely to come from urban areas, not be first-generation college students, and have parents with higher occupational status and income. CONCLUSIONS Assuming quality can be indicated by prior academic achievement at the point of selection, PPs achieved this mission. However, doing so limited medical students' diversity. This may be unhelpful in achieving the Education Plan's goal to better serve China's health needs.
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Affiliation(s)
- You You
- National Center for Health Professions Education Development, Peking University, Beijing, People's Republic of China
- Institute of Economics of Education, Peking University, Beijing, People's Republic of China
| | - Weimin Wang
- National Center for Health Professions Education Development, Peking University, Beijing, People's Republic of China
- Health Science Center, Peking University, Beijing, People's Republic of China
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Wondimagegn D, Whitehead CR, Cartmill C, Rodrigues E, Correia A, Salessi Lins T, Costa MJ. Faster, higher, stronger - together? A bibliometric analysis of author distribution in top medical education journals. BMJ Glob Health 2023; 8:e011656. [PMID: 37321659 PMCID: PMC10367082 DOI: 10.1136/bmjgh-2022-011656] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/11/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Medical education and medical education research are growing industries that have become increasingly globalised. Recognition of the colonial foundations of medical education has led to a growing focus on issues of equity, absence and marginalisation. One area of absence that has been underexplored is that of published voices from low-income and middle-income countries. We undertook a bibliometric analysis of five top medical education journals to determine which countries were absent and which countries were represented in prestigious first and last authorship positions. METHODS Web of Science was searched for all articles and reviews published between 2012 and 2021 within Academic Medicine, Medical Education, Advances in Health Sciences Education, Medical Teacher, and BMC Medical Education. Country of origin was identified for first and last author of each publication, and the number of publications originating from each country was counted. RESULTS Our analysis revealed a dominance of first and last authors from five countries: USA, Canada, UK, Netherlands and Australia. Authors from these five countries had first or last authored 70% of publications. Of the 195 countries in the world, 43% (approximately 83) were not represented by a single publication. There was an increase in the percentage of publications from outside of these five countries from 23% in 2012 to 40% in 2021. CONCLUSION The dominance of wealthy nations within spaces that claim to be international is a finding that requires attention. We draw on analogies from modern Olympic sport and our own collaborative research process to show how academic publishing continues to be a colonised space that advantages those from wealthy and English-speaking countries.
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Affiliation(s)
- Dawit Wondimagegn
- College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Cynthia Ruth Whitehead
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Carrie Cartmill
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eloy Rodrigues
- Documentation and Library Services, University of Minho, Braga, Portugal
| | - Antónia Correia
- Documentation and Library Services, University of Minho, Braga, Portugal
| | - Tiago Salessi Lins
- Department of Health Promotion, Federal University of Paraiba, Paraiba, Brazil
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Fikrat-Wevers S, De Leng WE, Van Den Broek WW, Woltman AM, Stegers-Jager KM. The added value of free preparatory activities for widening access to medical education: a multi-cohort study. BMC MEDICAL EDUCATION 2023; 23:196. [PMID: 36991413 PMCID: PMC10053372 DOI: 10.1186/s12909-023-04191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Medical schools are reported to be less accessible to students with non-traditional backgrounds. These students face barriers when applying for and transitioning to medical school, which may be reduced by offering free preparatory activities. By equalizing access to resources, these activities are expected to reduce disparities in selection outcomes and early academic performance. In the present study, four free institutionally-provided preparatory activities were evaluated by comparing the demographic composition of participating and non-participating applicants. Additionally, the association between participation and selection outcomes and early academic performance was investigated for subgroups (based on sex, migration background and parental education). METHODS Participants were applicants to a Dutch medical school in 2016-2019 (N = 3592). Free preparatory activities included Summer School (N = 595), Coaching Day (N = 1794), Pre-Academic Program (N = 217), and Junior Med School (N = 81), supplemented with data on participation in commercial coaching (N = 65). Demographic compositions of participants and non-participants were compared using chi-squared tests. Regression analyses were performed to compare selection outcomes (curriculum vitae [CV], selection test score, probability of enrolment) and early academic performance (first-course grade) between participants and non-participants of demographic subgroups, controlling for pre-university grades and participation in other activities. RESULTS Generally, no differences in sociodemographic compositions of participants and non-participants were found, but males participated less often in Summer School and Coaching Day. Applicants with a non-Western background participated less often in commercial coaching, but the overall participation rate was low and participation had negligible effects on selection outcomes. Participation in Summer School and Coaching Day were stronger related with selection outcomes. In some cases, this association was even stronger for males and candidates with a migration background. After controlling for pre-university grades, none of the preparatory activities were positively associated with early academic performance. CONCLUSIONS Free institutionally-provided preparatory activities may contribute to student diversity in medical education, because usage was similar across sociodemographic subgroups, and participation was positively associated with selection outcomes of underrepresented and non-traditional students. However, since participation was not associated with early academic performance, adjustments to activities and/or curricula are needed to ensure inclusion and retention after selection.
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Affiliation(s)
- S Fikrat-Wevers
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - W E De Leng
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - W W Van Den Broek
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - A M Woltman
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - K M Stegers-Jager
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
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10
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Fikrat‐Wevers S, Stegers‐Jager K, Groenier M, Koster A, Ravesloot JH, Van Gestel R, Wouters A, van den Broek W, Woltman A. Applicant perceptions of selection methods for health professions education: Rationales and subgroup differences. MEDICAL EDUCATION 2023; 57:170-185. [PMID: 36215062 PMCID: PMC10092456 DOI: 10.1111/medu.14949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
CONTEXT Applicant perceptions of selection methods can affect motivation, performance and withdrawal and may therefore be of relevance in the context of widening access. However, it is unknown how applicant subgroups perceive different selection methods. OBJECTIVES Using organisational justice theory, the present multi-site study examined applicant perceptions of various selection methods, rationales behind perceptions and subgroup differences. METHODS Applicants to five Dutch undergraduate health professions programmes (N = 704) completed an online survey including demographics and a questionnaire on applicant perceptions applied to 11 commonly used selection methods. Applicants rated general favourability and justice dimensions (7-point Likert scale) and could add comments for each method. RESULTS Descriptive statistics revealed a preference for selection methods on which applicants feel more 'in control': General favourability ratings were highest for curriculum-sampling tests (mean [M] = 5.32) and skills tests (M = 5.13), while weighted lottery (M = 3.05) and unweighted lottery (M = 2.97) were perceived least favourable. Additionally, applicants preferred to distinguish themselves on methods that assess attributes beyond cognitive abilities. Qualitative content analysis of comments revealed several conflicting preferences, including a desire for multiple selection methods versus concerns of experiencing too much stress. Results from a linear mixed model of general favourability indicated some small subgroup differences in perceptions (based on gender, migration background, prior education and parental education), but practical meaning of these differences was negligible. Nevertheless, concerns were expressed that certain selection methods can hinder equitable admission due to inequal access to resources. CONCLUSIONS Our findings illustrate that applicants desire to demonstrate a variety of attributes on a combination of selection tools, but also observe that this can result in multiple drawbacks. The present study can help programmes in deciding which selection methods to include, which more negatively perceived methods should be better justified to applicants, and how to adapt methods to meet applicants' needs.
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Affiliation(s)
- Suzanne Fikrat‐Wevers
- Institute of Medical Education Research RotterdamErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Karen Stegers‐Jager
- Institute of Medical Education Research RotterdamErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Marleen Groenier
- Technical Medical Centre, Technical MedicineUniversity of TwenteEnschedeThe Netherlands
| | - Andries Koster
- Department of Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Jan Hindrik Ravesloot
- Department of Medical Biology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Renske Van Gestel
- Department of Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Anouk Wouters
- Faculty of Medicine VUAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and EducationVU University AmsterdamAmsterdamThe Netherlands
| | - Walter van den Broek
- Institute of Medical Education Research RotterdamErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Andrea Woltman
- Institute of Medical Education Research RotterdamErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
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Mulder L, Wouters A, Fikrat-Wevers S, Koster AS, Ravesloot JH, Croiset G, Kusurkar RA. Influence of social networks in healthcare on preparation for selection procedures of health professions education: a Dutch interview study. BMJ Open 2022; 12:e062474. [PMID: 36316069 PMCID: PMC9628659 DOI: 10.1136/bmjopen-2022-062474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Health professions education (HPE) students are often not representative of the populations they will serve. The underrepresentation of non-traditional students is problematic because diversity is essential for promoting excellence in health education and care. This study aimed to understand the perceptions of traditional and non-traditional students regarding facilitators and barriers in preparing for HPE selection procedures, and to determine the role of social networks in their decision-making and preparations to apply. METHODS A qualitative study was conducted with 26 Dutch youth who were interested in university-level HPE programmes. Semistructured interviews and sociograms were analysed using thematic analysis, adopting a constructivist approach. RESULTS Twenty-six high school students participated, with traditional and non-traditional backgrounds, with and without social networks in healthcare and higher education. Two themes were constructed. First, four high-impact facilitators helped to overcome barriers to apply and in preparation for selection: access to a social network connection working or studying in healthcare, to correct information, to healthcare experience and to a social network connection in higher education. Lack of information was the main barrier while access to social network connections in healthcare was the main facilitator to overcome this barrier. However, this access was unevenly distributed. Second, access alone is not enough: the need for agency to make use of available facilitators is also essential. CONCLUSIONS The themes are discussed using intersectionality. Traditional students with access to facilitators develop their self-efficacy and agency within social structures that privilege them, whereas non-traditional students must develop those skills without such structures. Our findings provide recommendations for the ways in which universities can remove barriers that cause unequal opportunities to prepare for the selection of HPE programmes. Along with equitable admissions, these recommendations can help to achieve a more representative student population and subsequently a better quality of health education and care.
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Affiliation(s)
- Lianne Mulder
- Amsterdam UMC location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anouk Wouters
- Amsterdam UMC location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Fikrat-Wevers
- Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Andries S Koster
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jan Hindrik Ravesloot
- Amsterdam UMC location University of Amsterdam, Department of Medical Biology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Gerda Croiset
- Wenckebach Institute for Education and Training, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rashmi A Kusurkar
- Amsterdam UMC location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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