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Jones RL, Prusmetikul S, Whitehorn S. Differential attainment in assessment of postgraduate surgical trainees: a scoping review. BMC MEDICAL EDUCATION 2024; 24:597. [PMID: 38816822 PMCID: PMC11141033 DOI: 10.1186/s12909-024-05580-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Solving disparities in assessments is crucial to a successful surgical training programme. The first step in levelling these inequalities is recognising in what contexts they occur, and what protected characteristics are potentially implicated. METHODS This scoping review was based on Arksey & O'Malley's guiding principles. OVID and Embase were used to identify articles, which were then screened by three reviewers. RESULTS From an initial 358 articles, 53 reported on the presence of differential attainment in postgraduate surgical assessments. The majority were quantitative studies (77.4%), using retrospective designs. 11.3% were qualitative. Differential attainment affects a varied range of protected characteristics. The characteristics most likely to be investigated were gender (85%), ethnicity (37%) and socioeconomic background (7.5%). Evidence of inequalities are present in many types of assessment, including: academic achievements, assessments of progression in training, workplace-based assessments, logs of surgical experience and tests of technical skills. CONCLUSION Attainment gaps have been demonstrated in many types of assessment, including supposedly "objective" written assessments and at revalidation. Further research is necessary to delineate the most effective methods to eliminate bias in higher surgical training. Surgical curriculum providers should be informed by the available literature on inequalities in surgical training, as well as other neighbouring specialties such as medicine or general practice, when designing assessments and considering how to mitigate for potential causes of differential attainment.
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Affiliation(s)
- Rebecca L Jones
- Department of Surgery and Cancer, Imperial College London, London, UK.
- Department of Ophthalmology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Alexandra House, Sandford Road, Cheltenham, GL53 7AN, UK.
| | - Suwimol Prusmetikul
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sarah Whitehorn
- Department of Surgery and Cancer, Imperial College London, London, UK
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Nolan HA, Owen K. Medical student experiences of equality, diversity, and inclusion: content analysis of student feedback using Bronfenbrenner's ecological systems theory. BMC MEDICAL EDUCATION 2024; 24:5. [PMID: 38172809 PMCID: PMC10765790 DOI: 10.1186/s12909-023-04986-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Issues relating to equality, diversity, and inclusion (EDI) significantly impact on medical student achievement and wellbeing. Interventions have been introduced at curricular and organisational levels, yet progress in addressing these issues remains limited. Timely evaluation is needed to assess effectiveness of interventions, and to explore issues and interactions in learning environments impacting on student experience. We introduced an anonymous question concerning students' experiences of EDI into routine online student feedback questionnaires, to scope the nature of ongoing issues and develop greater understanding of students' experiences in our programme environment. Ecological systems theory, which conceptualizes learning as a function of complex social interactions, determined by characteristics of individual learners and their environment, provides a framework for understanding. METHODS Free-text responses regarding experiences of EDI gathered over 20 months from all programme years (n = 760) were pooled for analysis, providing a holistic overview of experiences in the learning environment. A counting exercise identified broad categories reported by students. Content analysis of the qualitative dataset was undertaken. Bronfenbrenner's ecological systems theory was applied as a framework to demonstrate interdependencies between respondents' experiences and environments, and associated impacts. RESULTS Three hundred and seventy-six responses were received relating to wide-ranging EDI issues, most frequently gender or ethnicity. Responses mapped onto all areas of the ecological systems model, with frequent links between subsystems, indicating considerable complexity and interdependencies. Interpersonal interactions and associated impacts like exclusion were frequently discussed. Differential experiences of EDI-related issues in medical school compared to clinical settings were reported. Impacts of institutional leadership and wider societal norms were considered by respondents. Respondents discussed their need for awareness of EDI with reference to future professional practice. CONCLUSIONS Implementation of a regular free-text evaluation question allowed data-gathering across cohorts and throughout several stages of the curriculum, illuminating student experience. Connections established demonstrated intersectionality, and how environment and other factors interact, impacting on student experiences. Students experience EDI-related issues on multiple levels within the educational environment, with consequent impacts on learning. Any successful approach towards tackling issues and promoting equity of opportunity for all requires multi-level actions and widespread culture change. Students can offer fresh and distinct perspectives regarding change needed, to complement and diversify perspectives provided by staff and organisational leadership. Student voice should be enabled to shape change.
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Pamias-Velázquez KJ, Harper B. Predictors of Success in the National Physical Therapy Examination for Hispanic Doctor of Physical Therapy Students. JOURNAL, PHYSICAL THERAPY EDUCATION 2023; 37:243-249. [PMID: 38478817 DOI: 10.1097/jte.0000000000000294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/20/2023] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Hispanic/Latino students often underachieve in higher education programs in the health professions and have shown lower first-time pass rates on the National Physical Therapy Examination than their White peers. A plausible explanation for this difference is the lack of English proficiency. The purpose of this study was to determine predictive academic variables for passing licensure examination on the first attempt for Hispanic/Latino Doctor of Physical Therapy (DPT) students. REVIEW OF THE LITERATURE Numerous studies have been conducted to determine the factors that predict success on the National Physical Therapy Examination; however, there is a scarcity of literature on the predictors of success for Hispanic/Latino DPT students, particularly on the influence of English proficiency. SUBJECTS A nonprobability convenience sample of 67 Hispanic students from a single DPT program was used. METHODS A retrospective, predictive, correlational study was conducted. Data collection was performed by secondary analysis of student academic profiles. Predictor variables included proficiency in the English language; undergraduate grade point average; verbal, quantitative, and written skills; and first-year and third-year grade point average while enrolled in the physical therapist education program. RESULTS The first-time pass rate was 59.7% (n = 40). Results showed that students who passed and those who did not pass on their first attempt differed in first-year and third-year program grade point average with large effect sizes of d = 1.13 and d = 1.48, respectively; however, third-year grade point average was the only significant independent predictor of success. English proficiency and preadmission variables did not predict first-time success. DISCUSSION AND CONCLUSION The results suggest first-year and third-year grade point average may be used to identify at-risk students. Use of these variables is encouraged to monitor the progression of students. The study highlighted the need to identify additional predictors of performance.
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Affiliation(s)
- Kristian J Pamias-Velázquez
- Kristian J. Pamias Velazquez is an adjunct professor in the Department of Physical Therapy at the University of Puerto Rico, Medical Sciences Campus, P.O. BOX 365067, San Juan, PR 00936-5067 . Please address all correspondence to Kristian J. Pamias Velazquez
- Brent Harper is an adjunct professor in the College of Graduate Health Studies at the A.T. Still University, and is an associate professor at the Chapman University
| | - Brent Harper
- Kristian J. Pamias Velazquez is an adjunct professor in the Department of Physical Therapy at the University of Puerto Rico, Medical Sciences Campus, P.O. BOX 365067, San Juan, PR 00936-5067 . Please address all correspondence to Kristian J. Pamias Velazquez
- Brent Harper is an adjunct professor in the College of Graduate Health Studies at the A.T. Still University, and is an associate professor at the Chapman University
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Morrison N, Zaman T, Webster G, Sorinola O, Blackburn C. 'Where are you really from?': a qualitative study of racial microaggressions and the impact on medical students in the UK. BMJ Open 2023; 13:e069009. [PMID: 37147091 PMCID: PMC10163503 DOI: 10.1136/bmjopen-2022-069009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE To explore graduate-entry medical students' experiences of racial microaggressions, the impact of these on learning, performance and attainment, and their views on how these can be reduced. DESIGN Qualitative study using semistructured focus groups and group interviews. SETTING UK. PARTICIPANTS 20 graduate-entry medical students were recruited using volunteer and snowball sampling; all students self-identified as being from racially minoritised (RM) backgrounds. RESULTS Participants reported experiencing numerous types of racial microaggressions during their time at medical school. Students' accounts highlighted how these impacted directly and indirectly on their learning, performance and well-being. Students frequently reported feeling uncomfortable and out of place in teaching sessions and clinical placements. Students also reported feeling invisible and ignored in placements and not being offered the same learning opportunities as their white counterparts. This led to lack of access to learning experiences or disengagement from learning. Many participants described how being from an RM background was associated with feelings of apprehension and having their 'guards up', particularly at the start of new clinical placements. This was perceived to be an additional burden that was not experienced by their white counterparts. Students suggested that future interventions should focus on institutional changes to diversify student and staff populations; shifting the culture to build and maintain inclusive environments; encouraging open, transparent conversations around racism and promptly managing any student-reported racial experiences. CONCLUSION RM students in this study reported that their medical school experiences were regularly affected by racial microaggressions. Students believed these microaggressions impeded their learning, performance and well-being. It is imperative that institutions increase their awareness of the difficulties faced by RM students and provide appropriate support in challenging times. Fostering inclusion as well as embedding antiracist pedagogy into medical curricula is likely to be beneficial.
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Affiliation(s)
- Nariell Morrison
- Department of Education, University of Oxford, Oxford, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Tabbasum Zaman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Georgia Webster
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Olanrewaju Sorinola
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Clare Blackburn
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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van Moppes NM, Willems S, Nasori M, Bont J, Akkermans R, van Dijk N, van den Muijsenbergh M, Visser M. Ethnic minority GP trainees at risk for underperformance assessments: a quantitative cohort study. BJGP Open 2023; 7:BJGPO.2022.0082. [PMID: 36343966 DOI: 10.3399/bjgpo.2022.0082] [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: 06/04/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recent studies suggest that ethnic minority students underperform in standardised assessments commonly used to evaluate their progress. This disparity seems to also hold for postgraduate medical students and GP trainees, and may affect the quality of primary health care, which requires an optimally diverse workforce. AIMS To address the following: 1) to determine to what extent ethnic minority GP trainees are more at risk of being assessed as underperforming than their majority peers; 2) to investigate whether established underperformance appears in specific competence areas; and 3) to explore first- and second-generation ethnic minority trainees' deviations. DESIGN & SETTING Quantitative retrospective cohort design in Dutch GP specialty training (start years: 2015-2017). METHOD In 2020-2021, the authors evaluated files on assessed underperformance of 1700 GP trainees at seven Dutch GP specialty training institutes after excluding five opt-outs and 165 incomplete datasets (17.4% ethnic minority trainees). Underperformance was defined as the occurrence of the following, which was prompted by the training institute: 1) preliminary dropout; 2) extension of the educational pathway; and/or 3) mandatory coaching pathways. Statistics Netherlands (CBS) anonymised the files and added data about ethnic group. Thereafter, the authors performed logistic regression for potential underperformance analysis and χ2 tests for competence area analysis. RESULTS Ethnic minority GP trainees were more likely to face underperformance assessments than the majority group (odds ratio [OR] 2.41, 95% confidence interval [CI] = 1.67 to 3.49). Underperformance was not significantly nested in particular competence areas. First-generation ethnic minority trainees seemed more at risk than their second-generation peers. CONCLUSION Ethnic minority GP trainees seem more at risk of facing educational barriers than the majority group. Additional qualitative research on underlying factors is essential.
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Affiliation(s)
- Nathanja Mariëtte van Moppes
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Quality of Care and Personalised Medicine, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Sander Willems
- Emergency Department, Rijnstate Hospital, Arnhem, Nijmegen, The Netherlands
| | - Mana Nasori
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Quality of Care and Personalised Medicine, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Jettie Bont
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Quality of Care and Personalised Medicine, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Reinier Akkermans
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Nynke van Dijk
- Faculties of Exercise & Sports, Nutrition, and Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Maria van den Muijsenbergh
- Department of General Practice, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Mechteld Visser
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Quality of Care and Personalised Medicine, Amsterdam Public Health, Amsterdam, The Netherlands
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Mukherji P, Adas MA, Clarke B, Galloway JB, Mulvey T, Norton S, Turner J, Russell MD, Lempp H, Li S. Changing trends in ethnicity and academic performance: observational cohort data from a UK medical school. BMJ Open 2022; 12:e066886. [PMID: 36521901 PMCID: PMC9756189 DOI: 10.1136/bmjopen-2022-066886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Quantify differential attainment by ethnicity in undergraduate medical assessments and evaluate whether institutional efforts to reduce the attainment gap have had impact. DESIGN Observational cohort study. SETTING A single UK MBBS medical programme. PARTICIPANTS Pseudonymised data of adults aged ≥18 years enrolled in one of the UK MBBS medical programmes between 2012 and 2018. Ethnicity was self-declared during enrolment as White, Asian, Black, mixed and other. MAIN OUTCOME MEASURE Module mark (distinction, merit, pass, fail) graded according to a variety of assessments, including single best answer examinations, objective structured clinical examinations and coursework submissions. All modular assessments are graded as a percentage. Logistic regression models were used to calculate relative risk ratio to study the association between ethnicity and attainment gap over a calendar and scholastic year. Models were adjusted for age, gender, social deprivation and scholastic year of study. RESULTS 3714 student records were included. In the sample, 2134 students (57%) were non-white. The proportion of non-white students increased from 2007 (49%) to 2018 (70%). Mean age was 18 (IQR 18-21) and 56.6% were females. Higher proportion of non-white students 218 (24.8%) were from more deprived backgrounds versus white 76 (14.8%). Compared with non-white, there were no significant differences in the proportion of students failing assessments. However, white students were more likely to achieve merit (relative risk ratio 1.29 (95% CI 1.08 to 1.45)) or distinction (1.69 (95% CI 1.37 to 2.08)). Differences in attainment gap have remained unchanged over time, and for black students, attainment gap grew between their first and final year of study. CONCLUSION A similar proportion (97%) of non-white and white students had a passing score, but attainment gap for higher grades persists over years despite widespread efforts in medical schools to diminish the attainment gap linked to ethnicity. Our findings are from a single institution, thus affecting generalisability.
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Affiliation(s)
| | - Maryam A Adas
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Benjamin Clarke
- Postgraduate Medical & Dental Education Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - James B Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Thomas Mulvey
- Clinical Education Department, King's College London, London, UK
| | - Sam Norton
- Psychology Department, Insitute of Psychiatry, King's College London, London, UK
| | - Jonathan Turner
- Clinical Education Department, King's College London, London, UK
| | - Mark D Russell
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Shuangyu Li
- Division of Medical Education, King's College London, London, UK
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Menezes A, Henry S, Agarwal G. It's high time Canada started collecting race-based performance data on medical training and careers. LANCET REGIONAL HEALTH. AMERICAS 2022; 14:100326. [PMID: 36777392 PMCID: PMC9904144 DOI: 10.1016/j.lana.2022.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anjali Menezes
- Differential Attainment REsearch Group (DARe), Assistant Clinical Professor (Adjunct), Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Shayna Henry
- Differential Attainment REsearch Group (DARe), Assistant Clinical Professor (Adjunct), Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Gina Agarwal
- Differential Attainment REsearch Group (DARe), Professor, McMaster Family Medicine Levitt Scholar, Department of Family Medicine, McMaster University, Hamilton, Canada
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Liu M, Cai J, Chen H, Shi L. Association of Personality Traits with Life and Work of Medical Students: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12376. [PMID: 36231679 PMCID: PMC9566667 DOI: 10.3390/ijerph191912376] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/04/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Personality traits are the basic components of an individual's personality. Although there are many published articles about the impact of personality traits on medical students, there is a lack of integrative reviews of existing articles. To close this gap, this review aims to summarize the impact of personality traits on medical students from two perspectives: life and work. METHODS The search was performed using the following databases: PubMed, Web of Science, Google Scholar, and EMBASE. All publications that assessed the impact of personality traits on life and work until February 2022 were selected. RESULTS Ninety-seven studies were included. The results suggest that personality traits could affect life performance, health outcomes, life satisfaction, the formation of doctor-patient relationships, mastery of knowledge, academic performance, and career planning. Different personality traits can have positive or negative impacts on these aspects. CONCLUSIONS The results of this review suggest that personality traits can affect medical students' lives and work. Therefore, based on the evaluation of the personality traits of medical students, it is necessary to design targeted courses and training for students to improve their personality traits, to bring about better results in their lives and work.
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Affiliation(s)
- Meichen Liu
- Modern Educational Technology Center, Harbin Medical University, Harbin 150086, China
| | - Jinquan Cai
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Hao Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Lei Shi
- School of Health Management, Southern Medical University, Guangzhou 510515, China
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Bandyopadhyay S, Boylan CT, Baho YG, Casey A, Asif A, Khalil H, Badwi N, Patel R. Ethnicity-related stereotypes and their impacts on medical students: A critical narrative review of health professions education literature. MEDICAL TEACHER 2022; 44:986-996. [PMID: 35311604 DOI: 10.1080/0142159x.2022.2051464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Stereotypes are oversimplified beliefs about groups of people. Social psychology concepts and theories describing ethnicity-related stereotypes are well reported in non-medical educational settings. In contrast, the full impact of stereotyping on medical students, and the extent to which they were represented in health professions education (HPE) is less well-described. Using the lens of social psychological theory, this review aimed to describe ethnicity-related stereotypes about medical students portrayed in HPE literature and the impacts of those stereotypes. METHODS A critical narrative approach was undertaken. Social psychology concepts and theories were used as a framework through which to review the impacts of ethnicity-related stereotypes on medical students as described in HPE literature. A database search of Ovid MEDLINE, JSTOR, Project Muse, and PsychINFO was conducted to identify both theoretical and empirical articles relating to this topic in the HPE literature. Data was synthesised using thematic analysis, giving particular care to appraise the evidence from perspectives in social psychology. FINDINGS In HPE, the experiences and impact of stereotyping on learners from minority ethnic groups was explained by social psychology concepts such as stereotype threat, stereotype reactance, attributional ambiguity, self-fulfilling prophecy, stereotype boost, stereotype lift, and stereotype masking. Stereotype boost and stereotype lift were particularly described among students who identified as White, whereas stereotype threat was described more commonly among students from minority ethnics groups. The impact of stereotyping is not just on assessment, but may be across all teaching and learning activities at medical school. INTERPRETATION Social psychology concepts and theories can be used to describe the experience and impact of ethnicity-related stereotypes in HPE. Educators can better support learners from minority ethnic groups by self-reflecting over assumptions about individuals from minority ethnic groups, as well as minimise the impact of stereotyping and bias to create more inclusive learning environments.
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Affiliation(s)
- Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Conor T Boylan
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Yousif G Baho
- Hull York Medical School, University of Hull, Kingston Upon Hull, UK & University of York, York, UK
| | - Anna Casey
- Brighton and Sussex Medical School, Brighton, UK
| | - Aqua Asif
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Halimah Khalil
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nermin Badwi
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rakesh Patel
- Medical Education Centre, School of Medicine, University of Nottingham, Nottingham, UK
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Atiomo W, Mbaki Y, Bhardwaj K, Hagan P. Academic attainment in international medical students might be optimised by educating them about cognitive load theory. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:90-91. [PMID: 35383573 PMCID: PMC9017506 DOI: 10.5116/ijme.6238.4dfd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Affiliation(s)
- William Atiomo
- College of Medicine, Mohamed Bin Rashid University (MBRU), Dubai, UAE
| | - Yvonne Mbaki
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Pamela Hagan
- School of Medicine, University of Nottingham, Nottingham, UK
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Rutledge M, Link K, Zapata I, Carter S. Medical student confidence when training for a female genitourinary exam using models and standardized patients. J Obstet Gynaecol Res 2022; 48:1466-1474. [PMID: 35272394 DOI: 10.1111/jog.15222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
AIM The purpose of this study is to investigate what factors make students feel confident and competent when performing a female genitourinary exam (FGUE) with normal, nonpathologic findings. We anticipated that students would increase their confidence and perceived competence from the first year to the second year of medical school, would prefer the use of specialized standardized patients (SSPs) over models, and that the results would vary by student demographics. METHODS Student confidence and perceived competence were measured using voluntary survey methods pre- and postinterventions. Interventions were defined as learning the FGUE on models alone for first-year medical students and learning the FGUE on SSPs with prior experience using models for second-year students. Survey responses were evaluated via generalized linear mixed models for numeric responses. RESULTS The results demonstrated that first- and second-year medical students of racial and ethnic minorities rated themselves as more confident and competent than Caucasian counterparts, which was in many cases more extensive than the effect of an additional year of medical education. Students felt that using SSPs alone was the best mode of learning the exam than either models alone or the combination of models and SSPs. Students' current specialty of choice did not correlate with increased confidence or perceived competence. CONCLUSION This study highlights how cultural differences have an impact on confidence and perceived competence in medical students as they prepare for performing a procedure as intimate to the patient as the FGUE.
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Affiliation(s)
- Mallory Rutledge
- Office of Simulation in Medicine and Surgery, Rocky Vista University, Parker, CO, USA
| | - Kelsey Link
- Office of Simulation in Medicine and Surgery, Rocky Vista University, Parker, CO, USA
| | - Isain Zapata
- Department of Biomedical Sciences, Rocky Vista University, Parker, CO, USA
| | - Susan Carter
- Office of Simulation in Medicine and Surgery, Rocky Vista University, Parker, CO, USA
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Fyfe M, Horsburgh J, Blitz J, Chiavaroli N, Kumar S, Cleland J. The do's, don'ts and don't knows of redressing differential attainment related to race/ethnicity in medical schools. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:1-14. [PMID: 34964930 PMCID: PMC8714874 DOI: 10.1007/s40037-021-00696-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Systematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different socio-demographic groups. This paper reviews the international evidence on differential attainment related to ethnicity/race in medical school, drawing together the key messages from research to date to provide guidance for educators to operationalize and enact change and identify areas for further research. METHODS Authors first identified areas of conceptual importance within differential attainment (learning, assessment, and systems/institutional factors) which were then the focus of a targeted review of the literature on differential attainment related to ethnicity/race in medical education and, where available and relevant, literature from higher education more generally. Each author then conducted a review of the literature and proposed guidelines based on their experience and research literature. The guidelines were iteratively reviewed and refined between all authors until we reached consensus on the Do's, Don'ts and Don't Knows. RESULTS We present 13 guidelines with a summary of the research evidence for each. Guidelines address assessment practices (assessment design, assessment formats, use of assessments and post-hoc analysis) and educational systems and cultures (student experience, learning environment, faculty diversity and diversity practices). CONCLUSIONS Differential attainment related to ethnicity/race is a complex, systemic problem reflective of unequal norms and practices within broader society and evident throughout assessment practices, the learning environment and student experiences at medical school. Currently, the strongest empirical evidence is around assessment processes themselves. There is emerging evidence of minoritized students facing discrimination and having different learning experiences in medical school, but more studies are needed. There is a pressing need for research on how to effectively redress systemic issues within our medical schools, particularly related to inequity in teaching and learning.
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Affiliation(s)
- Molly Fyfe
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Jo Horsburgh
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
- Centre for Higher Education Research and Scholarship, Imperial College London, London, UK
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Sonia Kumar
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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Curtis S, Mozley H, Langford C, Hartland J, Kelly J. Challenging the deficit discourse in medical schools through reverse mentoring-using discourse analysis to explore staff perceptions of under-represented medical students. BMJ Open 2021; 11:e054890. [PMID: 34952883 PMCID: PMC9066338 DOI: 10.1136/bmjopen-2021-054890] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Despite the increasing diversity of UK medical students, students from low-socioeconomic backgrounds, some minority groups and members of communities with protected identities remain under-represented in medicine. In trying to ascertain why this under-representation persists, literature focuses on the barriers and challenges faced by under-represented students as opposed to the institution's responsibility to remove or mitigate these obstacles. One UK University created a reverse mentoring scheme enabling students to mentor senior members of the medical faculty to help them understand the perspectives and experiences of students from minority backgrounds. This paper explores whether changes in staff perceptions of under-represented students resulted from engaging with reverse mentoring. METHODS This qualitative study explored the impact of the reverse mentoring scheme. Staff mentees were required to write a narrative text about the Higher Education journey of an under-represented medical student before and after the reverse mentoring intervention. These texts were compared using discourse analysis to identify shifts in language use that demonstrated a change in perceptions. RESULTS The key themes from five senior staff members indicate a positive change in staff characterisation of the students and an acceptance of institutional responsibility for challenges faced. Initial texts revealed a superficial understanding of the student journey that focused on individual deficit but had fairy tale endings depicting the medical school as benevolent. The follow-up texts revealed a deeper understanding reflected by the portrayal of students as capable agents and containing pragmatic endings acknowledging the responsibility of the medical school. CONCLUSION These findings highlight how removed senior staff can be from the reality of the student experience and that engaging with reverse mentoring helps to raise awareness and challenges the students face. This suggests a route for constructive change in medical schools and endorses the benefits of facilitating open discussion around educational inequity.
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Affiliation(s)
- Sally Curtis
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Heather Mozley
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Chloe Langford
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | | | - Jacquie Kelly
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
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Motie LZ, Kaini S. Response to: viva la VOSCE? BMC MEDICAL EDUCATION 2021; 21:527. [PMID: 34635101 PMCID: PMC8504427 DOI: 10.1186/s12909-021-02941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
Boyle et al. discuss the development and implementation of a Virtual Objective Structured Clinical Examination due to the COVID-19 pandemic lockdown precluding face-to-face Objective Structured Clinical Examinations, something we too as clinical medical students studying at University College London have experienced. We commend Boyle et al. for promptly creating and delivering this assessment. However, we believe this style of assessment has the potential to exacerbate the ethnic and social inequalities that currently exist within medical education. Going forward, it is imperative that the home environment is considered in an attempt to level the playing field.
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Affiliation(s)
| | - Shahil Kaini
- University College London (UCL), Gower St, London, UK
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King E, Norman EJ, Mossop LH, Cobb KA, Matthew SM, Scholz EC, Schull DN. Qualitative Research in Veterinary Medical Education: Part 1-Principles of Qualitative Design. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021; 48:511-518. [PMID: 34570686 DOI: 10.3138/jvme-2019-0101-p1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Qualitative methodologies are relative newcomers to health sciences education research. While they may look very different to their quantitative counterparts in terms of size and scope, when well-applied they offer a fresh perspective and generate valuable research findings. Although qualitative research is being increasingly conducted in veterinary medical education, there are few contextualized resources to assist those who would like to develop their expertise in this area. In this article, we address this by introducing the principles of qualitative research design in a veterinary medical education context. Drawing from a range of contemporary resources, we explore the types of research goals and questions that are amenable to qualitative inquiry and discuss the process of formulating a worthwhile research question. We explain what research paradigms are and introduce readers to some of the methodological options available to them in qualitative research. Examples from veterinary medical education are used to illustrate key points. In a second companion article, we will focus on the decisions that need to be made regarding data sampling, collection, and analysis. We will also consider how qualitative research is evaluated, and discuss how qualitative findings are applied. Taken together, the two articles build an understanding of qualitative research, illuminate its potential to contribute to the scholarship of teaching and learning in veterinary medical education, and equip readers with an improved capacity to appraise its value.
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Cramer L. Alternative strategies for closing the award gap between white and minority ethnic students. eLife 2021; 10:58971. [PMID: 34344502 PMCID: PMC8337073 DOI: 10.7554/elife.58971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
In the United Kingdom, undergraduate students from Black, Asian and other minority ethnic backgrounds receive lower classes of degrees than white students, and similar gaps have been reported in other countries. Such award gaps limit ethnic diversity in academic research, and in the broader job market. Whilst there has been some success in reducing the award gap in the UK, a significant gap still persists. Here, based on an analysis of students studying cell biology at University College London, I show that differences in performance at exams contribute significantly more to the award gap than differences in performance in coursework. From these data, plus scrutiny of the literature, alternative policies are identified to speed up the closure of the award gap and to remove the barriers that prevent students from Black, Asian and other minority ethnic backgrounds from progressing to PhD and postdoctoral positions.
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Affiliation(s)
- Louise Cramer
- MRC Laboratory for Molecular Cell Biology, UCL, London, United Kingdom.,Department Cell and Developmental Biology, UCL, London, United Kingdom
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Coleman DM, Dossett LA, Dimick JB. Building high performing teams: Opportunities and challenges of inclusive recruitment practices. J Vasc Surg 2021; 74:86S-92S. [PMID: 34303464 DOI: 10.1016/j.jvs.2021.03.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Abstract
Healthcare is most effectively delivered by high-performance teams, which require, not simply talent, but also diversity in their members, supported by a culture of equity that is open, supportive, and inclusive. Cognitive diversity offers a performance advantage, improving collective understanding and optimizing high-complexity problem solving. Diverse teams have been shown to outperform homogenous team, and this diversity, supplemented with equity and inclusion, yields a superior creative culture. High-performance teams rest on a foundation of standardized and inclusive recruitment practices. Standard recruitment procedures have been insufficient in broadening representation owing to the long-standing inequities and exclusion in medicine. As such, we have highlighted the opportunities for inclusive recruitment practices.
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Affiliation(s)
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, Mich
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Tiffin PA, Paton LW. Differential attainment in the MRCPsych according to ethnicity and place of qualification between 2013 and 2018: a UK cohort study. Postgrad Med J 2020; 97:764-776. [PMID: 32883769 DOI: 10.1136/postgradmedj-2020-137913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/26/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE OF THE STUDY To explore if differential pass rates exist in the clinical component of the UK postgraduate clinical psychiatry exam, the Clinical Assessment of Skills and Competencies (CASC), according to ethnicity and place of qualification (UK vs EEA vs overseas graduates). STUDY DESIGN Observational study using data from the UK Medical Education Database for 2140 doctors sitting the CASC for the first time between 2013 and 2018. RESULTS After controlling for age, sex, time of sitting and performance in the written components of the MRCPsych, differences in CASC pass rates persisted between UK graduates self-identifying as Black and Minority Ethnicity (BME) and non-BME (OR for passing 0.36, 95% CI 0.23 to 0.56, p<0.001). Both EEA (OR 0.25, 0.15 to 0.40, p<0.001) and overseas graduates (OR 0.07, 0.05 to 0.11, p<0.001) were less likely to pass the CASC at first attempt, even after controlling for the influence of educational and background variables. These groups, on average, had lower scores on written exams with substantial content relating to procedural skills (eg, critical appraisal) rather than pure recall of factual knowledge. CONCLUSIONS Substantial differences exist in clinical examination performance between UK BME and non-BME candidates, as well as between UK and non-UK graduates. These differences are not explained by differing levels of clinical knowledge. In the interests of equality, this situation requires further investigation and remediation. Future research should focus on understanding how potential bias may be acting within different stages of recruitment, training and assessment within psychiatry.
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Affiliation(s)
- Paul A Tiffin
- Mental Health and Addictions Research Group, Department of Health Sciences,, University of York, York, UK .,Health Professions Education Unit, Hull York Medical School, York, UK
| | - Lewis W Paton
- Mental Health and Addictions Research Group, Department of Health Sciences,, University of York, York, UK
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Robinson DBT, Hopkins L, James OP, Brown C, Powell AGMT, Abdelrahman T, Hemington-Gorse S, Walsh L, Egan RJ, Lewis W. Egalitarianism in surgical training: let equity prevail. Postgrad Med J 2020; 96:650-654. [DOI: 10.1136/postgradmedj-2020-137563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 11/04/2022]
Abstract
This study aimed to quantify core surgical trainee (CST) differential attainment (DA) related to three cohorts; white UK graduate (White UKG) versus black and minority ethnic UKG (BME UKG) versus international medical graduates (IMGs). The primary outcome measures were annual review of competence progression (ARCP) outcome, intercollegiate Membership of the Royal College of Surgeons (iMRCS) examination pass and national training number (NTN) selection. Intercollegiate Surgical Curriculum Programme (ISCP) portfolios of 264 consecutive CSTs (2010–2017, 168 white UKG, 66 BME UKG, 30 IMG) from a single UK regional post graduate medical region (Wales) were examined. Data collected prospectively over an 8-year time period was analysed retrospectively. ARCP outcomes were similar irrespective of ethnicity or nationality (ARCP outcome 1, white UKG 60.7% vs BME UKG 62.1% vs IMG 53.3%, p=0.395). iMRCS pass rates for white UKG vs BME UKG vs IMG were 71.4% vs 71.2% vs 50.0% (p=0.042), respectively. NTN success rates for white UKG vs BME UKG vs IMG were 36.9% vs 36.4% vs 6.7% (p=0.023), respectively. On multivariable analysis, operative experience (OR 1.002, 95% CI 1.001 to 1.004, p=0.004), bootcamp attendance (OR 2.615, 95% CI 1.403 to 4.871, p=0.002), and UKG (OR 7.081, 95% CI 1.556 to 32.230, p=0.011), were associated with NTN appointment. Although outcomes related to BME DA were equitable, important DA variation was apparent among IMGs, with iMRCS pass 21.4% lower and NTN success sixfold less likely than UKG. Targeted counter measures are required to let equity prevail in UK CST programmes.
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Liu J, Guo S, Gao R, DiStefano C. Investigating school children’s behavioral and emotional problems using pediatric symptoms checklist-17 in a structural equation modeling framework. SCHOOL PSYCHOLOGY INTERNATIONAL 2020. [DOI: 10.1177/0143034320912301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Pediatric Symptom Checklist-17 was originally used in primary care settings with parents to identify their children’s behavioral and emotional problems, but there has been some research supporting use of this scale in school settings. This study examined: (a) the factor structure and measurement invariance of the teacher-rated Pediatric Symptom Checklist-17 and (b) complex relationships among demographic characteristics, behavioral and emotional problems, and learning outcomes using structural equation modeling in elementary schools. A sample of 508 children in grades one and two were rated by their teachers with the Pediatric Symptom Checklist-17. Measures of Academic Progress test was utilized to measure participants’ learning outcomes in reading and math. The results confirmed a three-factor structure of the Pediatric Symptom Checklist-17 (internalizing problems, externalizing problems, and attention problems) and attested the measurement invariance across different demographic groups (i.e. gender, ethnicity, and grade levels). Boys were more likely to have severe attention problems which were associated with lower learning outcomes as seen by Measures of Academic Progress reading and math scores. Attention problems mediated the relationship between gender and learning outcomes. This study has implications for the use of the Pediatric Symptom Checklist-17 in school-based settings. Additionally, it highlights the potential relationships among gender, attention problems, and learning outcomes.
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Affiliation(s)
- Jin Liu
- University of South Carolina, USA
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21
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Affiliation(s)
- Katherine Woolf
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital London, UK
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22
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Morrison N, Machado M, Blackburn C. Student perspectives on barriers to performance for black and minority ethnic graduate-entry medical students: a qualitative study in a West Midlands medical school. BMJ Open 2019; 9:e032493. [PMID: 31784444 PMCID: PMC6924783 DOI: 10.1136/bmjopen-2019-032493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore graduate-entry medical students experiences of undergraduate training in the context of academic underperformance of medical students from ethnic minority backgrounds. DESIGN Qualitative study using semi-structured focus groups. SETTING A West Midlands medical school. PARTICIPANTS 24 graduate-entry MBChB students were recruited using volunteer and snowball sampling; all students self-identified as being from Black and Minority Ethnic (BME) backgrounds. RESULTS BME students reported facing a range of difficulties, throughout their undergraduate medical training, that they felt impeded their learning and performance. Their relationships with staff and clinicians, though also identified as facilitators to learning, were also perceived to have hindered progress, as many students felt that a lack of BME representation and lack of understanding of cultural differences among staff impacted their experience. Students also reported a lack of trust in the institution's ability to support BME students, with many not seeking support. Students' narratives indicated that they had to mask their identity to fit in among their peers and to avoid negative stereotyping. Although rare, students faced overt racism from their peers and from patients. Many students reported feelings of isolation, reduced self-confidence and low self-esteem. CONCLUSIONS BME students in this study reported experiencing relationship issues with other students, academic and clinical staff, lack of trust in the institution and some racist events. Although it is not clear from this small study of one institution whether these findings would be replicated in other institutions, they nevertheless highlight important issues to be considered by the institution concerned and other institutions. These findings suggest that all stakeholders of graduate-entry undergraduate medical education should reflect on the current institutional practices intended to improve student-peer and student-staff relationships. Reviewing current proposals intended to diversify student and staff populations as well as evaluating guidance on tackling racism is likely to be beneficial.
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Affiliation(s)
- Nariell Morrison
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Michelle Machado
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Clare Blackburn
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
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What moderates the attainment gap? The effects of social identity incompatibility and practical incompatibility on the performance of students who are or are not Black, Asian or Minority Ethnic. SOCIAL PSYCHOLOGY OF EDUCATION 2019. [DOI: 10.1007/s11218-019-09531-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Abstract
A successful journey through higher education is, for many, a once in a lifetime opportunity for social mobility. Unfortunately, one notable feature of higher education systems is that students from some backgrounds do not achieve the same academic attainments as do others. The current study tests the role of one particular set of processes: social identity (in)compatibility on academic performance. Participants were recruited at two time points from a pool of first year undergraduates at a modern London University (N = 215) of which 40.1% were classed as Black, Asian or Minority Ethnic (BAME), 57.1% as non-BAME and 2.8% did not provide this information. A prospective design was employed: Alongside demographic data, measures at the start of the academic year consisted of measures of student and ethnic identity, and both practical and identity incompatibility. At the end of the academic year, average marks achieved were gained for each student from the university’s registry system. Results indicate that BAME students had equal levels of student identity to non-BAME students, but higher levels of ethnic identity. They also typically experienced higher levels of both practical and identity incompatibility. Finally, BAME students had lower attainment than did non-BAME students. Both practical and identity incompatibility appeared to moderate this effect. However, contrary to predictions, it was only under conditions of low and medium levels of incompatibility that BAME students attained lower marks than their non-BAME peers. The theoretical and practical implications of these findings are discussed.
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24
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The challenges of understanding differential attainment in postgraduate medical education. Br J Gen Pract 2019; 69:426-427. [PMID: 31467003 DOI: 10.3399/bjgp19x705161] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Smyth L, Mavor KI, Gray LR. Not just who you are, but who you were before: Social identification, identity incompatibility, and performance‐undermining learning behaviour in higher education. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2019. [DOI: 10.1002/casp.2413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lillian Smyth
- Medical Education UnitAustralian National University Canberra ACT Australia
| | - Kenneth I. Mavor
- School of Psychology and NeuroscienceUniversity of St Andrews St Andrews UK
| | - Louie R. Gray
- School of Psychology and NeuroscienceUniversity of St Andrews St Andrews UK
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de Jong EM, Koomen HMY, Jellesma FC, Roorda DL. Teacher and child perceptions of relationship quality and ethnic minority children's behavioral adjustment in upper elementary school: A cross-lagged approach. J Sch Psychol 2018; 70:27-43. [PMID: 30340701 DOI: 10.1016/j.jsp.2018.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/30/2018] [Accepted: 06/22/2018] [Indexed: 11/17/2022]
Abstract
In this study, cross-lagged longitudinal modeling was used to examine associations between teacher-child relationship quality and children's behavioral adjustment in a sample of sixth grade ethnic minority children. In comparison to previous cross-lagged studies, children were older and cross-informant models were used. Both teachers (N = 12) and children (N = 226) reported on the relationship quality (Closeness, Conflict, and Dependency or Negative Expectations), and children's behavioral adjustment (Externalizing Problems, Internalizing Problems, and Prosocial Behavior) at the beginning and the end of the school year. Children's externalizing behavior at the beginning of the school year was consistently and positively associated with conflict at the end of the school year. Interestingly, dependency at time 1 was associated with children's behavioral adjustment at time 2, whereas for closeness and conflict associations were the other way around (i.e., children's behavior at time 1 was associated with teacher-child closeness and conflict at time 2). Taken together, our results seem to indicate that bidirectional associations between teacher-child relationships and behavioral adjustment apply to older, ethnic minority children as well.
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Affiliation(s)
- Elisabeth M de Jong
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15776, NL-1001 NG Amsterdam, the Netherlands.
| | - Helma M Y Koomen
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15776, NL-1001 NG Amsterdam, the Netherlands.
| | - Francine C Jellesma
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15776, NL-1001 NG Amsterdam, the Netherlands.
| | - Debora L Roorda
- Research Institute of Child Development and Education, University of Amsterdam, P.O. Box 15776, NL-1001 NG Amsterdam, the Netherlands.
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Teherani A, Hauer KE, Fernandez A, King TE, Lucey C. How Small Differences in Assessed Clinical Performance Amplify to Large Differences in Grades and Awards: A Cascade With Serious Consequences for Students Underrepresented in Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1286-1292. [PMID: 29923892 DOI: 10.1097/acm.0000000000002323] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
While students entering medical schools are becoming more diverse, trainees in residency programs in competitive specialties and academic medicine faculty have not increased in diversity. As part of an educational continuous quality improvement process at the University of California, San Francisco, School of Medicine, the authors examined data for the classes of 2013-2016 to determine whether differences existed between underrepresented in medicine (UIM) and not-UIM students' clinical performance (clerkship director ratings and number of clerkship honors grades awarded) and honor society membership-all of which influence residency selection and academic career choices.This analysis demonstrated differences that consistently favored not-UIM students. Whereas the size and magnitude of differences in clerkship director ratings were small, UIM students received approximately half as many honors grades as not-UIM students and were three times less likely to be selected for honor society membership.The authors use these findings to illustrate the amplification cascade, a phenomenon in which small differences in assessed performance lead to larger differences in grades and selection for awards. The amplification cascade raises concerns about opportunities for UIM students to compete successfully for competitive residency programs and potentially enter academic careers. Using a fishbone diagram, a continuous quality improvement root cause analysis tool, the authors contextualize their institutional results. They describe potential causes of group differences, drawing from the education disparities literature, and propose interventions and future research. They also share countermeasures adopted at their institution and encourage other medical schools to consider similar exploration of their institutional data.
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Affiliation(s)
- Arianne Teherani
- A. Teherani is professor, Department of Medicine, education researcher, Center for Faculty Educators, and director of program evaluation, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0003-2936-9832. K.E. Hauer is professor, Department of Medicine, and associate dean for assessment, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-8812-4045. A. Fernandez is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. T.E. King Jr is professor, Department of Medicine, and dean, University of California, San Francisco, School of Medicine, San Francisco, California. C. Lucey is professor of medicine and vice dean for education, University of California, San Francisco, School of Medicine, San Francisco, California
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Patterson F, Tiffin PA, Lopes S, Zibarras L. Unpacking the dark variance of differential attainment on examinations in overseas graduates. MEDICAL EDUCATION 2018; 52:736-746. [PMID: 29879301 DOI: 10.1111/medu.13605] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/22/2017] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Differential performance in postgraduate examinations between home medical graduates and those who qualified outside their country of practice is well recognised. This difference is especially marked in the practical component of the UK Membership of the Royal College of General Practitioners (MRCGP) examination. The potential causes of such disparities are not well understood. METHODS Data were available for 1874 international medical graduates who applied for general practice (GP) specialty training in the UK in 2008-2012. The primary outcome was performance in the Clinical Skills Assessment (CSA) OSCE component of the MRCGP. The main predictors were performance on a situational judgement test (SJT) and clinical problem-solving test (CPST), a test of applied clinical knowledge, used in the selection for GP training. Data relating to demographic characteristics and English language fluency were also available. To better understand the relationship between the predictors, the selection measures and the outcome, a series of univariable and multivariable models were developed and tested, concluding with a structural equation model to explore causality. RESULTS The CSA rating was more strongly predicted by SJT scores (standardised beta, 0.26) than by performance on the CPST (standardised beta, 0.17). There was a relationship between English language fluency and CSA score that was mainly mediated via SJT performance. CONCLUSIONS These findings demonstrate that performance on an SJT predicts performance in a high-fidelity clinical simulation (the CSA) in international medical graduates. Although the constructs tested by SJTs are debated, and are likely to vary across settings, culturally appropriate knowledge of interpersonal competence is likely to be evaluated. Improving the confidence of doctors in this area through targeted educational interventions, rather than focusing on increased clinical knowledge, is likely to be more effective at reducing disparities observed in postgraduate examination performance. Thus, there are important implications for the design of specialty selection and licensing assessments globally.
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Affiliation(s)
| | - Paul A Tiffin
- Department of Health Sciences, Faculty of Science, University of York, York, UK
| | | | - Lara Zibarras
- Department of Psychology, City, University of London, London, UK
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Unwin E, Potts HWW, Dacre J, Elder A, Woolf K. Passing MRCP (UK) PACES: a cross-sectional study examining the performance of doctors by sex and country. BMC MEDICAL EDUCATION 2018; 18:70. [PMID: 29625566 PMCID: PMC5889582 DOI: 10.1186/s12909-018-1178-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/22/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND There is much discussion about the sex differences that exist in medical education. Research from the United Kingdom (UK) and United States has found female doctors earn less, and are less likely to be senior authors on academic papers, but female doctors are also less likely to be sanctioned, and have been found to perform better academically and clinically. It is also known that international medical graduates tend to perform more poorly academically compared to home-trained graduates in the UK, US, and Canada. It is uncertain whether the magnitude and direction of sex differences in doctors' performance is variable by country. We explored the association between doctors' sex and their performance at a large international high-stakes clinical examination: the Membership of the Royal Colleges of Physicians (UK) Practical Assessment of Clinical Examination Skills (PACES). We examined how sex differences varied by the country in which the doctor received their primary medical qualification, the country in which they took the PACES examination, and by the country in which they are registered to practise. METHODS Seven thousand six hundred seventy-one doctors attempted PACES between October 2010 and May 2013. We analysed sex differences in first time pass rates, controlling for ethnicity, in three groups: (i) UK medical graduates (N = 3574); (ii) non-UK medical graduates registered with the UK medical regulator, the General Medical Council (GMC), and thus likely to be working in the UK (N = 1067); and (iii) non-UK medical graduates without GMC registration and so legally unable to work or train in the UK (N = 2179). RESULTS Female doctors were statistically significantly more likely to pass at their first attempt in all three groups, with the greatest sex effect seen in non-UK medical graduates without GMC registration (OR = 1.99; 95% CI = 1.65-2.39; P < 0.0001) and the smallest in the UK graduates (OR = 1.18; 95% CI = 1.03-1.35; P = 0.02). CONCLUSIONS As found in a previous format of this examination and in other clinical examinations, female doctors outperformed male doctors. Further work is required to explore why sex differences were greater in non-UK graduates, especially those without GMC registration, and to consider how examination performance may relate to performance in practice.
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Affiliation(s)
- Emily Unwin
- Research Department of Medical Education, University College London Medical School, Royal Free Hospital, GF 664, Rowland Hill Street, London, NW3 2PF UK
| | - Henry W. W. Potts
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK
| | - Jane Dacre
- Research Department of Medical Education, University College London Medical School, Royal Free Hospital, GF 664, Rowland Hill Street, London, NW3 2PF UK
- Royal College of Physicians, 11 St Andrews Place, London, NW1 4LE UK
| | - Andrew Elder
- Royal College of Physicians, 11 St Andrews Place, London, NW1 4LE UK
| | - Katherine Woolf
- Research Department of Medical Education, University College London Medical School, Royal Free Hospital, GF 664, Rowland Hill Street, London, NW3 2PF UK
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Isik U, Wouters A, Ter Wee MM, Croiset G, Kusurkar RA. Motivation and academic performance of medical students from ethnic minorities and majority: a comparative study. BMC MEDICAL EDUCATION 2017; 17:233. [PMID: 29183363 PMCID: PMC5706443 DOI: 10.1186/s12909-017-1079-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/20/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Medical students from ethnic minorities underperform in knowledge and skills assessments both in pre-clinical and clinical education compared to the ethnic majority group. Motivation, which influences learning and academic performance of medical students, might play an important role in explaining these differences, but is under-investigated. This study aimed to compare two types of motivation (autonomous and controlled) of ethnic minority (Western and non-Western) and majority (Dutch) students, and their association with academic performance. METHODS In a cross-sectional study, all students of a Dutch medical school were invited to complete a survey including the Academic Self-Regulation Questionnaire, measuring autonomous and controlled motivation, in the academic year 2015-2016. Motivation was compared using Kruskal-Wallis test and performance was compared using One-Way ANOVA. Linear regression analysis was used to determine the association between motivation and performance (grade point average; GPA). RESULTS The response rate was 38.6% (n = 947). Autonomous motivation (AM) of non-Western students was higher than that of Dutch students in pre-clinical and clinical education (p < 0.05). Controlled motivation was higher in Western students than in Dutch students (pre-clinical education; p < 0.05). AM was associated with a higher GPA for Dutch (pre-clinical education; β = 0.33, p < 0.05) and Western students (clinical education; β = 0.57, p < 0.05) only. CONCLUSIONS Our results show significant differences in the type of motivation between the ethnic majority and minority groups. The association of motivation with performance also differs between ethnic groups. We found that AM has a positive influence on GPA. Further research is needed to uncover the underlying mechanisms.
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Affiliation(s)
- Ulviye Isik
- VUmc School of Medical Sciences, Research in Education, Amsterdam, the Netherlands.
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, the Netherlands.
- VUmc School of Medical Sciences, P.O. Box 7057, 1007, MB, Amsterdam, the Netherlands.
| | - Anouk Wouters
- VUmc School of Medical Sciences, Research in Education, Amsterdam, the Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, the Netherlands
| | - Marieke M Ter Wee
- Department of Epidemiology & Biostatistics, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Gerda Croiset
- VUmc School of Medical Sciences, Research in Education, Amsterdam, the Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, the Netherlands
| | - Rashmi A Kusurkar
- VUmc School of Medical Sciences, Research in Education, Amsterdam, the Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, the Netherlands
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Norris M, Hammond JA, Williams A, Grant R, Naylor S, Rozario C. Individual student characteristics and attainment in pre registration physiotherapy: a retrospective multi site cohort study. Physiotherapy 2017; 104:446-452. [PMID: 29352580 DOI: 10.1016/j.physio.2017.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 10/24/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Worldwide there is a desire to diversify the physiotherapy workforce. However, limited research indicates that some student characteristics linked to under-representation in pre registration physiotherapy education have lower attainment and greater attrition. This study explored the relationship between individual characteristics and success of students in pre registration physiotherapy education within South East England. DESIGN A retrospective multi site cohort study including pre registration physiotherapy programmes in the South East of England. Anonymised data included background information (age, gender, ethnicity, socio-economic status) and outcomes (assessment marks, type of award and classification of degree). Analysis involved Bayesian regression models and ordinal logistic regression to examine the association of student characteristics on outcomes. RESULTS Data from 1851 student records were collected from four institutions. There were significantly lower assessment scores for Asian (-11% 95% CI: -13.1 to -9.2), Black (-7%, 95% CI: -9.7 to -4.5) and Other/Mixed ethnicity groups (-5%, 95% CI: -7.1 to -2.4), most notable in clinical and observed assessments, compared to their White British colleagues. All BME groups also demonstrated worse odds for a one step lower overall award or no award (Black OR: 3.35, Asian OR: 3.97, Other OR: 2.03). Associations of learning disability, age and non-traditional entry routes with assessment scores and/or degree classification were also noted. CONCLUSION These findings suggest significant attainment gaps in pre registration physiotherapy education in this specific geographical region, particularly for non-White ethnic and disability groups. The association with assessment type challenges educators to look beyond a purely student deficit model to explore all factors that may lead to inequality.
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Affiliation(s)
- Meriel Norris
- Department of Clinical Sciences, Brunel University London, Kingston Lane, Uxbridge UB8 3PH, UK.
| | - John A Hammond
- Faculty of Health, Social Care and Education, Kingston University and St Georges University London, Cranmer Terrace, London SW17 0RE, UK
| | - Annabel Williams
- Department of Clinical Sciences, Brunel University London, Kingston Lane, Uxbridge UB8 3PH, UK
| | - Robert Grant
- Faculty of Health, Social Care and Education, Kingston University and St Georges University London, Cranmer Terrace, London SW17 0RE, UK
| | - Sandra Naylor
- Department of Clinical Sciences, Brunel University London, Kingston Lane, Uxbridge UB8 3PH, UK
| | - Catherine Rozario
- Department of Clinical Sciences, Brunel University London, Kingston Lane, Uxbridge UB8 3PH, UK
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Keren D, Lockyer J, Ellaway RH. Social studying and learning among medical students: a scoping review. PERSPECTIVES ON MEDICAL EDUCATION 2017; 6:311-318. [PMID: 28516340 PMCID: PMC5630528 DOI: 10.1007/s40037-017-0358-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Medical students study in social groups, which influence their learning, but few studies have investigated the characteristics of study groups and the impacts they have on students' learning. A scoping review was conducted on the topic of informal social studying and learning within medical education with the aim of appraising what is known regarding medical student attitudes to group study, the impact of group study on participants, and the methods that have been employed to study this. METHODS Using Arksey and O'Malley's scoping review principles, MEDLINE, EMBASE and CINAHL were searched, along with hand-searching and a targeted search of the grey literature; 18 peer reviewed and 17 grey literature records were included. RESULTS Thematic conceptual analysis identified a number of themes, including: the nature of group study; the utility and value of group studying including social learning facilitating student engagement, social learning as a source of motivation and accountability, and social learning as a source of wellbeing; and student preferences related to group studying, including its homophilic nature, transgressiveness, and effectiveness. Despite these emerging factors, the evidence base for this phenomenon is small. DISCUSSION The findings in this scoping review demonstrate a clear role for social interaction outside of the classroom, and encourage us to consider the factors in student networking, and the implications of this on medical students' academics. We also highlight areas in need of future research to allow us to better situate informal social learning within medical education and to enable educators to support this phenomenon.
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Affiliation(s)
- Daniela Keren
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Jocelyn Lockyer
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rachel H Ellaway
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Wikaire E, Curtis E, Cormack D, Jiang Y, McMillan L, Loto R, Reid P. Predictors of academic success for Māori, Pacific and non-Māori non-Pacific students in health professional education: a quantitative analysis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:299-326. [PMID: 28236125 DOI: 10.1007/s10459-017-9763-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 01/30/2017] [Indexed: 06/06/2023]
Abstract
Tertiary institutions internationally aim to increase student diversity, however are struggling to achieve equitable academic outcomes for indigenous and ethnic minority students and detailed exploration of factors that impact on success is required. This study explored the predictive effect of admission variables on academic outcomes for health professional students by ethnic grouping. Kaupapa Māori and Pacific research methodologies were used to conduct a quantitative analysis using data for 2686 health professional students [150 Māori, 257 Pacific, 2279, non-Māori non-Pacific (nMnP)]. The predictive effect of admission variables: school decile; attending school in Auckland; type of admission; bridging programme; and first-year bachelor results on academic outcomes: year 2-4 grade point average (GPA); graduating; graduating in the minimum time; and optimal completion for the three ethnic groupings and the full cohort was explored using multiple regression analyses. After adjusting for admission variables, for every point increase in first year bachelor GPA: year 2-4 GPA increased by an average of 0.46 points for Māori (p = 0.0002, 95% CI 0.22, 0.69), 0.70 points for Pacific (p < 0.0001, CI 0.52, 0.87), and 0.55 points for nMnP (p < 0.0001, CI 0.51, 0.58) students. For the total cohort, ethnic grouping was consistently the most significant predictor of academic outcomes. This study demonstrated clear differences in academic outcomes between both Māori and Pacific students when compared to nMnP students. Some (but not all) of the disparities between ethnic groupings could be explained by controlling for admission variables.
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Affiliation(s)
- Erena Wikaire
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Elana Curtis
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Donna Cormack
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of Science, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Louise McMillan
- Department of Statistics, Faculty of Science, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Rob Loto
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
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Sandars J. When I say … critical pedagogy. MEDICAL EDUCATION 2017; 51:351-352. [PMID: 27885702 DOI: 10.1111/medu.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/23/2016] [Accepted: 06/29/2016] [Indexed: 06/06/2023]
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Stegers-Jager KM, Brommet FN, Themmen APN. Ethnic and social disparities in different types of examinations in undergraduate pre-clinical training. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:1023-1046. [PMID: 27015959 PMCID: PMC5119835 DOI: 10.1007/s10459-016-9676-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/03/2016] [Indexed: 05/10/2023]
Abstract
Medical schools are increasingly faced with a more diverse student population. Generally, ethnic minority students are reported to underperform compared with those from the ethnic majority. However, there are inconsistencies in findings in different types of examinations. Additionally, little is known about the performance of first-generation university students and about performance differences across ethnic minority groups. This study aimed to investigate underperformance across ethnic minority groups and by first-generation university students in different types of written tests and clinical skills examinations during pre-clinical training. A longitudinal prospective cohort study of progress on a 3-year Dutch Bachelor of Medicine course was conducted. Participants included 2432 students who entered the course over a consecutive 6-year period (2008-2013). Compared with Dutch students, the three non-Western ethnic minority groups (Turkish/Moroccan/African, Surinamese/Antillean and Asian) underperformed in the clinical problem solving tests, the language test and the OSCEs. Findings on the theoretical end-of-block tests and writing skills tests, and results for Western minority students were less consistent. Age, gender, pre-university grade point average and additional socio-demographic variables (including first-generation university student, first language, and medical doctor parent) could explain the ethnicity-related differences in theoretical examinations, but not in language, clinical and writing skills examinations. First-generation university students only underperformed in the language test. Apparently, underperformance differs both across ethnic subgroups and between different types of written and clinical examinations. Medical schools should ensure their assessment strategies create a level playing field for all students and explore reasons for underperformance in the clinical and writing skills examinations.
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Affiliation(s)
- K M Stegers-Jager
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Centre Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, Netherlands.
| | - F N Brommet
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Centre Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, Netherlands
| | - A P N Themmen
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Centre Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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Attrill S, McAllister S, Lincoln M. Predictors of professional placement outcome: cultural background, English speaking and international student status. PERSPECTIVES ON MEDICAL EDUCATION 2016; 5:222-30. [PMID: 27492321 PMCID: PMC4978641 DOI: 10.1007/s40037-016-0289-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Placements provide opportunities for students to develop practice skills in professional settings. Learning in placements may be challenging for culturally and linguistically diverse (CALD) students, international students, or those without sufficient English proficiency for professional practice. This study investigated whether these factors, which are hypothesized to influence acculturation, predict poor placement outcome. Placement outcome data were collected for 854 students who completed 2747 placements. Placement outcome was categorized into 'Pass' or 'At risk' categories. Multilevel binomial regression analysis was used to determine whether being CALD, an international student, speaking 'English as an additional language', or a 'Language other than English at home' predicted placement outcome. In multiple multilevel analysis speaking English as an additional language and being an international student were significant predictors of 'at risk' placements, but other variables tested were not. Effect sizes were small indicating untested factors also influenced placement outcome. These results suggest that students' English as an additional language or international student status influences success in placements. The extent of acculturation may explain the differences in placement outcome for the groups tested. This suggests that learning needs for placement may differ for students undertaking more acculturative adjustments. Further research is needed to understand this and to identify placement support strategies.
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de Jong EM, Jellesma FC, Koomen HMY, de Jong PF. A Values-Affirmation Intervention Does Not Benefit Negatively Stereotyped Immigrant Students in the Netherlands. Front Psychol 2016; 7:691. [PMID: 27242604 PMCID: PMC4864537 DOI: 10.3389/fpsyg.2016.00691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/25/2016] [Indexed: 11/13/2022] Open
Abstract
Previous research showed that a values-affirmation intervention can help reduce the achievement gap between African American and European American students in the US. In the present study, it was examined if these results would generalize to ethnic minority students in a country outside the US, namely the Netherlands, where there is also an achievement gap between native and ethnic minority students. This type of intervention was tested in two separate studies, the first among first-year pre-vocational students (n = 361, 84% ethnic minority), and the second among sixth grade students (n = 290, 96% ethnic minority). Most minority participants had a Turkish-Dutch or Moroccan-Dutch immigrant background. In the second study, a third condition was added to the original paradigm, in which students elaborated on either their affirmation- or a control exercise with the help of a teaching assistant. We also examined whether values affirmation affected the level of problem behavior of negatively stereotyped ethnic minority youth. Contrary to what was expected, multilevel analyses revealed that the intervention had no effect on the school achievement or the problem behavior of the ethnic minority students. Possible explanations for these findings, mainly related to contextual and cultural differences between the Netherlands and the US, are discussed.
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Affiliation(s)
- Elisabeth M. de Jong
- Research Institute of Child Development and Education, University of AmsterdamAmsterdam, Netherlands
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Gill D. The association between trainee demographic factors and self-reported experience: Analysis of General Medical Council National Training Survey 2014 and 2015 data. JRSM Open 2016; 7:2054270416632705. [PMID: 27066263 PMCID: PMC4821398 DOI: 10.1177/2054270416632705] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives To investigate whether demographic factors are associated with self-reported experience amongst medical trainees in the UK. Design Retrospective analysis of survey data. Setting General Medical Council (UK) National Training Survey data for 2014 and 2015. Participants A total of 105,549 responses were provided from 68,551 participants when no data were removed. After removing data to preserve participant anonymity, there were 64,278 participants providing 99,076 responses. Main outcome measures Considered trainee factors were gender, ethnicity, country of primary medical qualification, grade, post specialty and deanery. Self-reported outcome measures were ‘overall satisfaction’, ‘adequate experience’, ‘workload’, ‘clinical supervision’, ‘educational supervision’, and ‘access to educational resources’. Results The experience of medical trainees across various indicators is differentially related to gender, ethnicity, country of primary medical qualification, grade, post specialty and deanery. Conclusions It is demonstrated here that trainee factors are associated with subjective experience across different indicators. Further work is required to explore the reasons behind this, and how this relates to trainee quality of life, work performance and career progression.
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Affiliation(s)
- Dipender Gill
- Imperial College London, Postgraduate Centre, Hammersmith Hospital, London W12 0HS, UK
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O'Reilly SL, Milner J. Supporting culturally and linguistically diverse students during clinical placement: strategies from both sides of the table. BMC MEDICAL EDUCATION 2015; 15:175. [PMID: 26466673 PMCID: PMC4606548 DOI: 10.1186/s12909-015-0458-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 10/05/2015] [Indexed: 05/05/2023]
Abstract
BACKGROUND Increasing proportions of Culturally and Linguistically Diverse (CALD) students within health professional courses at universities creates challenges in delivering inclusive training and education. Clinical placements are a core component of most health care degrees as they allow for applied learning opportunities. A research gap has been identified in regard to understanding challenges and strategies for CALD students in health professional placements. METHODS A key stakeholder approach was used to examine barriers and enablers experienced by CALD students in clinical placement. Semi-structured focus groups with healthcare students (n = 13) and clinical placement supervisors (n = 12) were employed. The focus groups were analysed using open coding and thematic analysis. RESULTS Three main barrier areas were identified: placement planning and preparation; teaching, assessment and feedback; and cultural and language issues. Potential solutions included addressing placement planning and preparation barriers, appropriate student placement preparation, pre-placement identification of higher risk CALD students, and diversity training for supervisors. For the barrier of teaching, assessment & feedback, addressing strategies were to: adapt student caseloads, encourage regular casual supervisor-student conversations, develop supportive placement delivery modes and structures, set expectations early, model the constructive feedback process, use visual aids, and tailor the learning environment to individual student needs. The enablers for cultural & language issues were to: build language and practical approaches for communication, raise awareness of the healthcare system (how it interacts with healthcare professions and how patients access it), and initiate mentoring programs. CONCLUSIONS The findings suggest that teaching and learning strategies should be student-centred, aiming to promote awareness of difference and its impacts then develop appropriate responses by both student and teacher. Universities and partnering agencies, such as clinical training providers, need to provide an inclusive learning environment for students from multiple cultural backgrounds.
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Affiliation(s)
- Sharleen L O'Reilly
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Julia Milner
- International Business School Suzhou, Xi'an Jiaotong-Liverpool University, 111 Ren Ai Road, Dushu Lake Higher Education Town, Suzhou Industrial Park, Suzhou, Jiangsu, 215123, China.
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McClelland GT, Horne M, Dearnley C, Raynsford J, Irving D. Experiences and Outcomes Among Undergraduate Health Professional Higher Education Students With Protected Characteristics: Disability, Gender, and Ethnicity. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/jpoc.21168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mehdizadeh L, Sturrock A, Dacre J. Are the General Medical Council's Tests of Competence fair to long standing doctors? A retrospective cohort study. BMC MEDICAL EDUCATION 2015; 15:80. [PMID: 25896823 PMCID: PMC4453964 DOI: 10.1186/s12909-015-0362-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 04/07/2015] [Indexed: 05/24/2023]
Abstract
BACKGROUND The General Medical Council's Fitness to Practise investigations may involve a test of competence for doctors with performance concerns. Concern has been raised about the suitability of the test format for doctors who qualified before the introduction of Single Best Answer and Objective Structured Clinical Examination assessments, both of which form the test of competence. This study explored whether the examination formats used in the tests of competence are fair to long standing doctors who have undergone fitness to practise investigation. METHODS A retrospective cohort design was used to determine an association between year of primary medical qualification and doctors' test of competence performance. Performance of 95 general practitioners under investigation was compared with a group of 376 volunteer doctors. We analysed performance on knowledge test, OSCE overall, and three individual OSCE stations using Spearman's correlation and regression models. RESULTS Doctors under investigation performed worse on all test outcomes compared to the comparison group. Qualification year correlated positively with performance on all outcomes except for physical examination (e.g. knowledge test r = 0.48, p < 0.001 and OSCE r = 0.37, p < 0.001). Qualification year was associated with test performance in doctors under investigation even when controlling for sex, ethnicity and qualification region. Regression analyses showed that qualification year was associated with knowledge test, OSCE and communication skills performance of doctors under investigation when other variables were controlled for. Among volunteer doctors this was not the case and their performance was more strongly related to where they qualified and their ethnic background. Furthermore, volunteer doctors who qualified before the introduction of Single Best Answer and OSCE assessments, still outperformed their peers under investigation. CONCLUSIONS Earlier graduates under fitness to practise investigation performed less well on the test of competence than their more recently qualified peers under investigation. The performance of the comparator group tended to stay consistent irrespective of year qualified. Our results suggest that the test format does not disadvantage early qualified doctors. We discuss findings in relation to the GMC's fitness to practise procedures and suggest alternative explanations for the poorer performance of long standing doctors under investigation.
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Affiliation(s)
- Leila Mehdizadeh
- Division of UCL Medical School, University College London, Royal Free Hospital, room GF/664, Hampstead, London, NW3 2PF, UK.
| | - Alison Sturrock
- Division of UCL Medical School, University College London, Royal Free Hospital, room GF/664, Hampstead, London, NW3 2PF, UK.
| | - Jane Dacre
- Royal College of Physicians, London, UK.
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Woolf K, Elton C, Newport M. The specialty choices of graduates from Brighton and Sussex Medical School: a longitudinal cohort study. BMC MEDICAL EDUCATION 2015; 15:46. [PMID: 25889968 PMCID: PMC4365809 DOI: 10.1186/s12909-015-0328-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 02/25/2015] [Indexed: 05/25/2023]
Abstract
BACKGROUND Since 2007 junior doctors in the UK have had to make major career decisions at a point when previously many had not yet chosen a specialty. This study examined when doctors in this new system make specialty choices, which factors influence choices, and whether doctors who choose a specialty they were interested in at medical school are more confident in their choice than those doctors whose interests change post-graduation. METHODS Two cohorts of students in their penultimate year at one medical school (n = 227/239) were asked which specialty interested them as a career. Two years later, 210/227 were sent a questionnaire measuring actual specialty chosen, confidence, influence of perceptions of the specialty and experiences on choice, satisfaction with medicine, personality, self-efficacy, and demographics. Medical school and post-graduation choices in the same category were deemed 'stable'. Predictors of stability, and of not having chosen a specialty, were calculated using bootstrapped logistic regression. Differences between specialties on questionnaire factors were analysed. RESULTS 50% responded (n = 105/277; 44% of the 239 Year 4 students). 65% specialty choices were 'stable'. Factors univariately associated with stability were specialty chosen, having enjoyed the specialty at medical school or since starting work, having first considered the specialty earlier. A regression found doctors who chose psychiatry were more likely to have changed choice than those who chose general practice. Confidence in the choice was not associated with stability. Those who chose general practice valued lifestyle factors. A psychiatry choice was associated with needing a job and using one's intellect to help others. The decision to choose surgical training tended to be made early. Not having applied for specialty training was associated with being lower on agreeableness and conscientiousness. CONCLUSION Medical school experiences are important in specialty choice but experiences post-graduation remain significant, particularly in some specialties (psychiatry in our sample). Career guidance is important at medical school and should be continued post-graduation, with senior clinicians supported in advising juniors. Careers advice in the first year post-graduation may be particularly important, especially for specialties which have difficulty recruiting or are poorly represented at medical school.
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Affiliation(s)
- Katherine Woolf
- University College London Medical School (UCLMS), Room GF/664, Royal Free Hospital, London, NW3 2PF, UK.
| | - Caroline Elton
- London Deanery, The Careers Unit, Room ST201, Stewart House, 32 Russell Square, London, WC1B 5DN, UK.
| | - Melanie Newport
- Brighton & Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, East Sussex BN1 9PX, UK.
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Green JA. The effect of English proficiency and ethnicity on academic performance and progress. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:219-28. [PMID: 24988998 DOI: 10.1007/s10459-014-9523-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 05/28/2014] [Indexed: 05/28/2023]
Abstract
Non-local ethnicity or nationality and lower English proficiency have been linked with poor performance in health professional education. This study sought to compare the relative contributions of ethnicity and English proficiency, and to do so in a context where students had not been selected via interviews or some other proxy for language proficiency. Ethnicity, citizenship, and demographic data, as well as academic performance and progress were obtained for three successive cohorts (entering in 2007, 2008 and 2009) into a three-year pharmacy programme, following a common first-year. Complete data was available for all 297 students entering via this path. By the end of the programme, controlling for grades at entry, students from some non-local ethnic backgrounds (p < .001) underperformed local students, as did males (p < .001) and those who had been identified as having low English proficiency in year 1 (p < .01). Males (p < .01) and one non-local ethnic group (p < .01) were also more likely to have to repeat a year of study. Ethnicity was a stronger predictor than English proficiency or acculturation, but English proficiency was still independently and additively predictive. This suggests that targeted support strategies for students with lower English language proficiency are still important, but that cultural differences should not be underestimated.
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Affiliation(s)
- James A Green
- School of Pharmacy, University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand,
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Sandars J, Sarojini Hart C. The capability approach for medical education: AMEE Guide No. 97. MEDICAL TEACHER 2015; 37:510-520. [PMID: 25697112 DOI: 10.3109/0142159x.2015.1013927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The capability approach, with its origins in economic and human development work, has a focus on the freedom of persons to make choices about how they wish to lead a valued life. There has been increasing recognition within general education that the capability approach offers a theoretical and practical framework to both implement and evaluate educational interventions that are designed to increase social justice, such as widening participation. There is great potential for the capability approach to also offer medical education a creative way for changing and evaluating curricula, with an emphasis on the teacher facilitating students to achieve their potential by recognising their aspirations and challenging the constraining factors to achieve their aspirations.
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Scior K, Bradley CE, Potts HWW, Woolf K, de C Williams AC. What predicts performance during clinical psychology training? BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 53:194-212. [PMID: 24206117 PMCID: PMC4153958 DOI: 10.1111/bjc.12035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 09/17/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES While the question of who is likely to be selected for clinical psychology training has been studied, evidence on performance during training is scant. This study explored data from seven consecutive intakes of the UK's largest clinical psychology training course, aiming to identify what factors predict better or poorer outcomes. DESIGN Longitudinal cross-sectional study using prospective and retrospective data. METHOD Characteristics at application were analysed in relation to a range of in-course assessments for 274 trainee clinical psychologists who had completed or were in the final stage of their training. RESULTS Trainees were diverse in age, pre-training experience, and academic performance at A-level (advanced level certificate required for university admission), but not in gender or ethnicity. Failure rates across the three performance domains (academic, clinical, research) were very low, suggesting that selection was successful in screening out less suitable candidates. Key predictors of good performance on the course were better A-levels and better degree class. Non-white students performed less well on two outcomes. Type and extent of pre-training clinical experience on outcomes had varied effects on outcome. Research supervisor ratings emerged as global indicators and predicted nearly all outcomes, but may have been biased as they were retrospective. Referee ratings predicted only one of the seven outcomes examined, and interview ratings predicted none of the outcomes. CONCLUSIONS Predicting who will do well or poorly in clinical psychology training is complex. Interview and referee ratings may well be successful in screening out unsuitable candidates, but appear to be a poor guide to performance on the course.
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Affiliation(s)
- Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College LondonUK
| | - Caroline E Bradley
- Research Department of Clinical, Educational and Health Psychology, University College LondonUK
| | - Henry W W Potts
- CHIME (Centre for Health Informatics & Multiprofessional Education), Institute of Epidemiology & Health Care, University College LondonUK
| | | | - Amanda C de C Williams
- Research Department of Clinical, Educational and Health Psychology, University College LondonUK
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Abstract
OBJECTIVES To assess whether international medical graduates passing the two examinations set by the Professional and Linguistic Assessments Board (PLAB1 and PLAB2) of the General Medical Council (GMC) are equivalent to UK graduates at the end of the first foundation year of medical training (F1), as the GMC requires, and if not, to assess what changes in the PLAB pass marks might produce equivalence. DESIGN Data linkage of GMC PLAB performance data with data from the Royal Colleges of Physicians and the Royal College of General Practitioners on performance of PLAB graduates and UK graduates at the MRCP(UK) and MRCGP examinations. SETTING Doctors in training for internal medicine or general practice in the United Kingdom. PARTICIPANTS 7829, 5135, and 4387 PLAB graduates on their first attempt at MRCP(UK) Part 1, Part 2, and PACES assessments from 2001 to 2012 compared with 18,532, 14,094, and 14,376 UK graduates taking the same assessments; 3160 PLAB1 graduates making their first attempt at the MRCGP AKT during 2007-12 compared with 14,235 UK graduates; and 1411 PLAB2 graduates making their first attempt at the MRCGP CSA during 2010-12 compared with 6935 UK graduates. MAIN OUTCOME MEASURES Performance at MRCP(UK) Part 1, Part 2, and PACES assessments, and MRCGP AKT and CSA assessments in relation to performance on PLAB1 and PLAB2 assessments, as well as to International English Language Testing System (IELTS) scores. MRCP(UK), MRCGP, and PLAB results were analysed as marks relative to the pass mark at the first attempt. RESULTS PLAB1 marks were a valid predictor of MRCP(UK) Part 1, MRCP(UK) Part 2, and MRCGP AKT (r=0.521, 0.390, and 0.490; all P<0.001). PLAB2 marks correlated with MRCP(UK) PACES and MRCGP CSA (r=0.274, 0.321; both P<0.001). PLAB graduates had significantly lower MRCP(UK) and MRCGP assessments (Glass's Δ=0.94, 0.91, 1.40, 1.01, and 1.82 for MRCP(UK) Part 1, Part 2, and PACES and MRCGP AKT and CSA), and were more likely to fail assessments and to progress more slowly than UK medical graduates. IELTS scores correlated significantly with later performance, multiple regression showing that the effect of PLAB1 (β=0.496) was much stronger than the effect of IELTS (β=0.086). Changes to PLAB pass marks that would result in international medical graduate and UK medical graduate equivalence were assessed in two ways. Method 1 adjusted PLAB pass marks to equate median performance of PLAB and UK graduates. Method 2 divided PLAB graduates into 12 equally spaced groups according to PLAB performance, and compared these with mean performance of graduates from individual UK medical schools, assessing which PLAB groups were equivalent in MRCP(UK) and MRCGP performance to UK graduates. The two methods produced similar results. To produce equivalent performance on the MRCP and MRGP examinations, the pass mark for PLAB1 would require raising by about 27 marks (13%) and for PLAB2 by about 15-16 marks (20%) above the present standard. CONCLUSIONS PLAB is a valid assessment of medical knowledge and clinical skills, correlating well with performance at MRCP(UK) and MRCGP. PLAB graduates' knowledge and skills at MRCP(UK) and MRCGP are over one standard deviation below those of UK graduates, although differences in training quality cannot be taken into account. Equivalent performance in MRCGP(UK) and MRCGP would occur if the pass marks of PLAB1 and PLAB2 were raised considerably, but that would also reduce the pass rate, with implications for medical workforce planning. Increasing IELTS requirements would have less impact on equivalence than raising PLAB pass marks.
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Affiliation(s)
- I C McManus
- UCL Medical School, University College London, London WC1E 6BT, UK
- Research Department of Clinical, Educational and Health Psychology, University College London
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Ferguson E, Semper H, Yates J, Fitzgerald JE, Skatova A, James D. The 'dark side' and 'bright side' of personality: when too much conscientiousness and too little anxiety are detrimental with respect to the acquisition of medical knowledge and skill. PLoS One 2014; 9:e88606. [PMID: 24586353 PMCID: PMC3937323 DOI: 10.1371/journal.pone.0088606] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/11/2014] [Indexed: 11/18/2022] Open
Abstract
Theory suggests that personality traits evolved to have costs and benefits, with the effectiveness of a trait dependent on how these costs and benefits relate to the present circumstances. This suggests that traits that are generally viewed as positive can have a ‘dark side’ and those generally viewed as negative can have a ‘bright side’ depending on changes in context. We test this in a sample of 220 UK medical students with respect to associations between the Big 5 personality traits and learning outcomes across the 5 years of a medical degree. The medical degree offers a changing learning context from pre-clinical years (where a more methodical approach to learning is needed) to the clinical years (where more flexible learning is needed, in a more stressful context). We argue that while trait conscientiousness should enhance pre-clinical learning, it has a ‘dark side’ reducing the acquisition of knowledge in the clinical years. We also suggest that anxiety has a ‘bright side’ enhancing the acquisition of skills in the clinical years. We also explore if intelligence enhances learning across the medical degree. Using confirmatory factor analysis and structural equation modelling we show that medical skills and knowledge assessed in the pre-clinical and clinical years are psychometrically distinguishable, forming a learning ‘backbone’, whereby subsequent learning outcomes are predicted by previous ones. Consistent with our predictions conscientiousness enhanced preclinical knowledge acquisition but reduced the acquisition of clinical knowledge and anxiety enhanced the acquisition of clinical skills. We also identified a curvilinear U shaped association between Surgency (extraversion) and pre-clinical knowledge acquisition. Intelligence predicted initial clinical knowledge, and had a positive total indirect effect on clinical knowledge and clinical skill acquisition. For medical selection, this suggests that selecting students high on conscientiousness may be problematic, as it may be excluding those with some degree of moderate anxiety.
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Affiliation(s)
- Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Heather Semper
- Centre for Health Psychology, Staffordshire University, Stoke on Trent, United Kingdom
| | - Janet Yates
- Medical Education Centre, University of Nottingham School of Medicine, Queen's Medical Centre, Nottingham, United Kingdom
| | | | - Anya Skatova
- Horizon Digital Economy Research, Nottingham University Innovation Park, Nottingham, United Kingdom
| | - David James
- Medical Education Centre, University of Nottingham School of Medicine, Queen's Medical Centre, Nottingham, United Kingdom
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Mehdizadeh L, Sturrock A, Myers G, Khatib Y, Dacre J. How well do doctors think they perform on the General Medical Council's Tests of Competence pilot examinations? A cross-sectional study. BMJ Open 2014; 4:e004131. [PMID: 24503300 PMCID: PMC3918998 DOI: 10.1136/bmjopen-2013-004131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate how accurately doctors estimated their performance on the General Medical Council's Tests of Competence pilot examinations. DESIGN A cross-sectional survey design using a questionnaire method. SETTING University College London Medical School. PARTICIPANTS 524 medical doctors working in a range of clinical specialties between foundation year two and consultant level. MAIN OUTCOME MEASURES Estimated and actual total scores on a knowledge test and Observed Structured Clinical Examination (OSCE). RESULTS The pattern of results for OSCE performance differed from the results for knowledge test performance. The majority of doctors significantly underestimated their OSCE performance. Whereas estimated knowledge test performance differed between high and low performers. Those who did particularly well significantly underestimated their knowledge test performance (t (196)=-7.70, p<0.01) and those who did less well significantly overestimated (t (172)=6.09, p<0.01). There were also significant differences between estimated and/or actual performance by gender, ethnicity and region of Primary Medical Qualification. CONCLUSIONS Doctors were more accurate in predicating their knowledge test performance than their OSCE performance. The association between estimated and actual knowledge test performance supports the established differences between high and low performers described in the behavioural sciences literature. This was not the case for the OSCE. The implications of the results to the revalidation process are discussed.
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Affiliation(s)
- Leila Mehdizadeh
- Division of UCL Medical School, University College London, London, UK
| | - Alison Sturrock
- Division of UCL Medical School, University College London, London, UK
| | - Gil Myers
- Division of UCL Medical School, University College London, London, UK
| | - Yasmin Khatib
- Barts and the London School of Medicine and Dentistry, Centre for Psychiatry, Queen Mary University of London, London, UK
| | - Jane Dacre
- Division of UCL Medical School, University College London, London, UK
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50
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McManus IC, Dewberry C, Nicholson S, Dowell JS, Woolf K, Potts HWW. Construct-level predictive validity of educational attainment and intellectual aptitude tests in medical student selection: meta-regression of six UK longitudinal studies. BMC Med 2013; 11:243. [PMID: 24229353 DOI: 10.1186/1741-7015-11-243/figures/5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/10/2013] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Measures used for medical student selection should predict future performance during training. A problem for any selection study is that predictor-outcome correlations are known only in those who have been selected, whereas selectors need to know how measures would predict in the entire pool of applicants. That problem of interpretation can be solved by calculating construct-level predictive validity, an estimate of true predictor-outcome correlation across the range of applicant abilities. METHODS Construct-level predictive validities were calculated in six cohort studies of medical student selection and training (student entry, 1972 to 2009) for a range of predictors, including A-levels, General Certificates of Secondary Education (GCSEs)/O-levels, and aptitude tests (AH5 and UK Clinical Aptitude Test (UKCAT)). Outcomes included undergraduate basic medical science and finals assessments, as well as postgraduate measures of Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) performance and entry in the Specialist Register. Construct-level predictive validity was calculated with the method of Hunter, Schmidt and Le (2006), adapted to correct for right-censorship of examination results due to grade inflation. RESULTS Meta-regression analyzed 57 separate predictor-outcome correlations (POCs) and construct-level predictive validities (CLPVs). Mean CLPVs are substantially higher (.450) than mean POCs (.171). Mean CLPVs for first-year examinations, were high for A-levels (.809; CI: .501 to .935), and lower for GCSEs/O-levels (.332; CI: .024 to .583) and UKCAT (mean = .245; CI: .207 to .276). A-levels had higher CLPVs for all undergraduate and postgraduate assessments than did GCSEs/O-levels and intellectual aptitude tests. CLPVs of educational attainment measures decline somewhat during training, but continue to predict postgraduate performance. Intellectual aptitude tests have lower CLPVs than A-levels or GCSEs/O-levels. CONCLUSIONS Educational attainment has strong CLPVs for undergraduate and postgraduate performance, accounting for perhaps 65% of true variance in first year performance. Such CLPVs justify the use of educational attainment measure in selection, but also raise a key theoretical question concerning the remaining 35% of variance (and measurement error, range restriction and right-censorship have been taken into account). Just as in astrophysics, 'dark matter' and 'dark energy' are posited to balance various theoretical equations, so medical student selection must also have its 'dark variance', whose nature is not yet properly characterized, but explains a third of the variation in performance during training. Some variance probably relates to factors which are unpredictable at selection, such as illness or other life events, but some is probably also associated with factors such as personality, motivation or study skills.
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Affiliation(s)
- I C McManus
- UCL Medical School, University College London, Gower Street, London WC1E 6BT, UK.
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