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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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Singh Grewal C, Bilal Khan M, Kiran Kaur Panesar J, Asher S, Mehan N. Exploring BAME Student Experiences in Healthcare Courses in the United Kingdom: A Systematic Review. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2024; 12:8-17. [PMID: 38313424 PMCID: PMC10837464 DOI: 10.30476/jamp.2023.98882.1825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/03/2023] [Indexed: 02/06/2024]
Abstract
Introduction Black, Asian, and Minority Ethnic (BAME) students in healthcare-related courses are exposed to various challenging experiences compared to their White counterparts, not only in the UK (United Kingdom) but across the globe. Underachieving, stereotyping, racial bias, and cultural differences, among other experiences, hinder their medical education, practice, and attainment. This review aimed to explore and understand the experiences of BAME students enrolled in healthcare related courses in the United Kingdom. Methods Computerised bibliographic search was carried out using MeSH and free text descriptors via PubMed, Cochrane, Google Scholar, and Science Direct for eligible English-published studies exploring BAME experiences in the UK from 2010-2023. Results A cumulative total of 813 studies were obtained from the literature search, of which five met the inclusion criteria. Quality assessment for risk of bias was assessed using the Newcastle Ottawa scale, yielding one study of satisfactory quality, while four were deemed to be of good quality. Conclusion BAME students pursuing health-related courses across the UK. face a range of experiences, including racial discrimination, unconscious bias, and a lack of representation and support. Additionally, BAME students are more likely to report incidents of racial harassment and withdraw from their respective courses as well as experiencing mental health issues due to their experiences.
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Affiliation(s)
| | | | | | - Simal Asher
- Walsall Healthcare NHS Trust, United Kingdom
| | - Navjyot Mehan
- School of Medicine, University of Manchester, United Kingdom
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Nolan HA, Owen K. Twelve tips to foster healthcare student recognition and reporting of unprofessional behaviour or concerns. MEDICAL TEACHER 2023; 45:1233-1238. [PMID: 37286476 DOI: 10.1080/0142159x.2023.2218541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Medical trainees and students are required to report concerns where they identify concerning practice or behaviours. While leadership attributes and skills are increasingly expected curricular outcomes, students still struggle to report concerns due to a variety of factors. Changing societal awareness and expectations continue to shine light on poor professionalism and unethical behaviours whose reach extends to medical training and education and that need to be systematically reported and addressed. To prepare graduates for these challenges in professional practice and for exercising skills of reporting concerns, education and training environments must ensure that speaking up is ingrained in the organisational ethos. Supported by evidence from the literature and our experience of revising and enhancing approaches, this paper outlines tips for developing and embedding an infrastructure that facilitates robust concerns reporting and management. Further, we consider mechanisms that support students to develop tendencies and skills for reporting concerns.
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Morrison N, Machado M, Blackburn C. Bridging the gap: Understanding the barriers and facilitators to performance for Black, Asian and Minority Ethnic medical students in the United Kingdom. MEDICAL EDUCATION 2023. [PMID: 37807122 DOI: 10.1111/medu.15246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Differential attainment is a well-known phenomenon in medical education. Despite a strong impetus for institutions and researchers to move away from a 'student deficit model' when exploring the attainment gap, little attention has been given to understanding the experiences of Black, Asian and Minority Ethnic (BAME) medical students. Informed by the social construction of learning theory, this is the first national study to explore how multiple dimensions of the medical school environment impact academic performance of BAME undergraduate medical students across the UK. METHODS Using a sequential explanatory mixed-methods approach, the authors conducted a survey and facilitated three focus groups across medical schools in the UK between 2020-2021. Participants self-identified as being from BAME backgrounds. Quantitative analyses included descriptive statistics and bivariate analyses. Qualitative data were analysed using thematic analysis, subsequently identifying inductive themes. RESULTS Three hundred sixty-two respondents completed the Phase 1 survey, and 17 participants participated in the Phase 2 focus groups. Although both survey and focus group participants identified facilitators to learning such as supportive relationships, students reported facing numerous barriers that they felt impeded their learning and performance. These barriers included limited access to educational resources, and undiversified curricula and medical school populations. Students also described both experiencing and witnessing various forms of racism throughout their educational journeys. DISCUSSION Students encountered various difficulties throughout their medical training that they felt impacted their learning and performance. This study offers novel insights into the experiences of BAME students and builds upon previous research. It also reveals the pervasive nature of racism within medical schools, highlighting the urgent need for institutional changes. Educators and institutions must go beyond merely recognising these barriers and facilitators; they must proactively innovate and adapt. In doing so, they pave the way for inclusive learning environments that truly foster a sense of belonging for BAME students.
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Affiliation(s)
- Nariell Morrison
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Education, University of Oxford, Oxford, UK
| | - Michelle Machado
- 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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Raju SA, Sanders SR, Bolton-Raju KS, Bowker-Howell FJ, Hall LR, Newton M, Neill GS, Holland WJ, Howford KL, Bolton EV, Arora P, Raju AS, Shah PJ, Azmy IAF, Sanders DS. A Cohort Study of the Diversity in Animated Films From 1937 to 2021: In a World Less Enchanted Can We Be More Encanto? Cureus 2023; 15:e43548. [PMID: 37719586 PMCID: PMC10502396 DOI: 10.7759/cureus.43548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/19/2023] Open
Abstract
Background Exposure to gender stereotypes in the media can develop and reinforce these attitudes in children. Individuals who are overweight, have health conditions, or are from a minority ethnic group (IMEG) are both underrepresented and poorly portrayed in the media. Role models can raise the aspirations of young children both professionally and in taking ownership of their health. We aimed to assess how the portrayal and diversity of characters in Disney, Pixar, and Dreamworks animated films have changed over time. Method A cohort study of all main characters in Disney, Pixar, and Dreamworks feature-length, theatrical, animated films from 1937 to 2021 was conducted. The portrayal of characters (R-score divided into negative, neutral, and positive -1, 0, and 1, respectively) was scored. The proportion of individuals with certain protected characteristics (sex, increased body mass index, physical or mental health conditions, being from an IMEG or part of the lesbian, gay, bisexual, transexual, and queer community) was also recorded. Results In total, 116 films and 1,275 characters were included. From the 1930s to 2020s, the proportion of women in films increased (16.7% to 47.3%, p=0.008) and their representation was more positive (mean R-score = -0.10 (SD:0.692) versus 0.49 (SD:0.837), p<0.001, respectively). The portrayal of overweight individuals has improved to a neutral position (mean R-score: -0.67 to 0.0). Both physical and mental illnesses are better portrayed (mean R-score: -0.18 to 0.34, p=0.004 and 0.5 to 1.0, p= 0.019, respectively). IMEGs introduced in 1953 now play more than just negative roles (mean R-score = -1 to 0.76, p=0.008). There is only one explicitly stated homosexual character. The most diverse film is Encanto. Conclusion This is the first study to comprehensively assess the diversity of animated film characters. We have identified an improvement in diversity and the way diverse individuals are portrayed which we hope continues.
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Affiliation(s)
- Suneil A Raju
- Department of Infection, Immunity and Cardiovascular Diseases, The University of Sheffield, Sheffield, GBR
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals National Health Service (NHS) Foundation Trust, Sheffield, GBR
| | - Samira R Sanders
- Department of Infection, Immunity and Cardiovascular Diseases, The University of Sheffield, Sheffield, GBR
| | - Kathryn S Bolton-Raju
- Department of Infection, Immunity and Cardiovascular Diseases, The University of Sheffield, Sheffield, GBR
| | - Freya J Bowker-Howell
- Department of Infection, Immunity and Cardiovascular Diseases, The University of Sheffield, Sheffield, GBR
| | - Lara R Hall
- Department of History, The University of Sheffield, Sheffield, GBR
| | - Millie Newton
- Department of Infection, Immunity and Cardiovascular Diseases, The University of Sheffield, Sheffield, GBR
| | - Gary S Neill
- Department of Infection, Immunity and Cardiovascular Diseases, The University of Sheffield, Sheffield, GBR
| | - William J Holland
- Department of Infection, Immunity and Cardiovascular Diseases, The University of Sheffield, Sheffield, GBR
| | - Katie L Howford
- Department of Infection, Immunity and Cardiovascular Diseases, The University of Sheffield, Sheffield, GBR
| | - Emma V Bolton
- Department of Infection, Immunity and Cardiovascular Diseases, The University of Sheffield, Sheffield, GBR
| | - Pranav Arora
- Department of Infection, Immunity and Cardiovascular Diseases, The University of Sheffield, Sheffield, GBR
| | - Aneil S Raju
- Department of Infection, Immunity and Cardiovascular Diseases, The University of Sheffield, Sheffield, GBR
| | - Premal J Shah
- Division of Psychiatry, The University of Edinburgh, Edinburgh, GBR
| | - Iman Ahmed F Azmy
- Department of Breast Surgery, Chesterfield Royal Hospital National Health Service (NHS) Foundation Trust, Chesterfield, GBR
| | - David S Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals National Health Service (NHS) Foundation Trust, Sheffield, GBR
- Department of Infection, Immunity and Cardiovascular Diseases, The University of Sheffield, Sheffield, GBR
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Burns RN, Southworth E, Santiago S, Stephenson-Famy A, Fay E, Wang EY, Cai F. Volume, Distribution, and Inequities by Race and Gender of Clinical Experiences Reported by Medical Students Entering Obstetrics and Gynecology Residencies. JOURNAL OF SURGICAL EDUCATION 2023; 80:657-665. [PMID: 36801203 DOI: 10.1016/j.jsurg.2023.01.014] [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: 12/04/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To assess for inequities by race and gender of fourth year medical students' (MS4s) self-reported clinical experience in obstetrics and gynecology (Ob/Gyn). DESIGN This was a voluntary, cross-sectional survey. Participants provided demographic data, information regarding their preparation for residency, and self-reported numbers of hands-on clinical experiences. Responses were compared across demographic categories to assess for disparity in pre-residency experiences. SETTING The survey was open to all MS4s matched to Ob/Gyn internships in the United States in 2021. PARTICIPANTS The survey was distributed primarily via social media. Eligibility was verified by participants supplying the names of their medical school of origin and their matched residency program prior to completing the survey. 1057/1469 (71.9%) MS4s entering Ob/Gyn residencies participated. Respondent characteristics were not different from nationally available data. RESULTS Median clinical experience numbers were calculated for hysterectomies (10; IQR 5-20), suturing opportunities (15; IQR 8-30), and vaginal deliveries (5.5; IQR 2-12). Non-White students had fewer hands-on experiences with hysterectomy, suturing, and cumulative clinical experiences when compared to White MS4s (p values <0.001). Female students had fewer hands-on experiences with hysterectomies (p < 0.04), vaginal delivery (p < 0.03), and cumulative experiences (p < 0.002) than male students. When assessed by quartiles, non-White students and female students were less likely to be in the top quartile for experience and more likely to be in the bottom quartile for experience than their White and male counterparts, respectively. CONCLUSIONS A significant number of medical students entering Ob/Gyn residency have minimal hands-on clinical experience with foundational procedures. Additionally, there are racial and gender disparities in clinical experiences of MS4s matching to Ob/Gyn internships. Future work should identify how biases in medical education may affect the access to clinical experience in medical school, and potential interventions to mitigate inequities in procedures and confidence prior to residency.
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Affiliation(s)
- R Nicholas Burns
- Division of Maternal Fetal Medicine, University of Washington Medical Center, Seattle, Washington.
| | - Elizabeth Southworth
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Sarah Santiago
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Alyssa Stephenson-Famy
- Division of Maternal Fetal Medicine, University of Washington Medical Center, Seattle, Washington
| | - Emily Fay
- Division of Maternal Fetal Medicine, University of Washington Medical Center, Seattle, Washington
| | - Eileen Y Wang
- Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fei Cai
- Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Flach A, Opacic X, Fielden S, Farnsworth V. Inclusivity in transitioning to medical school. CLINICAL TEACHER 2023:e13579. [PMID: 37186178 DOI: 10.1111/tct.13579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/05/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Alexander Flach
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | - Xenia Opacic
- Mid Yorkshire Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
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Fernando D, Kenny E. The identity impact of witnessing selective incivility: A study of minority ethnic professionals. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2022. [DOI: 10.1111/joop.12408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Dulini Fernando
- Centre for Decent Work and Productivity, Business School Manchester Metropolitan University Manchester UK
| | - Etlyn Kenny
- Birmingham University Business School University of Birmingham Birmingham UK
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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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van Andel CEE, Born MP, van den Broek WW, Stegers‐Jager KM. Student ethnicity predicts social learning experiences, self-regulatory focus and grades. MEDICAL EDUCATION 2022; 56:211-219. [PMID: 34543459 PMCID: PMC9293402 DOI: 10.1111/medu.14666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 06/03/2023]
Abstract
CONTEXT Ethnic minority students find that their ethnicity negatively affects the evaluation of their capacities and their feelings in medical school. This study tests whether ethnic minority and majority students differ in their 'self-regulatory focus' in clinical training, that is, their ways to approach goals, due to differences in social learning experiences. Self-regulatory focus consists of a promotion and prevention focus. People who are prone to stereotypes and unfair treatments are more likely to have a prevention focus and conceal certain identity aspects. The objectives of the study are to test whether ethnic minority students, as compared with ethnic majority students, are equally likely to have a promotion focus, but more likely to have a prevention focus in clinical training due to more negative social learning experiences (Hypothesis 1), and whether the relationship between student ethnicity and clinical evaluations can be explained by students' gender, social learning experiences, self-regulatory focus and impression management (Hypothesis 2). METHODS Survey and clinical evaluation data of 312 (71.2% female) clerks were collected and grouped into 215 ethnic majority (69.4%) and 95 ethnic minority students (30.6%). Students' social learning experiences were measured as perceptions of unfair treatment, trust in supervisors and social academic fit. Self-regulatory focus (general and work specific) and impression management were also measured. A parallel mediation model (Hypothesis 1) and hierarchical multiple regression analyses were used (Hypothesis 2). RESULTS Ethnic minority students had higher perceptions of unfair treatment and lower trust in their supervisors in clinical training. They were more prevention focused in clinical training, but this was not mediated by having more negative social learning experiences. Lower clinical evaluations for ethnic minority students were unexplained. Promotion focus in clinical training and trust in supervisors positively relate to clinical grades. CONCLUSION Student ethnicity predicts social learning experiences, self-regulatory focus and grades in clinical training. The hidden curriculum plausibly plays a role here.
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Affiliation(s)
| | - Marise P. Born
- Department of PsychologyErasmus University RotterdamRotterdamThe Netherlands
- Optentia and Faculty of Economic and Management SciencesNorth‐West UniversityPotchefstroomSouth Africa
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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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Krstić C, Krstić L, Tulloch A, Agius S, Warren A, Doody GA. The experience of widening participation students in undergraduate medical education in the UK: A qualitative systematic review. MEDICAL TEACHER 2021; 43:1044-1053. [PMID: 33861176 DOI: 10.1080/0142159x.2021.1908976] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Introduction: Most widening participation (WP) research is focused on medical school recruitment; there is a paucity of research examining whether the experience of medical school itself is an equal experience for both 'traditional' and WP students.Methods: This qualitative systematic review used the Joanna Briggs Institute (JBI) meta-aggregative approach to characterise the experience of undergraduate medical education in the UK from the perspective of WP students. Seven databases were searched, 27 studies were critically appraised, and 208 findings were grouped into 12 categories and four synthesised findings.Results: The majority of the research found relates to ethnic minority groups, with reports of other WP groups being less frequent. Whilst WP programmes attempt to alleviate disadvantages prior to entering university, our findings suggest that difficulties follow WP students into medical school. Unfamiliarity with higher education and lack of representation of WP staff in faculty can deter help-seeking behaviour and result in lack of trust. Furthermore, students from different backgrounds can find their identity conflicted upon entering medical school. Despite difficulties in establishing social networks with 'traditional' medical student peers, WP students form strong relationships with students from similar backgrounds.Conclusions: Ultimately, these students find that the uniqueness of their experience is a useful tool for communicating with diverse patients which they come across and are able to overcome adversity with the help of a supportive institution.
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Affiliation(s)
- Courtney Krstić
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Lazar Krstić
- School of Medicine, University of Nottingham, Nottingham, UK
| | - André Tulloch
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Stevie Agius
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Alistair Warren
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Gillian A Doody
- School of Medicine, University of Nottingham, Nottingham, UK
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Ellis R, Scrimgeour DSG, Brennan PA, Lee AJ, Cleland J. Does performance at medical school predict success at the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination? A retrospective cohort study. BMJ Open 2021; 11:e046615. [PMID: 34400449 PMCID: PMC8370550 DOI: 10.1136/bmjopen-2020-046615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Identifying predictors of success in postgraduate examinations can help guide the career choices of medical students and may aid early identification of trainees requiring extra support to progress in specialty training. We assessed whether performance on the educational performance measurement (EPM) and situational judgement test (SJT) used for selection into foundation training predicted success at the Membership of the Royal College of Surgeons (MRCS) examination. METHODS This was a longitudinal, cohort study using data from the UK Medical Education Database (https://www.ukmed.ac.uk). UK medical graduates who had attempted Part A (n=2585) and Part B (n=755) of the MRCS between 2014 and 2017 were included. χ2 and independent t-tests were used to examine the relationship between medical school performance and sociodemographic factors with first-attempt success at MRCS Part A and B. Multivariate logistic regression was employed to identify independent predictors of MRCS performance. RESULTS The odds of passing MRCS increased by 55% for Part A (OR 1.55 (95% CI 1.48 to 1.61)) and 23% for Part B (1.23 (1.14 to 1.32)) for every additional EPM decile point gained. For every point awarded for additional degrees in the EPM, candidates were 20% more likely to pass MRCS Part A (1.20 (1.13 to 1.29)) and 17% more likely to pass Part B (1.17 (1.04 to 1.33)). For every point awarded for publications in the EPM, candidates were 14% more likely to pass MRCS Part A (1.14 (1.01 to 1.28)). SJT score was not a statistically significant independent predictor of MRCS success. CONCLUSION This study has demonstrated the EPM's independent predictive power and found that medical school performance deciles are the most significant measure of predicting later success in the MRCS. These findings can be used by medical schools, training boards and workforce planners to inform evidence-based and contemporary selection and assessment strategies.
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Affiliation(s)
- Ricky Ellis
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Duncan S G Scrimgeour
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Peter A Brennan
- Department of Maxillo-Facial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Amanda J Lee
- Department of Medical Statistics, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Jennifer Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Singapore
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Fainstad TL, McClintock AH, Yarris LM. Bias in assessment: name, reframe, and check in. CLINICAL TEACHER 2021; 18:449-453. [PMID: 33787001 DOI: 10.1111/tct.13351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/19/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Abstract
Cognitive bias permeates almost every learner assessment in medical education. Assessment bias has the potential to affect a learner's education, future career and sense of self-worth. Decades of data show that there is little educators can do to overcome bias in learner assessments. Using in-group favouritism as an example, we offer an evidence-based, three-step solution to understand and move forward with cognitive bias in assessment: (1) Name: a simple admission about the presence of inherent bias in assessment, (2) Reframe: a rephrasing of assessment language to shed light on the assessor's subjectivity and (3) Check-in: a chance to ensure learner understanding and open lines of bidirectional communication. This process is theory-informed and based on decades of educational, sociological and psychological literature; we offer it as a logical first step towards a much-needed paradigm shift towards addressing bias in learner assessment.
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Affiliation(s)
- Tyra L Fainstad
- Department of Medicine, Division of General Internal Medicine, University of Colorado, Aurora, CO, USA
| | - Adelaide H McClintock
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA, USA
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Dutta N, Maini A, Afolabi F, Forrest D, Golding B, Salami RK, Kumar S. Promoting cultural diversity and inclusion in undergraduate primary care education. EDUCATION FOR PRIMARY CARE 2021; 32:192-197. [PMID: 33779517 DOI: 10.1080/14739879.2021.1900749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In this article, we review key factors in promoting a culturally diverse and inclusive learning environment for all undergraduate medical students, and the role of primary care educators in preparing students to work with diverse teams, patients and communities. These factors include approaches to curriculum and assessment, student community, faculty development and recruitment, and wider institutional factors. By highlighting these, including areas where further research, evaluation and consensus are needed, we hope to support further discourse on how primary care educators can promote culturally diverse and inclusive undergraduate medical education.
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Affiliation(s)
- Nina Dutta
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Arti Maini
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Fola Afolabi
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Dominique Forrest
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Bethany Golding
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - Sonia Kumar
- Department of Primary Care and Public Health, Imperial College London, London, UK
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16
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Baugh RF, Baugh AD. Cultural influences and the Objective Structured Clinical Examination. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2021; 12:22-24. [PMID: 33507878 PMCID: PMC7883802 DOI: 10.5116/ijme.5ff9.b817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Reginald F. Baugh
- Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Aaron D. Baugh
- Pulmonary, Critical Care, Allergy, Sleep Medicine, Department of Internal Medicine University of California San Francis-co Medical School, University of California San Francisco Medical Center, San Francisco, CA, USA
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O’Beirne C, Doody G, Agius S, Warren A, Krstic L. Experiences of Widening Participation students in undergraduate medical education in the United Kingdom: a qualitative systematic review protocol. JBI Evid Synth 2020; 18:2640-2646. [DOI: 10.11124/jbies-20-00064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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18
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Plews-Ogan ML, Bell TD, Townsend G, Canterbury RJ, Wilkes DS. Acting Wisely: Eliminating Negative Bias in Medical Education-Part 1: The Fundamentals. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S11-S15. [PMID: 32889935 DOI: 10.1097/acm.0000000000003699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Bias is a ubiquitous problem in human functioning. It has plagued medical decision making, making physicians prone to errors of perception and judgment. Racial, gender, ethnic, and religious negative biases infest physicians' perception and cognition, causing errors of judgment and behavior that are damaging. In Part 1 of this series of 2 papers, the authors address the problem of harmful bias, the science of cognition, and what is known about how bias functions in human perception and information processing. They lay the groundwork for an approach to reducing negative bias through awareness, reflection, and bias mitigation, an approach in which negative biases can be transformed-by education, experience, practice, and relationships-into positive biases toward one another. The authors propose wisdom as a conceptual framework for imagining a different way of educating medical students. They discuss fundamental cognitive, affective, and reflective components of wisdom-based education. They also review the skills of awareness, using debiasing strategies, compassion, fostering positive emotion, and reflection that are inherent to a wisdom-based approach to eliminating the negative effects of bias in medical education. In Part 2, the authors answer a key question: How can medical educators do better? They describe the interpersonal, structural, and cultural elements supportive of a wisdom-based learning environment, a culture of respect and inclusion in medical education.
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Affiliation(s)
- Margaret L Plews-Ogan
- M.L. Plews-Ogan is Brodie Professor of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Taison D Bell
- T.D. Bell is assistant professor of medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Gregory Townsend
- G. Townsend is associate professor of medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Randolph J Canterbury
- R.J. Canterbury is senior associate dean, Education, and professor of psychiatry and neurobehavioral sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - David S Wilkes
- D.S. Wilkes is dean, University of Virginia School of Medicine, Charlottesville, Virginia
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Winter R, Norman RI, Patel R. A qualitative exploration of the lived experience of GP trainees failing to progress in training. EDUCATION FOR PRIMARY CARE 2020; 32:10-18. [PMID: 33232197 DOI: 10.1080/14739879.2020.1831970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Challenges facing general practice are multiple and extreme. Amongst them is the increasing difficulty of recruiting and retaining General Practitioners (GPs). GPs cite heavy workload, work-related stress, little family time and psychological ill-health as factors influencing their decisions to leave or reduce working hours. Analysis of the literature suggests that these factors, amongst others, are present in GP training and trainees have similar experiences. An in-depth understanding of the challenges trainees in difficulty face is lacking.Our research aim was to better understand the factors that trainees perceive contribute to their failure to progress in training. A qualitative approach was adopted using semi-structured interviews with GP trainees identified as failing to progress satisfactorily or failing the MRCGP examinations. Interviews were audio-recorded and transcribed. Thematic analysis was used to understand the unique experiences of GP trainees and find common themes.Twenty-three interview transcripts were analysed. Emergent themes were presented using a framework of three distinct categories to aid data organisation and allocating themes and sub-themes: professional factors, personal factors, and social factors. Difficulties with managing work-load, poor motivation, lack of family time and psychological ill-health were significant themes for many. This study supports the evidence that difficulties facing GPs take root in training. Failure to fully understand trainees' journeys and associated challenges reduces opportunities to provide bespoke packages of care and remediation that fully address their needs.
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Affiliation(s)
- Rachel Winter
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Robert I Norman
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Rakesh Patel
- Medical Education, University of Nottingham, Nottingham, UK
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Bullock JL, Lockspeiser T, Del Pino-Jones A, Richards R, Teherani A, Hauer KE. They Don't See a Lot of People My Color: A Mixed Methods Study of Racial/Ethnic Stereotype Threat Among Medical Students on Core Clerkships. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S58-S66. [PMID: 32769459 DOI: 10.1097/acm.0000000000003628] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Stereotype threat is an important psychological phenomenon in which fear of fulfilling negative stereotypes about one's group impairs performance. The effects of stereotype threat in medical education are poorly characterized. This study examined the prevalence of racial/ethnic stereotype threat amongst fourth-year medical students and explored its impact on students' clinical experience. METHOD This was an explanatory sequential mixed methods study at 2 institutions in 2019. First, the authors administered the quantitative Stereotype Vulnerability Scale (SVS) to fourth-year medical students. The authors then conducted semistructured interviews among a purposive sample of students with high SVS scores, using a qualitative phenomenographic approach to analyze experiences of stereotype threat. The research team considered reflexivity through group discussion and journaling. RESULTS Overall, 52% (184/353) of students responded to the survey. Collectively, 28% of students had high vulnerability to stereotype threat: 82% of Black, 45% of Asian, 43% of Latinx, and 4% of White students. Eighteen students participated in interviews. Stereotype threat was a dynamic, 3-stage process triggered when students experienced the workplace through the colored lens of race/ethnicity by standing out, reliving past experiences, and witnessing microaggressions. Next, students engaged in internal dialogue to navigate racially charged events and workplace power dynamics. These efforts depleted cognitive resources and interfered with learning. Finally, students responded and coped to withstand threats. Immediate and deferred interventions from allies reduced stereotype threat. CONCLUSIONS Stereotype threat is common, particularly among non-White students, and interferes with learning. Increased minority representation and developing evidence-based strategies for allyship around microaggressions could mitigate effects of stereotype threat.
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Affiliation(s)
- Justin L Bullock
- J.L. Bullock is a first-year resident in internal medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Tai Lockspeiser
- T. Lockspeiser is assistant dean of medical education-assessment, evaluation, and outcomes, and associate professor, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Amira Del Pino-Jones
- A. del Pino-Jones is associate professor, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Regina Richards
- R. Richards is director, Office of Diversity and Inclusion, and assistant professor, Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Arianne Teherani
- A. Teherani is director of program evaluation and professor, Department of Medicine and Center for Faculty Educators, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
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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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22
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Bullock JL, Lai CJ, Lockspeiser T, O'Sullivan PS, Aronowitz P, Dellmore D, Fung CC, Knight C, Hauer KE. In Pursuit of Honors: A Multi-Institutional Study of Students' Perceptions of Clerkship Evaluation and Grading. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:S48-S56. [PMID: 31365406 DOI: 10.1097/acm.0000000000002905] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To examine medical students' perceptions of the fairness and accuracy of core clerkship assessment, the clerkship learning environment, and contributors to students' achievement. METHOD Fourth-year medical students at 6 institutions completed a survey in 2018 assessing perceptions of the fairness and accuracy of clerkship evaluation and grading, the learning environment including clerkship goal structures (mastery- or performance-oriented), racial/ethnic stereotype threat, and student performance (honors earned). Factor analysis of 5-point Likert items (1 = strongly disagree, 5 = strongly agree) provided scale scores of perceptions. Using multivariable regression, investigators examined predictors of honors earned. Qualitative content analysis of responses to an open-ended question yielded students' recommendations to improve clerkship grading. RESULTS Overall response rate was 71.1% (666/937). Students believed that being liked and particular supervisors most influenced final grades. Only 44.4% agreed that grading was fair. Students felt the clerkship learning environment promoted both mastery and performance avoidance behaviors (88.0% and 85.6%, respectively). Students from backgrounds underrepresented in medicine were more likely to experience stereotype threat vulnerability (55.7% vs 10.9%, P < .0005). Honors earned was positively associated with perceived accuracy of grading and interest in competitive specialties while negatively associated with stereotype threat. Students recommended strategies to improve clerkship grading: eliminating honors, training evaluators, and rewarding improvement on clerkships. CONCLUSIONS Participants had concerns around the fairness and accuracy of clerkship evaluation and grading and potential bias. Students expressed a need to redefine the culture of assessment on core clerkships to create more favorable learning environments for all students.
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Affiliation(s)
- Justin L Bullock
- J.L. Bullock is a first-year resident in internal medicine, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California. The author was a fourth-year medical student at the time of writing. C.J. Lai is director of internal medicine clerkships and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California. T. Lockspeiser is director of the assessment/competency committee and associate professor, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. P.S. O'Sullivan is director of research and development in medical education and professor, Department of Medicine and Department of Surgery, University of California, San Francisco School of Medicine, San Francisco, California. P. Aronowitz is clerkship director of internal medicine and professor, Department of Internal Medicine, University of California, Davis School of Medicine, Davis, California. D. Dellmore is director of medical student education and associate professor, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico. C.-C. Fung is assistant dean for medical education and associate professor, Keck School of Medicine of USC, Los Angeles, California. C. Knight is associate clerkship director and associate professor, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington. K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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Hammond JA, Williams A, Walker S, Norris M. Working hard to belong: a qualitative study exploring students from black, Asian and minority ethnic backgrounds experiences of pre-registration physiotherapy education. BMC MEDICAL EDUCATION 2019; 19:372. [PMID: 31619242 PMCID: PMC6794793 DOI: 10.1186/s12909-019-1821-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/26/2019] [Indexed: 06/01/2023]
Abstract
BACKGROUND Previous research has demonstrated that attainment inequalities exist for students from Black Asian and Minority Ethnic (BAME) groups in pre-registration physiotherapy education. While previous research has explored students from BAME backgrounds experience of university, the context of physiotherapy is unique and is under researched. Therefore the purpose of this study was to explore BAME student experiences during their physiotherapy training. METHODS Using a phenomenological approach pre-registration BSc and MSc students from BAME backgrounds from two universities who had completed both academic and clinical modules were invited to participate. Focus groups followed a topic guide developed from the literature and were facilitated by physiotherapy educators from outside the host institution. They were digitally recorded, transcribed verbatim and analysed thematically. Analytical triangulation was adopted throughout the research process as a mechanism to enhance rigour. RESULTS Seventeen students participated from a range of self-identified BAME backgrounds that were also representative of age, gender and course. Themes derived from the data included: feeling an outsider in reflections of belonging, behaviours by others that marginalise BAME and personal strategies to integrate in physiotherapy despite the lack of power and influence. Collectively these themes demonstrate a range of challenges which students from BAME backgrounds face within both an academic and practice learning environment. CONCLUSIONS While this may not be surprising based on other disciplines, this study demonstrates that studying physiotherapy as a student from BAME background requires persistence to overcome a series of many implicit challenges. Understanding the experiences of students from BAME backgrounds presents unique opportunities to educate the profession and co-create opportunities for a more diverse profession with practitioners and educators as role models. There is a need for greater training for educators to listen to these students' voices and their stories, and understand where institutional structures and practices could be modified to enable BAME student inclusion in physiotherapy education and practice.
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Affiliation(s)
- John A. Hammond
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Annabel Williams
- Department of Clinical Sciences, Brunel University London, London, UB8 3PH UK
| | - Saskia Walker
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, London, UB8 3PH UK
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George RE, Smith K, OʼReilly M, Dogra N. Perspectives of Patients With Mental Illness on How to Better Teach and Evaluate Diversity Education in the National Health Service. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2019; 39:92-102. [PMID: 31021967 DOI: 10.1097/ceh.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Diversity education is a mandatory requirement for all mental-health practitioners and health care professionals in the UK National Health Service. Wide variability exists in the development, delivery, and evaluation of diversity education across health care settings, with limited evidence to suggest the optimal approach for teaching this subject. This study aimed to explore the perspectives of patients with mental illness on how to better teach and evaluate diversity education in the National Health Service. METHODS A participatory research approach was used with five mental-health patient organizations. Forty-two patients with mental illness took part in three participatory workshops. Data were analyzed through template analysis. RESULTS The findings indicated that a focus on the nuances and dynamics of clinical relationships would be beneficial. Specifically, the relationship considered most important to examine with respect to diversity education was the "practitioner-self" relationship. DISCUSSION Reconstructing the relationship-centered care model with the addition of the practitioner-self relationship may be better suited to theoretically informing future developments in diversity education. Further research is needed to understand what educational approaches contribute toward a relationship-centered care outlook and how relationship building behaviors, particularly those relevant to the practitioner-self relationship are best developed in diverse settings.
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Affiliation(s)
- Riya Elizabeth George
- Dr. George: Lecturer in Clinical Communication Skills, Queen Mary University of London, and Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Robin Brook Centre, St Bartholomew's Hospital, London. Mr. Smith: Member of the Patient Advisory Forum, Health Education England, London, United Kingdom. Dr. O'Reilly: Senior Lecturer, University of Leicester and Research Consultant, NHS, Greenwood Institute of Child Health, Leicester, United Kingdom. Dr. Dogra: Professor of Psychiatry Education and Honorary Consultant in Child and Adolescent Psychiatry, University of Leicester, Greenwood Institute of Child Health, Leicester, United Kingdom
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Hordijk R, Hendrickx K, Lanting K, MacFarlane A, Muntinga M, Suurmond J. Defining a framework for medical teachers' competencies to teach ethnic and cultural diversity: Results of a European Delphi study. MEDICAL TEACHER 2019; 41:68-74. [PMID: 29490534 DOI: 10.1080/0142159x.2018.1439160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Medical students need to be trained in delivering diversity-responsive health care but unknown is what competencies teachers need. The aim of this study was to devise a framework of competencies for diversity teaching. METHODS An open-ended questionnaire about essential diversity teaching competencies was sent to a panel. This resulted in a list of 74 teaching competencies, which was sent in a second round to the panel for rating. The final framework of competencies was approved by the panel. RESULTS Thirty-four experts participated. The final framework consisted of 10 competencies that were seen as essential for all medical teachers: (1) ability to critically reflect on own values and beliefs; (2) ability to communicate about individuals in a nondiscriminatory, nonstereotyping way; (3) empathy for patients regardless of ethnicity, race or nationality; (4) awareness of intersectionality; (5) awareness of own ethnic and cultural background; (6) knowledge of ethnic and social determinants of physical and mental health of migrants; (7) ability to reflect with students on the social or cultural context of the patient relevant to the medical encounter; (8) awareness that teachers are role models in the way they talk about patients from different ethnic, cultural and social backgrounds; (9) empathy for students of diverse ethnic, cultural and social background; (10) ability to engage, motivate and let all students participate. CONCLUSIONS This framework of teaching competencies can be used in faculty development programs to adequately train all medical teachers.
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Affiliation(s)
- Rowan Hordijk
- a Academic Medical Centre, University of Amsterdam, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
| | - Kristin Hendrickx
- b Department of Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium
| | - Katja Lanting
- a Academic Medical Centre, University of Amsterdam, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
| | | | | | - Jeanine Suurmond
- a Academic Medical Centre, University of Amsterdam, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
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26
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Claridge H, Stone K, Ussher M. The ethnicity attainment gap among medical and biomedical science students: a qualitative study. BMC MEDICAL EDUCATION 2018; 18:325. [PMID: 30594175 PMCID: PMC6310969 DOI: 10.1186/s12909-018-1426-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/10/2018] [Indexed: 05/30/2023]
Abstract
BACKGROUND Black, Asian and Minority Ethnic (BAME) medical students and professionals frequently underachieve when compared with their White counterparts not only in the United Kingdom, but across the globe. There is no consensus for the definitive causes of this attainment gap, but suggestions contributing towards it include: increased feelings of isolation as a member of a minority culture or religion; a poorer higher education (HE) experience compared with White counterparts; and stereotype threat, whereby students underperform in exams from the stresses of fearing confirming to a negative-stereotype. METHODS The aim of this study was to gather qualitative data on HE experiences of medical and biomedical science students to explore factors contributing to the attainment gap. Audio-recorded, semi-structured interviews and a novel approach for this research area of ethnically-homogenous student-led focus groups, were held with students and staff at a healthcare-based university in London, where lower attainment, slower rates of degree completion and lower levels of satisfaction with HE experience were identified in BAME students compared with White students. Thematic analysis was used to manage, summarize and analyse the data. RESULTS Forty-one students and eight staff members were interviewed or took part in focus groups. The student data were best explained by two main themes: social factors and stereotyping, whilst staff data were also best explained by two main themes: social factors and student and staff behaviour. Social factors suggested ethnically-defined social networks and the informal transfer of knowledge impacted academic performance, isolating minority groups from useful academic information. BAME students may also be at a further disadvantage, being unable to attend social and academic functions for cultural or family reasons. Black students also mentioned changing their behaviour to combat negative stereotypes in a variety of contexts. CONCLUSIONS This study suggests that forms of discrimination, whether conscious or unconscious, may be negatively impacting the abilities of BAME students both in examinations and in coursework choice. It highlights the importance of social networks for the transfer of academic knowledge and the impact ethnicity may have on their formation, with issues around segregation and the sharing of information outside defined groups.
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Affiliation(s)
- Hugh Claridge
- Population Health Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Khadija Stone
- Swansea University Medical School, Grove Building, Singleton Park, Sketty, Swansea SA2 8PP UK
| | - Michael Ussher
- Population Health Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
- Institute for Social Marketing, University of Stirling, Stirling, FK8 1NZ UK
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Fassiotto M, Li J, Maldonado Y, Kothary N. Female Surgeons as Counter Stereotype: The Impact of Gender Perceptions on Trainee Evaluations of Physician Faculty. JOURNAL OF SURGICAL EDUCATION 2018; 75:1140-1148. [PMID: 29402668 DOI: 10.1016/j.jsurg.2018.01.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/13/2017] [Accepted: 01/13/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Similar to women in Science, Technology, Engineering and Mathematics disciplines, women in medicine are subject to negative stereotyping when they do not adhere to their sex-role expectations. These biases may vary by specialty, largely dependent on the gender's representation in that specialty. Thus, females in male-dominated surgical specialties are especially at risk of stereotype threat. Herein, we present the role of gender expectations using trainee evaluations of physician faculty at a single academic center, over a 5-year period (2010-2014). DESIGN Using Graduate Medical Education evaluation data of physician faculty from MedHub, we examined the differences in evaluation scores for male and female physicians within specialties that have traditionally had low female representation (e.g., surgical fields) compared to those with average or high female representation (e.g., pediatrics). SETTING Stanford Medicine residents and fellows' MedHub ratings of their physician faculty from 2010 to 2014. PARTICIPANTS A total of 3648 evaluations across 1066 physician faculty. RESULTS Overall, female physicians received lower median scores than their male counterparts across all specialties. When using regression analyses controlling for race, age, rank, and specialty-specific characteristics, the negative effect persists only for female physicians in specialties with low female representation. CONCLUSIONS This finding suggests that female physicians in traditionally male-dominated specialties may face different criteria based on sex-role expectations when being evaluated by trainees. As trainee evaluations play an important role in career advancement decisions, dictate perceptions of quality within academic medical centers and affect overall job satisfaction, we propose that these differences in evaluations based merely on gender stereotypes could account, in part, for the narrowing pipeline of women promoted to higher ranks in academic medicine.
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Affiliation(s)
- Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California.
| | - Jie Li
- Office of Graduate Medical Education, Stanford University Medical Center, Stanford, California
| | - Yvonne Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Nishita Kothary
- Department of Radiology, Stanford University School of Medicine, Stanford, California
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Kelly-Blake K, Garrison NA, Fletcher FE, Ajegba B, Smith N, Brafford M, Bogdan-Lovis E. Rationales for expanding minority physician representation in the workforce: a scoping review. MEDICAL EDUCATION 2018; 52:925-935. [PMID: 29932213 DOI: 10.1111/medu.13618] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/29/2018] [Accepted: 04/09/2018] [Indexed: 05/21/2023]
Abstract
OBJECTIVES The purpose of this study was to conduct a scoping review of the literature and to categorically map a 15-year trajectory of US undergraduate medical education rationales for and approaches to expanding under-represented minority (URM) physician representation in the medical workforce. Further aims were to comparatively examine related justifications and to consider international implications. METHODS From 1 June to 31 July 2015, the authors searched the Cochrane Library, ERIC, PsycINFO, PubMed, Scopus, Web of Science and Google Scholar for articles published between 2000 and 2015 reporting rationales for and approaches to increasing the numbers of members of URMs in undergraduate medical school. RESULTS A total of 137 articles were included in the scoping review. Of these, 114 (83%) mentioned workforce diversity and 73 (53%) mentioned concordance. The patient-physician relationship (n = 52, 38%) and service commitment (n = 52, 38%) were the most commonly cited rationales. The most frequently mentioned approaches to increasing minority representation were pipeline programmes (n = 59, 43%), changes in affirmative action laws (n = 32, 23%) and changes in admission policies (n = 29, 21%). CONCLUSIONS This scoping review of the 2000-2015 literature on strategies for and approaches to expanding URM representation in medicine reveals a repetitive, amplifying message of URM physician service commitment to vulnerable populations in medically underserved communities. Such message repetition reinforces policies and practices that might limit the full scope of URM practice, research and leadership opportunities in medicine. Cross-nationally, service commitment and patient-physician concordance benefits admittedly respond to recognised societal need, yet there is an associated risk for instrumentally singling out members of URMs to fulfil that need. The proceedings of a 2001 US Institute of Medicine symposium warned against creating a deterministic expectation that URM physicians provide care to minority populations. Our findings suggest that the expanding emphasis on URM service commitment and patient-physician concordance benefits warrants ongoing scrutiny and, more broadly, represent a cautionary tale of unintended consequences for medical educators globally.
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Affiliation(s)
- Karen Kelly-Blake
- Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Nanibaa' A Garrison
- Division of Bioethics, Department of Paediatrics, University of Washington, Seattle, Washington, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Faith E Fletcher
- Department of Health Behaviour, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Brittany Ajegba
- College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Nichole Smith
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Morgann Brafford
- Department of Forensic Psychology, Walden University, Minneapolis, Minnesota, USA
| | - Elizabeth Bogdan-Lovis
- Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
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Leitner JB, Ayduk Ö, Boykin CM, Mendoza-Denton R. Reducing negative affect and increasing rapport improve interracial mentorship outcomes. PLoS One 2018; 13:e0194123. [PMID: 29617368 PMCID: PMC5884483 DOI: 10.1371/journal.pone.0194123] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 02/12/2018] [Indexed: 11/18/2022] Open
Abstract
Research suggests that interracial mentoring relationships are strained by negative affect and low rapport. As such, it stands to reason that strategies that decrease negative affect and increase rapport should improve these relationships. However, previous research has not tested this possibility. In video-chats (Studies 1 and 2) and face-to-face meetings (Study 3), we manipulated the degree of mutual self-disclosure between mentees and mentors, a strategy that has been shown to reduce negative affect and increase rapport. We then measured negative affect and rapport as mediators, and mentee performance (quality of speech delivered; Studies 1 and 3) and mentor performance (warmth and helpfulness; Studies 2 and 3) as key outcomes. Results revealed that increased self-disclosure decreased negative affect and increased rapport for both mentees and mentors. Among mentees, decreased negative affect predicted better performance (Studies 1 and 3). Among mentors, increased rapport predicted warmer feedback (Studies 2 and 3). These effects remained significant when we meta-analyzed data across studies (Study 4), and also revealed the relationship of rapport to more helpful feedback. Findings suggest that affect and rapport are key features in facilitating positive outcomes in interracial mentoring relationships.
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Affiliation(s)
- Jordan B. Leitner
- Department of Psychology, University of California, Berkeley, Berkeley, California, United States of America
- * E-mail:
| | - Özlem Ayduk
- Department of Psychology, University of California, Berkeley, Berkeley, California, United States of America
| | - C. Malik Boykin
- Department of Psychology, University of California, Berkeley, Berkeley, California, United States of America
| | - Rodolfo Mendoza-Denton
- Department of Psychology, University of California, Berkeley, Berkeley, California, United States of America
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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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Stegers-Jager KM. Is it them or is it us? Unravelling ethnic disparities in undergraduate clinical performance. BMC Med 2017; 15:190. [PMID: 29065917 PMCID: PMC5655830 DOI: 10.1186/s12916-017-0959-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 11/10/2022] Open
Abstract
Given our increasingly diverse societies, there is an urgent need for research into the causes of persistent ethnic disparities in undergraduate clinical performance. It is argued that causes for underperformance can be identified from two perspectives, namely that of the students ('them') and that of the academic environment ('us'). Taking the 'us' perspective, Yeates et al. conducted a detailed experimental study aimed at understanding the processes underlying judgment and decision-making in clinical assessments. Contrary to their expectations, their study indicates that, despite the presence of active stereotypes, examiner bias does not explain ethnic minority students' underperformance. Naturally, future studies are required to confirm their findings. It is suggested that these studies should take into account various rater and situational factors (e.g. rater experience, increased cognitive load) that may influence examiners' reliance on stereotypes. However, future work should also focus on other potential impeding factors from both perspectives, including differences in communication styles. Knowing what leads to the ethnic disparities in performance is a prerequisite for designing interventions aimed at ensuring a level playing field for a diverse student population.Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0943-0.
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Affiliation(s)
- Karen 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.
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Yeates P, Woolf K, Benbow E, Davies B, Boohan M, Eva K. A randomised trial of the influence of racial stereotype bias on examiners' scores, feedback and recollections in undergraduate clinical exams. BMC Med 2017; 15:179. [PMID: 29065875 PMCID: PMC5655938 DOI: 10.1186/s12916-017-0943-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/11/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Asian medical students and doctors receive lower scores on average than their white counterparts in examinations in the UK and internationally (a phenomenon known as "differential attainment"). This could be due to examiner bias or to social, psychological or cultural influences on learning or performance. We investigated whether students' scores or feedback show influence of ethnicity-related bias; whether examiners unconsciously bring to mind (activate) stereotypes when judging Asian students' performance; whether activation depends on the stereotypicality of students' performances; and whether stereotypes influence examiner memories of performances. METHODS This is a randomised, double-blinded, controlled, Internet-based trial. We created near-identical videos of medical student performances on a simulated Objective Structured Clinical Exam using British Asian and white British actors. Examiners were randomly assigned to watch performances from white and Asian students that were either consistent or inconsistent with a previously described stereotype of Asian students' performance. We compared the two examiner groups in terms of the following: the scores and feedback they gave white and Asian students; how much the Asian stereotype was activated in their minds (response times to Asian-stereotypical vs neutral words in a lexical decision task); and whether the stereotype influenced memories of student performances (recognition rates for real vs invented stereotype-consistent vs stereotype-inconsistent phrases from one of the videos). RESULTS Examiners responded to Asian-stereotypical words (716 ms, 95% confidence interval (CI) 702-731 ms) faster than neutral words (769 ms, 95% CI 753-786 ms, p < 0.001), suggesting Asian stereotypes were activated (or at least active) in examiners' minds. This occurred regardless of whether examiners observed stereotype-consistent or stereotype-inconsistent performances. Despite this stereotype activation, student ethnicity had no influence on examiners' scores; on the feedback examiners gave; or on examiners' memories for one performance. CONCLUSIONS Examiner bias does not appear to explain the differential attainment of Asian students in UK medical schools. Efforts to ensure equality should focus on social, psychological and cultural factors that may disadvantage learning or performance in Asian and other minority ethnic students.
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Affiliation(s)
- Peter Yeates
- Medical Education Research, School of Medicine, David Weatherall Building, Keele University, Newcastle under Lyme, ST5 5BG, UK. .,Acute and Respiratory Medicine at Pennine Acute Hospitals NHS Trust, Bury, UK.
| | - Katherine Woolf
- University College London Medical School, University College London, London, UK
| | - Emyr Benbow
- Division of Medical Education, University of Manchester, Manchester, UK.,Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ben Davies
- North Devon Healthcare NHS Trust, Barnstaple, UK
| | - Mairhead Boohan
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Kevin Eva
- Centre for Health Education Scholarship, Faculty of Health, University of British Columbia, Vancouver, Canada
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Harendza S, Pyra M. Just fun or a prejudice? - physician stereotypes in common jokes and their attribution to medical specialties by undergraduate medical students. BMC MEDICAL EDUCATION 2017; 17:128. [PMID: 28747204 PMCID: PMC5530564 DOI: 10.1186/s12909-017-0964-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 07/13/2017] [Indexed: 05/19/2023]
Abstract
BACKGROUND Many jokes exist about stereotypical attributes of physicians in various specialties, which could lead to prejudices against physicians from a specific specialty. It is unknown whether and when medical students are aware of stereotypes about different specialties. The goal of this study was to analyze the degree of stereotypes that exist about medical specialties amongst undergraduate medical students at different stages of their education. METHODS One hundred fifty-two jokes with different content about attributes of physicians from different specialties were found by an internet search. In total, 36 characteristics of the five specialties of anesthesia, general surgery, internal medicine, orthopedics, and psychiatry were extracted from the jokes and they constituted the basis for the development of an online questionnaire. The questionnaire allowed each characteristic to be assigned to one of the five specialties and was sent to 999 undergraduate medical students from semester 1, 7, and 12 at the Medical Faculty of Hamburg University. RESULTS Three hundred eight (30.8%) of the invited students completed the survey. The characteristics of general surgeons and psychiatrists were assigned congruently most frequently (>50%). For internists and orthopedics, there was a significantly more congruent assignment of the characteristics by final year students versus students in their first semester. Male students assigned the characteristics of anesthetists and internists significantly more congruently than female students. The three characteristics "…are a bit slow on the uptake", "…consider income to be relatively unimportant", and "...apologize a lot" were not assigned to any of the five specialties by more than 50% of the students. CONCLUSIONS While stereotypes about physicians from certain specialties seem to exist commonly, medical educators need to be aware that stereotypes about specialties might develop during undergraduate medical training. In order to support students in their professional identity formation without developing stereotypes, medical educators should receive training. Performing a similar study with physicians in postgraduate training would shed some light on stereotypes and prejudices that might develop at a later stage in medical education.
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Affiliation(s)
- Sigrid Harendza
- III. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
| | - Martin Pyra
- III. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
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Leitner JB, Ayduk O, Mendoza-Denton R, Magerman A, Amey R, Kross E, Forbes CE. Self-distancing improves interpersonal perceptions and behavior by decreasing medial prefrontal cortex activity during the provision of criticism. Soc Cogn Affect Neurosci 2017; 12:534-543. [PMID: 27998998 PMCID: PMC5390725 DOI: 10.1093/scan/nsw168] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/18/2016] [Accepted: 11/14/2016] [Indexed: 11/25/2022] Open
Abstract
Previous research suggests that people show increased self-referential processing when they provide criticism to others, and that this self-referential processing can have negative effects on interpersonal perceptions and behavior. The current research hypothesized that adopting a self-distanced perspective (i.e. thinking about a situation from a non-first person point of view), as compared with a typical self-immersed perspective (i.e. thinking about a situation from a first-person point of view), would reduce self-referential processing during the provision of criticism, and in turn improve interpersonal perceptions and behavior. We tested this hypothesis in an interracial context since research suggests that self-referential processing plays a role in damaging interracial relations. White participants prepared for mentorship from a self-immersed or self-distanced perspective. They then conveyed negative and positive evaluations to a Black mentee while electroencephalogram (EEG) was recorded. Source analysis revealed that priming a self-distanced (vs self-immersed) perspective predicted decreased activity in regions linked to self-referential processing (medial prefrontal cortex; MPFC) when providing negative evaluations. This decreased MPFC activity during negative evaluations, in turn, predicted verbal feedback that was perceived to be more positive, warm and helpful. Results suggest that self-distancing can improve interpersonal perceptions and behavior by decreasing self-referential processing during the provision of criticism.
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Affiliation(s)
- Jordan B. Leitner
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Ozlem Ayduk
- Department of Psychology, University of California, Berkeley, CA, USA
| | | | - Adam Magerman
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Rachel Amey
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Ethan Kross
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Chad E. Forbes
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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Leduc JM, Rioux R, Gagnon R, Bourdy C, Dennis A. Impact of sociodemographic characteristics of applicants in multiple mini-interviews. MEDICAL TEACHER 2017; 39:285-294. [PMID: 28024439 DOI: 10.1080/0142159x.2017.1270431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Multiple mini-interviews (MMI) are commonly used for medical school admission. This study aimed to assess if sociodemographic characteristics are associated with MMI performance, and how they may act as barriers or enablers to communication in MMI. METHODS This mixed-method study combined data from a sociodemographic questionnaire, MMI scores, semi-structured interviews and focus groups with applicants and assessors. Quantitative and qualitative data were analyzed using multiple linear regression and a thematic framework analysis. RESULTS 1099 applicants responded to the questionnaire. A regression model (R2 = 0.086) demonstrated that being age 25-29 (β = 0.11, p = 0.001), female and a French-speaker (β = 0.22, p = 0.003) were associated with better MMI scores. Having an Asian-born parent was associated with a lower score (β = -0.12, p < 0.001). Candidates reporting a higher family income had higher MMI scores. In the qualitative data, participants discussed how maturity and financial support improved life experiences, how language could act as a barrier, and how ethnocultural differences could lead to misunderstandings. CONCLUSION Age, gender, ethnicity, socioeconomic status and language seem to be associated with applicants' MMI scores because of perceived differences in communications skills and life experiences. Monitoring this association may provide guidance to improve fairness of MMI stations.
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Affiliation(s)
- Jean-Michel Leduc
- a Division of Medical Microbiology and Infectious Diseases , Hôpital du Sacré-Coeur de Montréal , Montréal , Canada
| | - Richard Rioux
- b Health and Society Institute, Université du Québec à Montréal , Montréal , Canada
| | - Robert Gagnon
- c Center of Pedagogy Applied to Health Sciences, Université de Montréal , Montréal , Canada
| | - Christian Bourdy
- d Department of Family Medicine and Emergency Medicine , Université de Montréal , Montréal , Canada
| | - Ashley Dennis
- e Centre for Medical Education , University of Dundee , Dundee , UK
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Woolf K, Rich A, Viney R, Needleman S, Griffin A. Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study. BMJ Open 2016; 6:e013429. [PMID: 27888178 PMCID: PMC5168507 DOI: 10.1136/bmjopen-2016-013429] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Explore trainee doctors' experiences of postgraduate training and perceptions of fairness in relation to ethnicity and country of primary medical qualification. DESIGN Qualitative semistructured focus group and interview study. SETTING Postgraduate training in England (London, Yorkshire and Humber, Kent Surrey and Sussex) and Wales. PARTICIPANTS 137 participants (96 trainees, 41 trainers) were purposively sampled from a framework comprising: doctors from all stages of training in general practice, medicine, obstetrics and gynaecology, psychiatry, radiology, surgery or foundation, in 4 geographical areas, from white and black and minority ethnic (BME) backgrounds, who qualified in the UK and abroad. RESULTS Most trainees described difficult experiences, but BME UK graduates (UKGs) and international medical graduates (IMGs) could face additional difficulties that affected their learning and performance. Relationships with senior doctors were crucial to learning but bias was perceived to make these relationships more problematic for BME UKGs and IMGs. IMGs also had to deal with cultural differences and lack of trust from seniors, often looking to IMG peers for support instead. Workplace-based assessment and recruitment were considered vulnerable to bias whereas examinations were typically considered more rigorous. In a system where success in recruitment and assessments determines where in the country you can get a job, and where work-life balance is often poor, UK BME and international graduates in our sample were more likely to face separation from family and support outside of work, and reported more stress, anxiety or burnout that hindered their learning and performance. A culture in which difficulties are a sign of weakness made seeking support and additional training stigmatising. CONCLUSIONS BME UKGs and IMGs can face additional difficulties in training which may impede learning and performance. Non-stigmatising interventions should focus on trainee-trainer relationships at work and organisational changes to improve trainees' ability to seek social support outside work.
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Affiliation(s)
- Katherine Woolf
- Research Department of Medical Education, UCL Medical School, London, UK
| | - Antonia Rich
- Research Department of Medical Education, UCL Medical School, London, UK
| | - Rowena Viney
- Research Department of Medical Education, UCL Medical School, London, UK
| | - Sarah Needleman
- Research Department of Medical Education, UCL Medical School, London, UK
| | - Ann Griffin
- Research Department of Medical Education, UCL Medical School, London, UK
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Shaffer JF. Student performance in and perceptions of a high structure undergraduate human anatomy course. ANATOMICAL SCIENCES EDUCATION 2016; 9:516-528. [PMID: 26990231 DOI: 10.1002/ase.1608] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/20/2016] [Accepted: 02/12/2016] [Indexed: 06/05/2023]
Abstract
Human anatomy has usually been taught in a didactic fashion in colleges and universities. However, recent calls from United States governmental agencies have called for the transformation of undergraduate life sciences education to include active learning in the classroom. In addition, high structure courses have been shown to increase student engagement both in and out of the classroom and to improve student performance. Due to these reform efforts and the evidence on the benefits of these student-centered pedagogies, the goal of this study was to develop and assess a high structure college undergraduate human anatomy course with a lecture and laboratory component. The course was taught using a systems anatomy approach that required students to read the textbook and complete assignments before class, actively participate in class, and complete review quizzes after class. Results showed that teaching with high structure methods did not negatively affect any student groups (based on gender, ethnicity, or major) as measured by performance on lecture examinations and laboratory practical examinations. Students reported that reading the textbook and working with anatomical models were the most important towards helping them learn the course material and students' confidence in achieving the course goals significantly increased at the end of the course. The successful development and implementation of this course suggests that it is possible to teach human anatomy using active learning and high structure. Future studies can now be conducted to determine the contributions of specific course components to student success in high structure human anatomy courses. Anat Sci Educ 9: 516-528. © 2016 American Association of Anatomists.
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Affiliation(s)
- Justin F Shaffer
- Department of Developmental and Cell Biology, University of California Irvine, Irvine, California.
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Mole TB, Begum H, Cooper-Moss N, Wheelhouse R, MacKeith P, Sanders T, Wass V. Limits of 'patient-centredness': valuing contextually specific communication patterns. MEDICAL EDUCATION 2016; 50:359-369. [PMID: 26896021 DOI: 10.1111/medu.12946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/20/2015] [Accepted: 09/24/2015] [Indexed: 06/05/2023]
Abstract
CONTEXT Globally, doctor-patient communication is becoming synonymous with high-quality health care in the 21st century. However, what is meant by 'good communication' and whether there is consensus internationally remain unclear. OBJECTIVES Here, we characterise understandings of 'good communication' in future doctors from medical schools in three contextually contrasting continents. Given locally specific socio-cultural influences, we hypothesised that there would be a lack of global consensus on what constitutes 'good communication'. METHODS A standardised two-phase methodology was applied in turn to each of three medical schools in the UK, Egypt and India (n = 107 subjects), respectively, in which students were asked: 'What is good communication?' Phase I involved exploratory focus groups to define preliminary themes (mean number of participants per site: 17). Phase II involved thematic confirmation and expansion in one-to-one semi-structured interviews (mean number of participants per site: 18; mean hours of dialogue captured per site: 55). Findings were triangulated and analysed using grounded theory. RESULTS The overarching theme that emerged from medical students was that 'good communication' requires adherence to certain 'rules of communication'. A shared rule that doctors must communicate effectively despite perceived disempowerment emerged across all sites. However, contradictory culturally specific rules about communication were identified in relation to three major domains: family; gender, and emotional expression. Egyptian students perceived emotional aspects of Western doctors' communication strikingly negatively, viewing these doctors as problematically cold and unresponsive. CONCLUSIONS Contradictory perceptions of 'good communication' in future doctors are found cross-continentally and may contribute to prevalent cultural misunderstandings in medicine. The lack of global consensus on what defines good communication challenges prescriptively taught Western 'patient-centredness' and questions assumptions about international transferability. Health care professionals must be educated openly about flexible, context-specific communication patterns so that they can avoid cultural incompetence and tailor behaviours in ways that optimise therapeutic outcomes wherever they work around the globe.
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Affiliation(s)
- Tom B Mole
- Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Hasna Begum
- Department of Primary Care, School of Primary Care, Health Education Yorkshire and the Humber, University of Leeds, Leeds, UK
| | - Nicola Cooper-Moss
- Department of Primary Care, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Rebecca Wheelhouse
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK
| | - Pieter MacKeith
- Department of Primary Care, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Tom Sanders
- Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Valerie Wass
- Department of Medical Education, Faculty of Health, Keele University, Keele, UK
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Wass V. Opening our eyes to Global Health; a philosophy of universal values. PERSPECTIVES ON MEDICAL EDUCATION 2015; 4:331-333. [PMID: 26370693 PMCID: PMC4673063 DOI: 10.1007/s40037-015-0210-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Globalization is advancing at a pace. As we strive to introduce 'Global Health' into clinical curricula we risk fundamental misunderstandings unless we clearly define what we aim to achieve. Clinicians must be prepared for a life time of uncertainty, change and challenge. The fluctuating world arena will undoubtedly impact on their future work in ways we cannot predict. Population migration, climate change and shifts in cultural dominance are already at play. Global health risks being translated through the eyes of Western ideology as disease-based curricula focused paternalistically on 'helping' the developing world. We must not lack humility to open eyes to learning within the context of increasingly diverse environments and patient populations. Global health is as 'local' as it is 'international'. It should be viewed, I argue, as a philosophy based on the values and expectations found within ourselves and our communities. Responding to globalization lies not only in knowledge but embraces human rights, justice and, most importantly, self-awareness. Knowledge is more easily translated into curriculum objectives. We risk letting future clinicians and their patients down if we ignore the other universal values.
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Affiliation(s)
- Val Wass
- Faculty of Health, Keele University, ST5 5BG, Staffordshire, 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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McGarvey A, Brugha R, Conroy RM, Clarke E, Byrne E. International students' experience of a western medical school: a mixed methods study exploring the early years in the context of cultural and social adjustment compared to students from the host country. BMC MEDICAL EDUCATION 2015; 15:111. [PMID: 26134823 PMCID: PMC4488065 DOI: 10.1186/s12909-015-0394-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 06/12/2015] [Indexed: 05/10/2023]
Abstract
BACKGROUND Few studies have addressed the challenges associated with international students as they adapt to studying medicine in a new host country. Higher level institutions have increasing numbers of international students commencing programmes. This paper explores the experiences of a cohort of students in the early years of medical school in Ireland, where a considerable cohort are from an international background. METHODS A mixed exploratory sequential study design was carried out with medical students in the preclinical component of a five year undergraduate programme. Data for the qualitative phase was collected through 29 semi-structured interviews using the peer interview method. Thematic analysis from this phase was incorporated to develop an online questionnaire combined with components of the Student Adaptation to College Questionnaire and Student Integration Questionnaire. First year students were anonymously surveyed online. The Mokken Scaling procedure was used to investigate the students' experiences, both positive and negative. RESULTS Three main themes are identified; social adjustment, social alienation and cultural alienation. The response rate for the survey was 49% (467 Respondents). The Mokken Scaling method identified the following scales (i) Positive experience of student life; (ii) Social alienation, which comprised of negative items about feeling lonely, not fitting in, being homesick and (iii) Cultural alienation, which included the items of being uncomfortable around cultural norms of dress and contact between the sexes. With the threshold set to H = 0.4. Subscales of the positive experiences of student life scale are explored further. CONCLUSIONS Overall student adjustment to a western third level college was good. Students from regions where cultural distance is greatest reported more difficulties in adjusting. Students from these regions also demonstrate very good adaptation. Some students from the host country and more similar cultural backgrounds were also struggling. Acculturation is more complex than being associated with cultural distance and worthy of further exploration.
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Affiliation(s)
- A McGarvey
- Anatomy Department, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - R Brugha
- Division of Population and Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - R M Conroy
- Division of Population and Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - E Clarke
- Health Professions Education Centre, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - E Byrne
- Division of Population and Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
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An investigation of the relationship between ethnicity and success in a BSc (Hons) Physiotherapy degree programme in the UK. Physiotherapy 2015; 101:198-203. [DOI: 10.1016/j.physio.2014.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 08/29/2014] [Indexed: 11/19/2022]
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Vaughan S, Sanders T, Crossley N, O'Neill P, Wass V. Bridging the gap: the roles of social capital and ethnicity in medical student achievement. MEDICAL EDUCATION 2015; 49:114-23. [PMID: 25545579 DOI: 10.1111/medu.12597] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/26/2014] [Accepted: 08/01/2014] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Within medical education, there is a discrepancy between the achievement level of White students and that of their ethnic minority peers. The processes underlying this disparity have not been adequately investigated or explained. This study utilises social network analysis to investigate the impact of relationships on medical student achievement by ethnicity, specifically by examining homophily (the tendency to interact with others in the same group) by ethnicity, age and role. METHODS Data from a cross-sectional social network study conducted in one UK medical school are presented and are analysed alongside examination records obtained from the medical school. Participants were sampled across the four hospital placement sites; a total of 158 medical students in their clinical phase (Years 3 and 4) completed the survey. The research was designed and analysed using social capital theory. RESULTS Although significant patterns of ethnic and religious homophily emerged, no link was found between these factors and achievement. Interacting with problem-based learning (PBL) group peers in study-related activities, and having seniors in a wider academic support network were directly linked to better achievement. Students in higher academic quartiles were more likely to be named by members of their PBL group in study activities and to name at least one tutor or clinician in their network. Students from lower-achieving groups were least likely to have the social capital enabling, and resulting from, interactions with members of more expert social groups. CONCLUSIONS Lower levels of the social capital that mediates interaction with peers, tutors and clinicians may be the cause of underperformance by ethnic minority students. Because of ethnic homophily, minority students may be cut off from potential and actual resources that facilitate learning and achievement.
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Affiliation(s)
- Suzanne Vaughan
- School of Medicine, University of Manchester, Manchester, UK
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Maurin D, Pacault C, Galès B. [The jokes are vectors of stereotypes. Example of the medical profession from 220 jokes]. Presse Med 2014; 43:e385-92. [PMID: 25284735 DOI: 10.1016/j.lpm.2014.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/21/2014] [Accepted: 05/27/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Sociological studies have shown the link between humor and unconscious ideas that we have of the society in which we evolve. We conducted a survey to answer the question: "What were the stereotypes of our medical profession that emerge from a transcript of jokes collected in a medical population?" METHODS Recruitment of the source population (doctors and medical students) was done through different personal and professional mailing lists, Twitter, Facebook, medical press. The inclusion period was six weeks (from June 6 to July 14, 2013). Each physician recruited received the link to our blog: http://humourmedical.overblog.com which contained a link to the questionnaire. Physicians responded to the following proposition: "tell the joke involving doctors you laugh the most". Analysis of jokes was made by three investigators. Firstly, two investigators (DM and CP) and pooled of results to generate a stereotype for each joke. Then a triangulation was made with a third investigator (BG), to determine the final stereotype. RESULTS Five hundred and twelve jokes have been collected on the site and 448 were included in the analysis, representing 220 jokes. The gender of respondents was 284 men (63%) and 164 women (37%), a ratio of 1.7. One hundred and fifty-six different stereotypes were classified into six themes: 46 stereotypes 'the vicissitudes of the medical profession'; 45 'hospital', the war of the block; 34 'personality traits doctor'; 14 'psychiatrist'; 12 'physician and sexuality'; 5 'medical studies and carabin woes'. Anesthetists were represented as lazy, inveterate coffee drinkers and less awakened than their sleeping patients. Surgeons were seen as megalomaniacal, tyrannical with other professions, operating without thinking, as their brain down to a neuron. Medical students appeared docile and absurd. Psychiatrists were as crazy as their patients, sometimes passing them to the consultation and looking only at their past relationship. Other stereotypes of doctors were used: the venality, the salacious, cynicism. CONCLUSION We showed that the stereotypes contained in the medical jokes were quite caricatured and portrayed an unflattering picture of doctors in general. These traits were necessarily marked to emphasize the humorous effect of a joke. We have not entered into the reality of these stereotypes or their social role in the relationship between doctors.
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Affiliation(s)
- Damien Maurin
- Université Joseph-Fourier, faculté de médecine de Grenoble, département universitaire de médecine générale, domaine de la Merci, place du commandant Nal, 38706 La Tronche cedex, France.
| | - Clément Pacault
- Université Joseph-Fourier, faculté de médecine de Grenoble, département universitaire de médecine générale, domaine de la Merci, place du commandant Nal, 38706 La Tronche cedex, France
| | - Brieuc Galès
- Université Joseph-Fourier, faculté de médecine de Grenoble, département universitaire de médecine générale, domaine de la Merci, place du commandant Nal, 38706 La Tronche cedex, France
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Duggan EM, O'Tuathaigh CMP, Horgan M, O'Flynn S. Enhanced research assessment performance in graduate vs. undergraduate-entry medical students: implications for recruitment into academic medicine. QJM 2014; 107:735-41. [PMID: 24677321 DOI: 10.1093/qjmed/hcu064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies investigating variance between the academic performance of direct-entry (DEM) versus graduate-entry (GEM) medical students have yielded conflicting results, but their performance in undergraduate research-based assessments has not been compared to-date. AIM We aimed to compare the results of DEM and GEM students with respect to their senior research dissertation module. METHODS This retrospective study examined the final year results between 2011-2012 in DEM, (n = 219) and GEM (n = 84) students. Between-group comparisons of dissertation module marks were conducted using independent t-tests. Correlations between marks in dissertation module and in other disciplines assessed during the final year were attained using Pearson's correlation. Multiple regression analysis was employed to adjust for potential confounding factors such as student age and gender. RESULTS No apparent difference was apparent between the DEM and GEM students with respect to results achieved across the clinical disciplines examined. However, GEM students performed significantly better than DEMs in their senior research dissertation assessment (Mean = 66.81% vs. 65.00%, fully adjusted p = 0.048). The variable which remained influential in regression analysis was nationality, where North American and Asian students were demonstrated to score lower than their Irish counterparts in the dissertation module (B coefficient = -1.90, SE = 0.94, P = 0.045 and B coefficient = -4.88, SE = 1.00, P < 0.001 respectively). CONCLUSIONS Performance in the research-based module was significantly better in GEM relative to their DEM colleagues. This finding may have implications for future recruitment into academic medicine, as aptitude and interest in research at undergraduate level has been shown to be associated with increased likelihood of an academic career in medicine.
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Affiliation(s)
- E M Duggan
- From the Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - C M P O'Tuathaigh
- From the Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - M Horgan
- From the Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - S O'Flynn
- From the Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
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Palmgren PJ, Lindquist I, Sundberg T, Nilsson GH, Laksov KB. Exploring perceptions of the educational environment among undergraduate physiotherapy students. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2014; 5:135-46. [PMID: 25341223 PMCID: PMC4212412 DOI: 10.5116/ijme.53a5.7457] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/21/2014] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The aim of this study was to explore areas of strength and weakness in the educational environment as perceived by undergraduate physiotherapy students and to investigate these areas in relation to the respondents' demographic characteristics. METHODS This study utilized a cross-sectional study design and employed the Dundee Ready Education Environment Measure, a 50-item, self-administered inventory relating to a variety of topics directly pertinent to educational environments. Convenience sampling was used, and the scores were compared across demographic variables. All undergraduate physiotherapy students in their first five terms of the programme in a major Swedish university were invited to participate in the study. RESULTS A total of 222 students (80%) completed the inventory. With an overall score of 150/200 (75%), the students rated the educational environment in this institution as "more positive than negative". Two items consistently received deprived scores - authoritarian teachers and teaching with an overemphasis on factual learning. Students in term 4 differed significantly from others, and students with earlier university education experience perceived the atmosphere more negatively than their counterparts. There were no significant differences with regards to other demographic variables. CONCLUSIONS This study provides valuable insight into how undergraduate physiotherapy students perceive their educational environment. In general, students perceived that their educational programme fostered a sound educational environment. However, some areas require remedial measures in order to enhance the educational experience.
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Affiliation(s)
- Per J. Palmgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Ingrid Lindquist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Tobias Sundberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Gunnar H. Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Klara B. Laksov
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
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Gomez E, Wright JG. A simple strategy to reduce stereotype threat for orthopedic residents. Can J Surg 2014; 57:E19-24. [PMID: 24666454 DOI: 10.1503/cjs.020812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Stereotype threat, defined as the predicament felt by people in either positive or negative learning experiences where they could conform to negative stereotypes associated with their own group membership, can interfere with learning. The purpose of this study was to determine if a simple orientation session could reduce stereotype threat for orthopedic residents. METHODS The intervention group received an orientation on 2 occasions focusing on their possible responses to perceived poor performance in teaching rounds and the operating room (OR). Participants completed a survey with 7 questions typical for stereotype threat evaluating responses to their experiences. The questions had 7 response options with a maximum total score of 49, where higher scores indicated greater degree of experiences typical of stereotype threat. RESULTS Of the 84 eligible residents, 49 participated: 22 in the nonintervention and 27 in the intervention group. The overall scores were 29 and 29.4, and 26.2 and 25.8 in the nonintervention and intervention groups for their survey responses to perceived poor performance in teaching rounds (p = 0.85) and the OR (p = 0.84), respectively. Overall, responses typical of stereotype threat were greater for perceived poor performance at teaching rounds than in the OR (p = 0.001). CONCLUSION Residents experience low self-esteem following perceived poor performance, particularly at rounds. A simple orientation designed to reduce stereotype threat was unsuccessful in reducing this threat overall. Future research will need to consider longer-term intervention as possible strategies to reduce perceived poor performance at teaching rounds and in the OR.
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Affiliation(s)
- Everlyne Gomez
- The University of California, Irvine, Health & Disease Research Program, Orange, Calif
| | - James G Wright
- The Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Departments of Public Health Sciences and Health Policy, Management and Evaluation, University of Toronto, Department of Surgery, The Hospital for Sick Children, and Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ont
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Simpson PL, Scicluna HA, Jones PD, Cole AMD, O’Sullivan AJ, Harris PG, Velan G, McNeil HP. Predictive validity of a new integrated selection process for medical school admission. BMC MEDICAL EDUCATION 2014; 14:86. [PMID: 24755325 PMCID: PMC3999457 DOI: 10.1186/1472-6920-14-86] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 04/09/2014] [Indexed: 05/10/2023]
Abstract
BACKGROUND This paper is an evaluation of an integrated selection process utilising previous academic achievement [Universities Admission Index (UAI)], a skills test [Undergraduate Medicine and Health Sciences Admission Test (UMAT)], and a structured interview, introduced (in its entirety) in 2004 as part of curriculum reform of the undergraduate Medicine Program at the University of New South Wales (UNSW), Australia. Demographic measures of gender, country of birth, educational background and rurality are considered. METHOD Admission scores and program outcomes of 318 students enrolled in 2004 and 2005 were studied. Regression analyses were undertaken to determine whether selection scores predicted overall, knowledge-based and clinical-based learning outcomes after controlling for demographics. RESULTS UAI attained the highest values in predicting overall and knowledge-based outcomes. The communication dimension of the interview achieved similar predictive values as UAI for clinical-based outcomes, although predictive values were relatively low. The UMAT did not predict any performance outcome. Female gender, European/European-derived country of birth and non-rurality were significant predictors independent of UAI scores. CONCLUSION Results indicate promising validity for an integrated selection process introduced for the Medicine Program at UNSW, with UAI and interview predictive of learning outcomes. Although not predictive, UMAT may have other useful roles in an integrated selection process. Further longitudinal research is proposed to monitor and improve the validity of the integrated student selection process.
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Affiliation(s)
- Paul L Simpson
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Helen A Scicluna
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Philip D Jones
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Andrew MD Cole
- School of Public Health & Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Peter G Harris
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Gary Velan
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - H Patrick McNeil
- South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Rheumatology, Liverpool Hospital, Locked Bag 7103, Liverpool BC NSW 1871, Australia
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Does ethnicity, gender or age of physiotherapy students affect performance in the final clinical placements? An exploratory study. Physiotherapy 2014; 100:9-13. [DOI: 10.1016/j.physio.2013.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 05/17/2013] [Indexed: 11/19/2022]
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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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