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Fikrat-Wevers S, Stegers-Jager KM, Mulder LMA, Cheung J, Van Den Broek WW, Woltman AM. Improving selection procedures in health professions education from the applicant perspective: an interview study. BMC MEDICAL EDUCATION 2024; 24:849. [PMID: 39112957 PMCID: PMC11308236 DOI: 10.1186/s12909-024-05761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION Applicant perceptions of selection impact motivation and performance during selection, and student diversity. However, in-depth insight into which values underly these perceptions is lacking, creating challenges for aligning selection procedures with applicant perceptions. This qualitative interview study aimed to identify values applicants believe should underlie selection, and how, according to applicants, these values should be used to make specific improvements to selection procedures in undergraduate health professions education (HPE). METHODS Thirty-one applicants to five undergraduate HPE programs in the Netherlands participated in semi-structured interviews using Appreciative Inquiry, an approach that focuses on what goes well to create vision for improvement, to guide the interviews. Transcriptions were analyzed using thematic analysis, adopting a constructivist approach. RESULTS Applicants' values related to the aims of selection, the content of selection, and the treatment of applicants. Applicants believed that selection procedures should aim to identify students who best fit the training and profession, and generate diverse student populations to fulfill societal needs. According to applicants, the content of selection should be relevant for the curriculum and profession, assess a comprehensive set of attributes, be of high quality, allow applicants to show who they are, and be adapted to applicants' current developmental state. Regarding treatment, applicants believed that selection should be a two-way process that fosters reflection on study choice, be transparent about what applicants can expect, safeguard applicants' well-being, treat all applicants equally, and employ an equitable approach by taking personal circumstances into account. Applicants mentioned specific improvements regarding each value. DISCUSSION Applicants' values offer novel insights into what they consider important preconditions for the design of selection procedures. Their suggested improvements can support selection committees in better meeting applicants' needs.
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Affiliation(s)
- S Fikrat-Wevers
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room Na2310, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - K M Stegers-Jager
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room Na2310, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - L M A Mulder
- Amsterdam UMC location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, The Netherlands
| | - J Cheung
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room Na2310, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - W W Van Den Broek
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room Na2310, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - A M Woltman
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room Na2310, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Li X, Zhang Y, Han Y. The substitution effect of financial and non-financial incentives at different income levels in physician recruitment: evidence from medical students in China. BMC MEDICAL EDUCATION 2024; 24:503. [PMID: 38724945 PMCID: PMC11080174 DOI: 10.1186/s12909-024-05374-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/30/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Understanding how medical students respond to financial and non-financial incentives is crucial for recruiting health workers and attracting health talents in medical education. However, both incentives are integrated in working practice, and existing theoretical studies have suggested that various income levels may influence the substitution effect of both incentives, while the empirical evidence is lacking. Furthermore, little attention has been paid to the intrinsic motivation. This study aimed to explore the substitution effect of extrinsic incentives at different income levels, also taking intrinsic altruism into account. METHODS We used the behavioral data from Zhang et al.'s experiments, which involved discrete choice experiments (DCEs) to assess the job preferences of medical students from six teaching hospitals in Beijing, China. The incentive factors included monthly income, work location, work environment, training and career development opportunities, work load, and professional recognition. Additionally, a lab-like experiment in the medical decision-making context was conducted to quantify altruism based on utility function. Furthermore, we separated the choice sets based on the actual income and distinguished the medical students on altruism. The willingness to pay (WTP) was used to estimate the substitution effect of incentives through conditional logit model. RESULTS There was a significant substitution effect between non-financial and financial incentives. As income increased, non-financial incentives such as an excellent work environment, and sufficient career development became relatively more important. The impact of the increase in income on the substitution effect was more pronounced among individuals with higher altruism. Concerning the non-financial incentive work environment, in contrast to the growth of 546 CNY (84 USD) observed in the low-altruism group, the high-altruism group experienced a growth of 1040 CNY (160 USD) in the substitution effect. CONCLUSIONS The increase in the income level exerted an influence on the substitution effect of non-financial incentives and financial incentives, especially in high-altruism medical students. Policymakers should attach importance to a favorable environment and promising career prospects on the basis of ensuring a higher income level. Medical school administrations should focus on promoting altruistic values in medical education, enhancing talent incentives and teaching strategies to encourage medical students to devote themselves to the medical professions.
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Affiliation(s)
- Xinyan Li
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China
| | - Yue Zhang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China
- Qilu Hospital of Shandong University, No.107, Wen Hua Xi Road, Lixia District, Jinan, Shandong, 250012, China
| | - Youli Han
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
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Ball A, Brecknell J. Healthcare apprenticeships: assessing the potential benefits to an acute care provider NHS organization. Postgrad Med J 2024; 100:127-130. [PMID: 37973401 DOI: 10.1093/postmj/qgad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
The introduction of healthcare-based apprenticeships to become both a physician associate and a doctor has been approved for delivery in England. This will revolutionize medical training and it is hoped that medical training would be more accessible. This has generated a mixture of reactions, some enthusiastic and others concerned. This paper gauges interest among staff at Barking, Havering, and Redbridge University Hospitals NHS Trust in pursuing training as a doctor and/or physician associate through the apprenticeship route. Applicants were interviewed to discover their motivations for interest, and the potential benefit to the Trust of these new opportunities was also assessed. This revealed that applicants were primarily driven through intrinsic motivations, such as a lifelong dream to be a doctor and a desire to fulfil a patient-facing role. Many expressed financial and social situations were a barrier to prior application, making the apprenticeship role more attractive. Healthcare professionals should accurately represent the population that they serve, which is currently not the case. The prospective applicants, with diverse backgrounds and existing healthcare experience, can help to improve patient care through their diverse perspective and understanding of multidisciplinary team working. This article highlights the potential of medical-based apprenticeships to help address longstanding challenges in medical education and workforce diversity. Furthermore, there could be significant financial and practical benefits to the trust of upskilling enthusiastic staff. However, there is currently a lack of clarity regarding selection processes and entry criteria, which must be addressed.
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Affiliation(s)
- Alfred Ball
- Department of Medical Education, Barking Havering & Redbridge University Hospitals NHS Trust, Queen's Hospital, Rom Valley Way, Romford, RM7 0AG, United Kingdom
| | - John Brecknell
- Department of Medical Education, Barking Havering & Redbridge University Hospitals NHS Trust, Queen's Hospital, Rom Valley Way, Romford, RM7 0AG, United Kingdom
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Fikrat-Wevers S, Stegers-Jager KM, Afonso PM, Koster AS, Van Gestel RA, Groenier M, Ravesloot JH, Wouters A, Van Den Broek WW, Woltman AM. Selection tools and student diversity in health professions education: a multi-site study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1027-1052. [PMID: 36653557 PMCID: PMC9848043 DOI: 10.1007/s10459-022-10204-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/29/2022] [Indexed: 06/16/2023]
Abstract
Student diversity in health professions education (HPE) can be affected by selection procedures. Little is known about how different selection tools impact student diversity across programs using different combinations of traditional and broadened selection criteria. The present multi-site study examined the chances in selection of subgroups of applicants to HPE undergraduate programs with distinctive selection procedures, and their performance on corresponding selection tools. Probability of selection of subgroups (based on gender, migration background, prior education, parental education) of applicants (N = 1935) to five selection procedures of corresponding Dutch HPE undergraduate programs was estimated using multilevel logistic regression. Multilevel linear regression was used to analyze performance on four tools: prior-education grade point average (pe-GPA), biomedical knowledge test, curriculum-sampling test, and curriculum vitae (CV). First-generation Western immigrants and applicants with a foreign education background were significantly less likely to be selected than applicants without a migration background and with pre-university education. These effects did not vary across programs. More variability in effects was found between different selection tools. Compared to women, men performed significantly poorer on CVs, while they had higher scores on biomedical knowledge tests. Applicants with a non-Western migration background scored lower on curriculum-sampling tests. First-generation Western immigrants had lower CV-scores. First-generation university applicants had significantly lower pe-GPAs. There was a variety in effects for applicants with different alternative forms of prior education. For curriculum-sampling tests and CVs, effects varied across programs. Our findings highlight the need for continuous evaluation, identifying best practices within existing tools, and applying alternative tools.
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Affiliation(s)
- S Fikrat-Wevers
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-207, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - K M Stegers-Jager
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-207, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - P M Afonso
- Department of Biostatistics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A S Koster
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - R A Van Gestel
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - M Groenier
- Technical Medical Centre, Technical Medicine, University of Twente, Enschede, The Netherlands
| | - J H Ravesloot
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Wouters
- Faculty of Medicine VU, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - W W Van Den Broek
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-207, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - A M Woltman
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-207, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Ibrahim Bashir MM, Fadelalla Alrayah MA, Elsayed Mustafa ME, Abdulla Maroof MK, Omer Hamad MA, Ali Mohamedosman MM. Medicine as a career choice: a comprehensive study on factors influencing Sudanese students to opt in/out medical career. BMC MEDICAL EDUCATION 2023; 23:418. [PMID: 37287048 DOI: 10.1186/s12909-023-04415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The medical profession is one of the most highly respected and desired professions among students worldwide, most likely because it provides opportunities for both a financially and socially rewarding career. However, while it has been quite established that factors such as self-interest, family pressure, friend pressure, and socioeconomic status do influence the choice of medicine among students worldwide, the exact reasons for an individual to join a medical school may actually vary worldwide. The aim of this study was to comprehensively explore factors influencing medical students to opt in/out medical careers in Sudan. METHODS An institutional based descriptive cross-sectional study was conducted at University of Khartoum in the year 2022 with a random sample of 330 students that was obtained from the medical students at the The University of Khartoum, Faculty of Medicine using stratified random sampling. RESULTS Self-interest was the most common factor influencing opting in (choosing) medical profession (70.6%) (n = 233), followed by getting a very high score in high-school that qualifies into the faculty (55.5%) (n = 183). Regarding the factors affecting medical students' choices, parental pressure was the main factor (37.0%) (n = 122), followed by other relatives' pressure (12.4%) (n = 41), and 4.2% (n = 14) chose Peer pressure. 59.7% (n = 197) of the participants stated that they were not affected by any of these factors. Most of the participants felt that the general perception of the medical profession by society is that it is prestigious and has good career opportunities, only 5.8% (n = 19) believed that it is "Not appreciated at all" by the society. A statistically significant association was found between the type of admission & parent pressure (p value 0.01). out of 330 participants, (56.1%) (n = 185) have opted out i.e. lost their interest or regretted their choice of medical career. Academic difficulties was the most common factor causing students to opt-out of the medical career (37%) (n = 122) followed by Multiple suspensions of education (35.2%) (n = 116), Current political & security conflicts in Sudan (29.7%) (n = 98), Poor quality of education (24.8%). The proportion of students having regrets for the medical profession was significantly higher among females. Over one third of the participants reported having depressive symptoms more than half days of the week. No statically significant correlation was established between the academic level and having these depressive symptoms and no statistically significant correlation was established between the decision to opt-out and the academic level (class) of the individuals (P = 0.105). CONCLUSIONS Over half of Sudanese medical students at the University of Khartoum have already lost their interest or regretted their choice of medical career choice. Whether these future doctor chose to drop out or continue their path in the medical career suggests that they are more prone to serious hardships in their future careers. A careful comprehensive approach should further explore and try to offer solutions for problems like "Academic difficulties", "multiple suspension of education", and "poor quality of education" for they were the most common factors that caused medical students to opt out of the medical career.
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Fikrat-Wevers S, De Leng WE, Van Den Broek WW, Woltman AM, Stegers-Jager KM. The added value of free preparatory activities for widening access to medical education: a multi-cohort study. BMC MEDICAL EDUCATION 2023; 23:196. [PMID: 36991413 PMCID: PMC10053372 DOI: 10.1186/s12909-023-04191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Medical schools are reported to be less accessible to students with non-traditional backgrounds. These students face barriers when applying for and transitioning to medical school, which may be reduced by offering free preparatory activities. By equalizing access to resources, these activities are expected to reduce disparities in selection outcomes and early academic performance. In the present study, four free institutionally-provided preparatory activities were evaluated by comparing the demographic composition of participating and non-participating applicants. Additionally, the association between participation and selection outcomes and early academic performance was investigated for subgroups (based on sex, migration background and parental education). METHODS Participants were applicants to a Dutch medical school in 2016-2019 (N = 3592). Free preparatory activities included Summer School (N = 595), Coaching Day (N = 1794), Pre-Academic Program (N = 217), and Junior Med School (N = 81), supplemented with data on participation in commercial coaching (N = 65). Demographic compositions of participants and non-participants were compared using chi-squared tests. Regression analyses were performed to compare selection outcomes (curriculum vitae [CV], selection test score, probability of enrolment) and early academic performance (first-course grade) between participants and non-participants of demographic subgroups, controlling for pre-university grades and participation in other activities. RESULTS Generally, no differences in sociodemographic compositions of participants and non-participants were found, but males participated less often in Summer School and Coaching Day. Applicants with a non-Western background participated less often in commercial coaching, but the overall participation rate was low and participation had negligible effects on selection outcomes. Participation in Summer School and Coaching Day were stronger related with selection outcomes. In some cases, this association was even stronger for males and candidates with a migration background. After controlling for pre-university grades, none of the preparatory activities were positively associated with early academic performance. CONCLUSIONS Free institutionally-provided preparatory activities may contribute to student diversity in medical education, because usage was similar across sociodemographic subgroups, and participation was positively associated with selection outcomes of underrepresented and non-traditional students. However, since participation was not associated with early academic performance, adjustments to activities and/or curricula are needed to ensure inclusion and retention after selection.
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Affiliation(s)
- S Fikrat-Wevers
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - W E De Leng
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - W W Van Den Broek
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - A M Woltman
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - K M Stegers-Jager
- Institute of Medical Education Research Rotterdam, Erasmus MC, University Medical Center Rotterdam, Room AE-241, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Fikrat‐Wevers S, Stegers‐Jager K, Groenier M, Koster A, Ravesloot JH, Van Gestel R, Wouters A, van den Broek W, Woltman A. Applicant perceptions of selection methods for health professions education: Rationales and subgroup differences. MEDICAL EDUCATION 2023; 57:170-185. [PMID: 36215062 PMCID: PMC10092456 DOI: 10.1111/medu.14949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
CONTEXT Applicant perceptions of selection methods can affect motivation, performance and withdrawal and may therefore be of relevance in the context of widening access. However, it is unknown how applicant subgroups perceive different selection methods. OBJECTIVES Using organisational justice theory, the present multi-site study examined applicant perceptions of various selection methods, rationales behind perceptions and subgroup differences. METHODS Applicants to five Dutch undergraduate health professions programmes (N = 704) completed an online survey including demographics and a questionnaire on applicant perceptions applied to 11 commonly used selection methods. Applicants rated general favourability and justice dimensions (7-point Likert scale) and could add comments for each method. RESULTS Descriptive statistics revealed a preference for selection methods on which applicants feel more 'in control': General favourability ratings were highest for curriculum-sampling tests (mean [M] = 5.32) and skills tests (M = 5.13), while weighted lottery (M = 3.05) and unweighted lottery (M = 2.97) were perceived least favourable. Additionally, applicants preferred to distinguish themselves on methods that assess attributes beyond cognitive abilities. Qualitative content analysis of comments revealed several conflicting preferences, including a desire for multiple selection methods versus concerns of experiencing too much stress. Results from a linear mixed model of general favourability indicated some small subgroup differences in perceptions (based on gender, migration background, prior education and parental education), but practical meaning of these differences was negligible. Nevertheless, concerns were expressed that certain selection methods can hinder equitable admission due to inequal access to resources. CONCLUSIONS Our findings illustrate that applicants desire to demonstrate a variety of attributes on a combination of selection tools, but also observe that this can result in multiple drawbacks. The present study can help programmes in deciding which selection methods to include, which more negatively perceived methods should be better justified to applicants, and how to adapt methods to meet applicants' needs.
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Affiliation(s)
- Suzanne Fikrat‐Wevers
- Institute of Medical Education Research RotterdamErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Karen Stegers‐Jager
- Institute of Medical Education Research RotterdamErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Marleen Groenier
- Technical Medical Centre, Technical MedicineUniversity of TwenteEnschedeThe Netherlands
| | - Andries Koster
- Department of Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Jan Hindrik Ravesloot
- Department of Medical Biology, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Renske Van Gestel
- Department of Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Anouk Wouters
- Faculty of Medicine VUAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and EducationVU University AmsterdamAmsterdamThe Netherlands
| | - Walter van den Broek
- Institute of Medical Education Research RotterdamErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Andrea Woltman
- Institute of Medical Education Research RotterdamErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
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Mulder L, Wouters A, Fikrat-Wevers S, Koster AS, Ravesloot JH, Croiset G, Kusurkar RA. Influence of social networks in healthcare on preparation for selection procedures of health professions education: a Dutch interview study. BMJ Open 2022; 12:e062474. [PMID: 36316069 PMCID: PMC9628659 DOI: 10.1136/bmjopen-2022-062474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Health professions education (HPE) students are often not representative of the populations they will serve. The underrepresentation of non-traditional students is problematic because diversity is essential for promoting excellence in health education and care. This study aimed to understand the perceptions of traditional and non-traditional students regarding facilitators and barriers in preparing for HPE selection procedures, and to determine the role of social networks in their decision-making and preparations to apply. METHODS A qualitative study was conducted with 26 Dutch youth who were interested in university-level HPE programmes. Semistructured interviews and sociograms were analysed using thematic analysis, adopting a constructivist approach. RESULTS Twenty-six high school students participated, with traditional and non-traditional backgrounds, with and without social networks in healthcare and higher education. Two themes were constructed. First, four high-impact facilitators helped to overcome barriers to apply and in preparation for selection: access to a social network connection working or studying in healthcare, to correct information, to healthcare experience and to a social network connection in higher education. Lack of information was the main barrier while access to social network connections in healthcare was the main facilitator to overcome this barrier. However, this access was unevenly distributed. Second, access alone is not enough: the need for agency to make use of available facilitators is also essential. CONCLUSIONS The themes are discussed using intersectionality. Traditional students with access to facilitators develop their self-efficacy and agency within social structures that privilege them, whereas non-traditional students must develop those skills without such structures. Our findings provide recommendations for the ways in which universities can remove barriers that cause unequal opportunities to prepare for the selection of HPE programmes. Along with equitable admissions, these recommendations can help to achieve a more representative student population and subsequently a better quality of health education and care.
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Affiliation(s)
- Lianne Mulder
- Amsterdam UMC location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anouk Wouters
- Amsterdam UMC location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Fikrat-Wevers
- Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Andries S Koster
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jan Hindrik Ravesloot
- Amsterdam UMC location University of Amsterdam, Department of Medical Biology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Gerda Croiset
- Wenckebach Institute for Education and Training, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rashmi A Kusurkar
- Amsterdam UMC location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Bonvin S, Stiefel F, Gholam M, Bourquin C. Calling situated: a survey among medical students supplemented by a qualitative study and a comparison with a surveyed sample of physicians. BMC MEDICAL EDUCATION 2022; 22:619. [PMID: 35971124 PMCID: PMC9376571 DOI: 10.1186/s12909-022-03642-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Calling within the medical context receives growing academic attention and empirical research has started to demonstrate its beneficial effects. The purpose of this study is to investigate what motivates students to enter medical school and what role calling may play (i), to evaluate if calling influences the way in which they experience their studies (ii), and to compare medical students' experience of calling with those of physicians. METHODS A questionnaire survey was distributed among medical students (N = 1048; response rate above 60%) of the University of Lausanne in Switzerland. It was supplemented by a group discussion between bachelor medical students (N = 8) and senior physicians (N = 4), focusing on different facets of calling. An existing data set of a survey among physicians, addressing calling with the same questionnaire, was used to compare students' and physicians' attitudes towards calling. Survey data were analyzed with the habitual statistical procedures for categorical and continuous variables. The group discussion was analyzed with thematic analysis. RESULTS The survey showed that experiencing calling is a motivational factor for study choice and influences positively choice consistency. Students experiencing calling differed from those who did not: they attributed different definitions to calling, indicated more often prosocial motivational factors for entering medical school and perceived the learning context as less burdensome. The analysis of the group discussion revealed that the concept of calling has a fluid definition. It was conceived as having the characteristics of a double-edged sword and as originating from within or outside or from a dialectic interplay between the inner and outer world. Finally, calling is experienced less often by physicians than by medical students, with a decreasing prevalence as the immersion in the clinical years of the study of medicine progresses. CONCLUSIONS Calling plays an important role in study choice and consistency of medical students. Given its relevance for medical students and its ramifications with the learning context, calling should become a topic of the reflexive parts of the medical curriculum. We critically discuss the role played by calling for medical students and provide some perspectives on how calling could be integrated in the reflection and teaching on physicianhood.
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Affiliation(s)
- S Bonvin
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - F Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Gholam
- Center of Epidemiological Psychiatry and Psychopathology (CEPP), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Mulder L, Wouters A, Twisk JWR, Koster AS, Akwiwu EU, Ravesloot JH, Croiset G, Kusurkar RA. Selection for health professions education leads to increased inequality of opportunity and decreased student diversity in The Netherlands, but lottery is no solution: A retrospective multi-cohort study. MEDICAL TEACHER 2022; 44:790-799. [PMID: 35236235 DOI: 10.1080/0142159x.2022.2041189] [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 Concerns exist about the role of selection in the lack of diversity in health professions education (HPE). In The Netherlands, the gradual transition from weighted lottery to selection allowed for investigating the variables associated with HPE admission, and whether the representativeness of HPE students has changed. METHOD We designed a retrospective multi-cohort study using Statistics Netherlands microdata of all 16-year-olds on 1 October 2008, 2012, and 2015 (age cohorts, N > 600,000) and investigated whether they were eligible students for HPE programs (n > 62,000), had applied (n > 14,000), and were HPE students at age 19 (n > 7500). We used multivariable logistic regression to investigate which background variables were associated with becoming an HPE student. RESULTS HPE students with ≥1 healthcare professional (HP) parent, ≥1 top-10% income/wealth parent, and women are overrepresented compared to all age cohorts. During hybrid lottery/selection (cohort-2008), applicants with ≥1 top-10% wealth parent and women had higher odds of admission. During 100% selection (cohort-2015) this remained the case. Additionally, applicants with ≥1 HP parent had higher odds, those with a migration background had lower odds. CONCLUSIONS Odds of admission are increasingly influenced by applicants' backgrounds. Targeted recruitment and equitable admissions procedures are required to increase matriculation of underrepresented students.
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Affiliation(s)
- Lianne Mulder
- Amsterdam UMC, Research in Education, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
- LEARN! Faculty of Psychology and Education, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anouk Wouters
- Amsterdam UMC, Research in Education, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
- LEARN! Faculty of Psychology and Education, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Andries S Koster
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Eddymurphy U Akwiwu
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Jan H Ravesloot
- Department of Medical Biology, Amsterdam UMC, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerda Croiset
- Wenckebach Institute for Education and Training, University Medical Center Groningen, Groningen, The Netherlands
| | - Rashmi A Kusurkar
- Amsterdam UMC, Research in Education, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
- LEARN! Faculty of Psychology and Education, Vrije Universiteit, Amsterdam, The Netherlands
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Zhang R, Pei J, Wang Y, Wang L, Yeerjiang Y, Gao H, Xu W. COVID-19 outbreak improves attractiveness of medical careers in Chinese senior high school students. BMC MEDICAL EDUCATION 2022; 22:241. [PMID: 35379234 PMCID: PMC8978502 DOI: 10.1186/s12909-022-03309-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/23/2022] [Indexed: 05/15/2023]
Abstract
BACKGROUND The shortage of healthcare workers is becoming a serious global problem. The underlying reasons may be specific to the healthcare system in each country. Over the past decade, medicine has become an increasingly unpopular profession in China due to the heavy workload, long-term training, and inherent risks. The ongoing COVID-19 pandemic has placed the life-saving roles of healthcare professionals under the spotlight. This public health crisis may have a profound impact on career choices in Chinese population. METHODS We conducted a questionnaire-based online survey among 21,085 senior high school students and 21,009 parents from 24 provinces (or municipalities) of China. We investigated the change of interest in medical study due to the outbreak of COVID-19 and the potential motivational factors based on the expectancy-value theory framework. Pearson correlation analysis was used to assess the correlation of static or dynamic interest in medical career pursuit with the reported number of COVID-19 cases. Logistic regression model was adopted to analyze the main factors associated with students' choices. RESULTS We observed an increased preference for medical study post the outbreak of COVID-19 in both students (17.5 to 29.6%) and parents (37.1 to 47.3%). Attainment value was found to be the main reason for the choice among students, with the contribution to society rated as the top motivation. On the other hand, the predominant demotivation in high school students was lack of interest, followed by concerns regarding violence against doctors, heavy workload, long-term training and heavy responsibility as a doctor. Additionally, students who were female, in the resit of final year, had highly educated parents and outside of Hubei province were significantly associated with a keen interest in pursuing medical study. CONCLUSIONS This is the first multi-center cross-sectional study exploring the positive change and motivations of students' preferences in medical study due to the outbreak of COVID-19. Our results may help medical educators, researchers and policymakers to restructure medical education to make it more appealing to high school students, particularly, to develop a more supportive social and working environment for medical professionals to maintain the observed enhanced enthusiasm.
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Affiliation(s)
- Ruoxin Zhang
- Department of Epidemiology, Key Lab of Health Technology Assessment (National Health Commission), Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Jianfeng Pei
- Department of Epidemiology, Key Lab of Health Technology Assessment (National Health Commission), Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Yanli Wang
- Wuhan No.4 High School, 347 Jie Fang Avenue, Wuhan, 430022, Hubei Province, China
| | - Lei Wang
- Department of Epidemiology, Key Lab of Health Technology Assessment (National Health Commission), Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Yeerzhati Yeerjiang
- Department of Epidemiology, Key Lab of Health Technology Assessment (National Health Commission), Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Haifeng Gao
- Admissions Office, Shanghai Medical College of Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Wanghong Xu
- Department of Epidemiology, Key Lab of Health Technology Assessment (National Health Commission), Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, China.
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Simon P, Chiniara G, St-Pierre L, Ahossi E, Dogba MJ, Cléophat J, Chénier C, Dubuc É, Landry C, Vonarx N, Pilote B. [First wave of COVID-19 in Quebec: Healthcare workers' motivation to treat infected patients]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2022; Vol. 33:853-862. [PMID: 35485017 DOI: 10.3917/spub.216.0853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Retention of healthcare workers (HCWs) in the healthcare system during the COVID-19 pandemic could become a challenge. It is therefore important to better understand what are the motivational elements that could explain a greater or lesser motivation to care for infected patients. OBJECTIVES To evaluate factors modulating HCWs' willingness to treat COVID-19 infected patients. METHODS HCWs from Québec, Canada, were invited to complete an online survey during the first wave of the COVID-19 pandemic between the months of April and July 2020. The survey focused on the intention to avoid treating infected patients, prior experiences in treating COVID-19 patients and anxiety levels. Descriptive statistics and multiple regression analysis were used to assess which factors explained differences in HCWs intention to avoid treating patients. RESULTS A total of 430 HCW completed the survey. A majority were women (87%) and nurses (50%). Of those, 12% indicated having considered measures to avoid working with COVID-19 infected patients and 5% indicated having taken actions to avoid working with infected patients. A further 18% indicated that they would use a hypothetical opportunity to avoid working with infected patients. Having previously treated infected patients was associated with a significant reduction in the intention to avoid work (OR: 0.56 CI 0.36-0.86). Amongst HCWs, physicians had a significantly reduced intention to avoid treating infected patients (OR: 0.47 CI 0.23-0.94). We also found that an increase in anxiety score was associated with a greater intention to avoid treating COVID-19 infected patients (OR: 1.06 CI 1.04-1.08). CONCLUSION Study results suggest that previous experience in treating COVID-19 infected patients is protective in terms of work-avoidance intentions. We also found that amongst HCWs, physicians had a significantly lower intention to avoid working with COVID-19 infected patients. Finally, our results show that increase in anxiety is associated with a higher intention to avoid treating infected patients. Characterization of factors associated with low anxiety levels and low reluctance to work during the COVID-19 pandemic could be useful in staffing facilities during the present and future healthcare crisis.
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Watari T, Nagai N, Kono K, Onigata K. Background factors associated with academic motivation for attending medical school immediately after admission in Japan: A single‐center study. J Gen Fam Med 2022; 23:164-171. [PMID: 35509336 PMCID: PMC9062539 DOI: 10.1002/jgf2.528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/02/2022] [Accepted: 02/05/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Takashi Watari
- General Medicine Center Shimane University Hospital Shimane Japan
| | | | - Kaori Kono
- Shimane University Faculty of Medicine Shimane Japan
| | - Kazumichi Onigata
- Shimane University Faculty of Medicine Shimane Japan
- Postgraduate Clinical Training Center Shimane University Hospital Shimane Japan
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Pfarrwaller E, Voirol L, Piumatti G, Karemera M, Sommer J, Gerbase MW, Guerrier S, Baroffio A. Students' intentions to practice primary care are associated with their motives to become doctors: a longitudinal study. BMC MEDICAL EDUCATION 2022; 22:30. [PMID: 35016672 PMCID: PMC8750802 DOI: 10.1186/s12909-021-03091-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical schools can contribute to the insufficient primary care physician workforce by influencing students' career preferences. Primary care career choice evolves between matriculation and graduation and is influenced by several individual and contextual factors. This study explored the longitudinal dynamics of primary care career intentions and the association of students' motives for becoming doctors with these intentions in a cohort of undergraduate medical students followed over a four-year period. METHODS The sample consisted of medical students from two classes recruited into a cohort study during their first academic year, and who completed a yearly survey over a four-year period from their third (end of pre-clinical curriculum) to their sixth (before graduation) academic year. Main outcome measures were students' motives for becoming doctors (ten motives rated on a 6-point scale) and career intentions (categorized into primary care, non-primary care, and undecided). Population-level flows of career intentions were investigated descriptively. Changes in the rating of motives over time were analyzed using Wilcoxon tests. Two generalized linear mixed models were used to estimate which motives were associated with primary care career intentions. RESULTS The sample included 217 students (60% females). Career intentions mainly evolved during clinical training, with smaller changes at the end of pre-clinical training. The proportion of students intending to practice primary care increased over time from 12.8% (year 3) to 24% (year 6). Caring for patients was the most highly rated motive for becoming a doctor. The importance of the motives cure diseases, saving lives, and vocation decreased over time. Primary care career intentions were positively associated with the motives altruism and private practice, and negatively associated with the motives prestige, academic interest and cure diseases. CONCLUSION Our study indicates that career intentions are not fixed and change mainly during clinical training, supporting the influence of clinical experiences on career-related choices. The impact of students' motives on primary care career choice suggests strategies to increase the attractivity of this career, such as reinforcing students' altruistic values and increasing the academic recognition of primary care.
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Affiliation(s)
- Eva Pfarrwaller
- University Institute for Primary Care (IuMFE), Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Genève 4, Switzerland.
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Lionel Voirol
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Giovanni Piumatti
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Public Health, Faculty of BioMedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Mucyo Karemera
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Johanna Sommer
- University Institute for Primary Care (IuMFE), Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Genève 4, Switzerland
| | - Margaret W Gerbase
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Guerrier
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
- Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Anne Baroffio
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Isik U, Wouters A, Verdonk P, Croiset G, Kusurkar RA. "As an ethnic minority, you just have to work twice as hard." Experiences and motivation of ethnic minority students in medical education. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:272-278. [PMID: 34515955 PMCID: PMC8505584 DOI: 10.1007/s40037-021-00679-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Adequate representation of ethnic minority groups in the medical workforce is crucial for ensuring equitable healthcare to diverse patient groups. This requires recruiting ethnic minority medical students and taking measures that enable them to complete their medical studies successfully. Grounded in self-determination theory and intersectionality, this paper explores the experiences of ethnic minority medical students across intersections with gender and other categories of difference and how these relate to students' motivation. METHODS An explorative, qualitative study was designed. Six focus groups were conducted with 26 ethnic minority students between December 2016 and May 2017. Thematic analysis was performed to identify, analyse and report themes within the data. RESULTS The findings were categorized into three main themes: the role of autonomy in the formation of motivation, including students' own study choice and the role of their family; interactions/'othering' in the learning environment, including feelings of not belonging; and intersection of ethnic minority background and gender with being 'the other', based on ethnicity. DISCUSSION Ethnic minority students generally do not have a prior medical network and need role models to whom they can relate. Ensuring or even appointing more ethnic minority role models throughout the medical educational continuum-for example, specialists from ethnic minorities in teaching and/or mentoring roles in the education-and making them more visible to students is recommended. Moreover, a culture needs to be created in the educational environment in which students and staff can discuss their ethnicity-related differences.
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Affiliation(s)
- Ulviye Isik
- Amsterdam UMC, Research in Education, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands.
| | - Anouk Wouters
- Amsterdam UMC, Research in Education, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Petra Verdonk
- Amsterdam UMC, Department of Ethics, Law & Humanities, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Gerda Croiset
- University Medical Center Groningen, Groningen, The Netherlands
| | - Rashmi A Kusurkar
- Amsterdam UMC, Research in Education, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
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Koob C, Schröpfer K, Coenen M, Kus S, Schmidt N. Factors influencing study engagement during the COVID-19 pandemic: A cross-sectional study among health and social professions students. PLoS One 2021; 16:e0255191. [PMID: 34314450 PMCID: PMC8315536 DOI: 10.1371/journal.pone.0255191] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The aim of this study is to explore factors influencing the study engagement of health and social professions students during the COVID-19 pandemic. While antecedents of study engagement have been studied previously, the factors influencing engagement under pandemic conditions have not yet been investigated. Furthermore, there is a particular need for research among students in health and social professions programs, as these students are particularly affected by the pandemic. As theoretical basis, the study draws on the demands-resources-theory. It is hypothesized that pandemic-related study and personal resources drive engagement during the pandemic, and that pandemic-related demands negatively influence engagement. METHOD The study uses a cross-sectional survey to explore the hypothesized effects. The sample consists of 559 university students of health and social professions in Germany. The study was carried out in July 2020, towards the end of the first digital semester and after the first peak in COVID-19 cases. Data are analyzed using linear multiple regression analysis. RESULTS The findings show that the demands-resources-theory is suitable to explain study engagement even under pandemic conditions. Suitable digital learning formats and social support are identified as important study resources for study engagement during major life events, while emotional resilience, active self-care and academic self-efficacy are identified as important personal resources. CONCLUSIONS Under pandemic conditions academic institutions should focus on providing beneficial teaching formats and innovative ways to support students lacking social networks. Besides, they should consider developing means to help students structuring daily life as well as establishing initiatives to strengthen students' self-efficacy beliefs.
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Affiliation(s)
- Clemens Koob
- Department of Health and Nursing, Catholic University of Applied Sciences Munich, Munich, Germany
| | - Kristina Schröpfer
- Department of Medical Information Processing, Biometry, and Epidemiology—IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Department of Medical Information Processing, Biometry, and Epidemiology—IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Sandra Kus
- Department of Medical Information Processing, Biometry, and Epidemiology—IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Nicole Schmidt
- Department of Social Work, Munich, Catholic University of Applied Sciences Munich, Munich, Germany
- Gynecology Division, Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
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Gibson Smith K, Alexander K, Cleland J. Opening up the black box of a Gateway to Medicine programme: a realist evaluation. BMJ Open 2021; 11:e049993. [PMID: 34261690 PMCID: PMC8280889 DOI: 10.1136/bmjopen-2021-049993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES A Gateway to Medicine programme, developed in partnership between a further and higher education setting and implemented to increase the socioeconomic diversity of medicine, was examined to identify precisely what works within the programme and why. DESIGN This study employed realist evaluation principles and was undertaken in three phases: document analysis and qualitative focus groups with widening access (WA) programme architects; focus groups and interviews with staff and students; generation of an idea of what works. SETTING Participants were recruited from a further/higher education setting and were either enrolled or involved in the delivery of a Gateway to Medicine programme. PARTICIPANTS Twelve staff were interviewed either individually (n=3) or in one of three group interviews. Nine focus groups (ranging from 5 to 18 participants in each focus group) were carried out with Gateway students from three consecutive cohorts at 2-3 points in their Gateway programme year. RESULTS Data were generated to determine what 'works' in the Gateway programme. Turning a realist lens on the data identified six inter-relating mechanisms which helped students see medicine as attainable and achievable and prepared them for the transition to medical school. These were academic confidence (M1); developing professional identity (M2); financial support/security (M3); supportive relationships with staff (M4) and peers (M5); and establishing a sense of belonging as a university student (M6). CONCLUSIONS By unpacking the 'black box' of a Gateway programme through realist evaluation, we have shown that such programmes are not solely about providing knowledge and skills but are rather much more complex in respect to how they work. Further work is needed to further test the mechanisms identified in our study in other contexts for theory development and to identify predictors of effectiveness in terms of students' preparedness to transition.
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Affiliation(s)
- Kathrine Gibson Smith
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kirsty Alexander
- Research Department of Medical Education, University College London, London, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Zhang D, Li G, Mu L, Thapa J, Li Y, Chen Z, Shi L, Su D, Son H, Pagan JA. Trends in Medical School Application and Matriculation Rates Across the United States From 2001 to 2015: Implications for Health Disparities. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:885-893. [PMID: 33656008 PMCID: PMC8630772 DOI: 10.1097/acm.0000000000004033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Socioeconomic and geographic determinants of medical school application and matriculation may help explain the unequal distribution of physicians in the United States. This study describes trends in MD-granting medical school application and matriculation rates and explores the relationship between county median family income, proximity to a medical school, and medical school application and matriculation rates. METHOD Data were obtained from the Association of American Medical Colleges, including the age, gender, and Federal Information Processing Standards code for county of legal residence for each applicant and matriculant to U.S. MD-granting medical schools from 2001 through 2015. The application and matriculation rates in each county were calculated using the number of applicants and matriculants per 100,000 residents. Counties were classified into 4 groups according to the county median family income (high-income, middle-income, middle-low-income, low-income). The authors performed chi-square tests to assess trends across the study period and the association of county median family income with application and matriculation rates. RESULTS There were 581,833 applicants and 262,730 (45.2%) matriculants to MD-granting medical schools between 2001 and 2015. The application rates per 100,000 residents during 2001-2005, 2006-2010, and 2011-2015 were 57.2, 62.7, and 69.0, respectively, and the corresponding matriculation rates were 27.5, 28.1, and 29.8. The ratios of the application rate in high-income counties to that in low-income counties during the 3 time periods were 1.9, 2.4, and 2.8, respectively. CONCLUSIONS The application and matriculation rates to MD-granting medical schools increased steadily from 2001 to 2015. Yet, applicants and matriculants disproportionately came from high-income counties. The differences in the application and matriculation rates between low-income and high-income counties grew during this period. Exploring these differences can lead to better understanding of the factors that drive geographic differences in physician access and the associated health disparities across the United States.
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Affiliation(s)
- Donglan Zhang
- D. Zhang is assistant professor, Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia; ORCID: https://orcid.org/0000-0001-5225-4721
| | - Gang Li
- G. Li is a PhD student, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China, and Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia; ORCID: https://orcid.org/0000-0002-6513-2907
| | - Lan Mu
- L. Mu is professor, Department of Geography, University of Georgia, Athens, Georgia; ORCID: https://orcid.org/0000-0003-0199-9509
| | - Janani Thapa
- J. Thapa is assistant professor, Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia; ORCID: https://orcid.org/0000-0002-0468-0387
| | - Yan Li
- Y. Li is associate professor, Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York; ORCID: https://orcid.org/0000-0002-0468-0387
| | - Zhuo Chen
- Z. Chen is associate professor, Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia; ORCID: https://orcid.org/0000-0002-5351-3489
| | - Lu Shi
- L. Shi is associate professor, Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina; ORCID: https://orcid.org/0000-0001-8352-2813
| | - Dejun Su
- D. Su is associate professor, Center for Reducing Health Disparities, Department of Health Promotion, Social & Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska; ORCID: https://orcid.org/0000-0002-7723-3262
| | - Heejung Son
- H. Son is a PhD student, Department of Health Policy and Management and Department of Epidemiology & Biostatistics, College of Public Health, University of Georgia, Athens, Georgia; ORCID: https://orcid.org/0000-0001-9425-9504
| | - Jose A Pagan
- J.A. Pagan is professor, Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York; ORCID: https://orcid.org/0000-0002-8915-9602
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Murray C, Mountford‐Zimdars A, Mattick K. Which disadvantaged students study medicine? Analysis of an English outreach scheme. Health Sci Rep 2021; 4:e264. [PMID: 33977155 PMCID: PMC8102056 DOI: 10.1002/hsr2.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Students from disadvantaged backgrounds continue to be underrepresented in medical education. Widening participation (WP) or outreach schemes seek to increase diversity. Drawing on previously unexplored data from a scheme called Realising Opportunities in England, this study aimed to investigate which high-achieving socioeconomically disadvantaged students in a national WP scheme went on to study medicine at university. METHODS This retrospective longitudinal study analyzed data of 2665 16-year-olds on a WP scheme in England between 2010 and 2014. Descriptive statistics and logistic regression analyses investigated any differences between those that went on to study medicine and those that did not. Eligibility for studying medicine, student's neighborhood, gender, ethnicity, parent's higher education experience, exam attainment, interest in medicine, and their subject of choice for university at age 16 were considered. RESULTS Of the 1850 students who were tracked to a university destination, only 55 (3%) studied medicine. Participants with high exam results, female, Asian, and from neighborhoods of higher university entry were most likely to study medicine. In the multivariate model, only prior attainment and intention to study medicine predicted studying medicine. Three hundred and forty Realising Opportunities participants expressed interest in studying medicine at age 16, but 80 (24%) were found to have unrealistic aspirations based on their prior academic attainment. CONCLUSIONS Attainment and intention were key factors for predicting medicine enrolment among these outreach scheme participants. Some students interested in studying medicine had insufficient academic attainment to compete for medical school places. Efforts to equalize attainment and provide guidance for career choice are crucial factors for students from disadvantaged backgrounds.
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Yang C, Jin X, Yan J, Zhang J, Chen C, Cheng Y, You J, Deng G. An investigation of the intention and reasons of senior high school students in China to choose medical school. BMC MEDICAL EDUCATION 2021; 21:242. [PMID: 33902559 PMCID: PMC8077942 DOI: 10.1186/s12909-021-02677-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/15/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Shortages of qualified health workers have been a global concern, especially in developing countries. China also faces this dilemma, which hinders the development of public health services. Senior high school students are a group who are considering their college majors and careers after graduation. They are also a potential and basic talent reserve for the health sector. This survey focused on senior high school students' intention to learn clinical medicine and explored potential influencing factors. METHODS An anonymous questionnaire containing 20 items was distributed to 5344 senior high school students. The questions covered the following topics: students' intention to learn clinical medicine, personal and family information, understanding of medical education, cognition of doctors' working conditions, and doctor-patient relationships. Logistic regression and the chi-square test were used to compare students with and without a clear intention to learn clinical medicine to explore influencing factors. RESULTS Only 5.6% of senior high school students had a clear intention to learn medicine (CILCM). Personal and family information had distinct impacts. Interest and anatomy course were also associated with students' choice. There was a positive correlation between understanding of medical education and students' intention Meanwhile, students' cognition of doctors, career prospects, and social status had significant impacts. The more optimistic students were about doctors' working conditions and doctor-patient relationships, the more likely they were to have a CILCM. CONCLUSION To some extent, this survey reflects the shortage of medical talent in China and provides possible clues for solving this problem. In addition, these findings may provide a perspective for understanding the development of health services in developing countries.
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Affiliation(s)
- Chaoqun Yang
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650 Xin Songjiang Road, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xuerui Jin
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650 Xin Songjiang Road, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ji Yan
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650 Xin Songjiang Road, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Junkai Zhang
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650 Xin Songjiang Road, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Canyu Chen
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650 Xin Songjiang Road, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yaqing Cheng
- Youth League Committee Office, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jialin You
- Youth League Committee Office, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Guoying Deng
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650 Xin Songjiang Road, Shanghai, China.
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21
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Manor U, Allon R, Gan-Or H, Yahal O, Benov A, Chen J. Previous Military Medical Exposure as a Motivator for a Medical Career. Mil Med 2021; 186:757-761. [PMID: 33499460 DOI: 10.1093/milmed/usaa335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/24/2020] [Accepted: 09/04/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION A variety of factors influence the motivation to choose a medical career; however, the influence of premedical experiences on health professional trainees' choices is a neglected one. We hypothesize that medical exposure during service in the Israeli Air Force special operations forces (SOFs) has an impact on motivation for medical studies. The Israeli scenario, in which career choice is anteceded by substantial military experience, allows us to examine this hypothesis. MATERIALS AND METHODS We conducted a retrospective cohort study among physicians and medical students who served as operators in the Israeli Air Force SOF; Unit 669 (an airborne combat search and rescue unit), and Shaldag (an airborne SOF unit). All medical students and physicians enlisted between January 2001 and December 2010 were eligible for enrollment. RESULTS Of over 700 operators screened, 3.7% of Shaldag veterans and 11.1% of Unit 669 veterans had started or finished medical school (P-value < 0.001). Overall, 49 veterans answered the questionnaire and enrolled in the study, of whom 17 (34.7%) were Shaldag veterans and 32 (65.3%) were Unit 669 veterans. Subjective questions implied a significant effect of the service in Unit 669 on career choice. Paramedics had a relative risk of becoming physicians of 7.37 when compared to nonparamedic operators, irrespective of their original unit. CONCLUSIONS Medical exposure of Unit 669 operators during military service significantly contributed to their motivation for becoming physicians. Thus, military service in this setting acts de facto as an effective medical immersion program. This adds another factor to the myriad of factors that motivate young adults in their choice of a medical career.
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Affiliation(s)
- Uri Manor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.,Sheba Medical Center, Tel HaShomer, Ramat Gan 5266202, Israel
| | - Raviv Allon
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa 3200003, Israel
| | - Hadar Gan-Or
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa 3200003, Israel
| | - Orr Yahal
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Avi Benov
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel.,Israel Defense Forces, Medical Corps, Tel HaShomer, Ramat Gan 5265601, Israel
| | - Jacob Chen
- Israel Defense Forces, Medical Corps, Tel HaShomer, Ramat Gan 5265601, Israel
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22
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Fuente-Vidal A, March-Amengual JM, Bezerra de Souza DL, Busquets-Alibés E, Sole S, Cañete S, Jerez-Roig J. Factors influencing student choice of a degree in physiotherapy: a population-based study in Catalonia (Spain). PeerJ 2021; 9:e10991. [PMID: 33850646 PMCID: PMC8019530 DOI: 10.7717/peerj.10991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background In other healthcare professions, there has been extensive research into students' motivation, but studies aiming to determine what leads individuals to choose a degree in physiotherapy are scarce. This research study had three main objectives: to obtain a sociodemographic profile of first-year physiotherapy students in Catalonia; to determine the factors that lead individuals to choose a degree in physiotherapy; and to determine potential differences, according to gender and country of origin. Methods This is an observational, cross-sectional, multicentre study. Data were collected by means of a self-administered, ad-hoc questionnaire, consisting of 15 Likert scale questions, options ranging from "not influencing at all -1-" to "extremely influencing -5-". Ten out of the twelve universities in Catalonia (Spain) that offer a degree in physiotherapy participated in this study. The sample consisted of 941 first-year physiotherapy students (55.2% men; mean age 20.1, SD: 3.4). Results The most determinant factors leading individuals to pursue a degree in physiotherapy were: helping others (95.6%); the relationship between physiotherapy and sports (79%); physiotherapy involving manual work (76.4%); and it being perceived as providing multiple job opportunities (75.9%). Male and French students were attracted due to its relation to sports (MD = 0.369, p < 0.001 and MD = 0.130, p < 0.027), perception of it being an easy degree (MD = 0.148, p < 0.001 and MD = 0.091, p < 0.037), admiration for a known physiotherapist (MD = 0.223, p = 0.006 and MD = 0.265, p = 0.001), employability (MD = 0.297, p < 0.001 and MD = 0.706, p < 0.001), good income (MD = 0.190, p = 0.002 and MD = 0.609, p < 0.001) and social recognition (MD = 0.164, p = 0.011 and MD = 0.286, p < 0.001). Helping others (MD = -0.149, p < 0.001) and interest in the sciences (MD = -0.164, p = 0.030) were more determinant for female students. Male students were more guided by recommendation (MD = 0.234, p = 0.001) and to complement previous studies (MD = 0.237, p = 0.016). French students tended to present more interest in the selection of physiotherapy as a wish since childhood (MD = 0.595, p < 0.001), due to its multiple job opportunities (MD = 0.427, p < 0.001) and because of manual work, and did not choose it to complement previous studies (MD = -1.122, p < 0.001). Conclusions The desire to help and care for others, the relation to sports, and involving manual work are the predominant factors that lead students to pursue a degree in physiotherapy. Female students favour helping others and science, whereas male students favour its relation to sports, complementing studies, social factors (admiration, recommendation, friendship) and socioeconomic determinants such as employability, good income or social recognition. When compared to Spanish students, French students were more motivated by its connection to sports, social and socioeconomic factors and some vocational determinants such as being a wish since childhood and interest in a manual profession.
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Affiliation(s)
- Andrea Fuente-Vidal
- University School for Health and Sports (EUSES), Interuniversity degree in Physiotherapy, University of Barcelona and University of Girona, Spain.,Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Jaume-Miquel March-Amengual
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain.,Càtedra de Bioètica Fundació Grífols, UVic-UCC, Vic, Barcelona, Spain
| | - Dyego L Bezerra de Souza
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain.,Federal University of Rio Grande do Norte, Department of Collective Health, Graduate Programme in Collective Health, Natal, Rio Grande do Norte, Brazil
| | - Ester Busquets-Alibés
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain.,Càtedra de Bioètica Fundació Grífols, UVic-UCC, Vic, Barcelona, Spain
| | - Silvia Sole
- Faculty of Nursery and Physiotherapy, GESEC Research Group, University of Lleida, Lleida, Spain
| | - Sergi Cañete
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Javier Jerez-Roig
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
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23
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Wouters A. Getting to know our non-traditional and rejected medical school applicants. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:132-134. [PMID: 32270368 PMCID: PMC7283413 DOI: 10.1007/s40037-020-00579-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Anouk Wouters
- Faculty of Medicine Vrije Universiteit Amsterdam, Research in Education, Amsterdam UMC, Amsterdam, The Netherlands.
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24
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Ball R, Alexander K, Cleland J. "The biggest barrier was my own self": the role of social comparison in non-traditional students' journey to medicine. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:147-156. [PMID: 32323114 PMCID: PMC7283443 DOI: 10.1007/s40037-020-00580-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Social comparisons strongly influence an individual's concept of self, their aspirations and decisions. This study investigates how non-traditional applicants used social comparison to shape their preferences, beliefs and predictions whilst preparing an application for medical school. METHODS Semi-structured interviews were conducted with 12 UK medical students from non-traditional backgrounds to explore their process of 'getting ready' for medical school, and the role social comparison played in their experiences. Thematic analysis was used to inductively develop themes in the data, before findings were interpreted through the 'triadic model' of social comparison. RESULTS Findings revealed that participants looked to the opinions of those with similar norms and backgrounds to accept their desire to study medicine. They sought the opinions of 'experts' to affirm a belief in their suitability but lacked confidence until success in crucial examinations 'proved', in their own view, that they had the ability to do medicine. Social comparison to peers who were perceived to be less committed to medicine, and to relatable role models, reassured participants that someone from their background could succeed in medicine. DISCUSSION Our findings further understanding about 'how' and 'why' exposure to relevant experts, peers and role models can positively influence application to medicine through the lens of social comparison. We recommend widening access initiatives promote and foster various opportunities for social comparison to help counter non-traditional students' feelings of uncertainty about their ability and prospects, and to reorient their focus away from achieving the required grades before preparing the non-academic aspects of their application.
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Affiliation(s)
- Rachel Ball
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kirsty Alexander
- Research Department for Medical Education (RDME), UCL Medical School, University College London, London, UK.
| | - Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), Institute for Education in Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
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25
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Alexander K, Cleland J, Nicholson S. Bridging the cultural divide? Exploring school pupils' perceptions of medicine. MEDICAL EDUCATION 2019; 53:571-583. [PMID: 30761588 DOI: 10.1111/medu.13805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/17/2018] [Accepted: 12/14/2018] [Indexed: 05/14/2023]
Abstract
CONTEXT Literature published around a decade ago demonstrated that UK individuals from non-traditional groups may not consider, or aspire to, medicine because of sociocultural barriers and instead may perceive medicine as 'not for the likes of me'. Since this time, the UK higher education landscape has undergone significant change, with an increased emphasis on student choice and widening access (WA) initiatives. Consequently, the present study looks anew at the perceptions of medicine held by school pupils from non-traditional backgrounds to assess whether sociocultural factors remain a major barrier to medicine. METHODS Focus groups were conducted with 71 high-achieving school pupils in their penultimate or final years (aged 16-18 years). Participants attended UK state-funded schools engaged with medical school WA initiatives. Transcripts were analysed thematically using a data-driven approach. Themes were then interpreted through the conceptual lens of the 'reflexive habitus', an adapted version of Bourdieu's classic concept. RESULTS Participants did not perceive that sociocultural differences would deter them from aspiring to, or pursuing, the career of their choice. Some participants identified their 'different' background as a strength to bring to medicine. They reported that intrinsic motivators (personal interest and fulfilment) were most important in their own career choices. When asked what they believed might have motivated current medical students for the career, participants debated the role of extrinsic motivators (high status and income) versus intrinsic ones. 'Hot knowledge' (social contacts) from within medicine helped some participants reconcile any clash in perceived values and better imagine themselves in the profession. CONCLUSIONS These non-traditional school pupils from schools engaged with WA initiatives appear to have embraced the belief that medicine is for anyone with the appropriate desire and ability, regardless of background. Furthermore, some pupils reported that some aspects of their 'difference' (diversity) could help enrich the workforce and patient care.
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Affiliation(s)
- Kirsty Alexander
- Centre for Healthcare Education Research and Innovation (CHERI), Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
| | - Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
| | - Sandra Nicholson
- Centre for Medical Education, Institute of Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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26
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Vos CMP, Wouters A, Jonker M, de Haan M, Westerhof MA, Croiset G, Kusurkar RA. Bachelor completion and dropout rates of selected, rejected and lottery-admitted medical students in the Netherlands. BMC MEDICAL EDUCATION 2019; 19:80. [PMID: 30866918 PMCID: PMC6417017 DOI: 10.1186/s12909-019-1511-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/03/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Evidence for the effectiveness of the selection of medical students is weak. This study aimed to examine the added value of a two-step selection procedure (first step non-academic, second step academic tests) to a pre-university GPA-based lottery procedure. Because previous research has suggested that participation in selection (regardless of the outcome) is a predictor of study success, this study is the first to include students who initially applied for selection, then refrained from (actively) participating in selection and were eventually admitted through lottery. METHODS Bachelor completion and dropout rates of selected (n = 416) and lottery-admitted students from four cohorts (2006-2009) were compared using logistic regression analysis. Four groups of lottery-admitted students were distinguished: students who were rejected after step 2 (n = 57), were rejected after step 1 (n = 169), withdrew during selection step 1 (n = 42) and students who only applied for lottery (n = 366). Covariates included gender, age, pre-university GPA and cohort. RESULTS There was a significant association between admission group and obtaining a bachelor degree in three years. Selected students were more likely to obtain a bachelor degree within three years (64.2% versus 51.6%; OR = 1.7) or four years (81.5% versus 74.3%; OR = 1.6) than students who only applied to a lottery (p < 0.05); selected students also seemed more likely to obtain all Year-1 course credits than students who withdrew during step 1 (40.4% versus 21.4%; OR = 2.3; p < 0.05). We found no significant association between dropout and admission groups. Students rejected at step 1 or 2 did not perform significantly different from selected students on any of the outcome measures. CONCLUSIONS The findings indicated that students at risk for study delay in the preclinical phase in our context were more likely to refrain from applying to a demanding selection procedure when a less demanding alternative was available. We found no significant associations between the non-academic and academic selection steps and bachelor completion and dropout rates. These findings suggest that the presence of the selection was more important than these specific selection components. In follow-up research, we plan to investigate the associations between the admission groups and outcome measures in the clinical phase.
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Affiliation(s)
- Catharina M. P. Vos
- Department of Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! research institute for learning and education. Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands
- Department of Policy, Innovation and Quality, Amsterdam UMC, Vrije Universiteit Amsterdam, VUmc School of Medical Sciences , Amsterdam, the Netherlands
| | - Anouk Wouters
- Department of Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! research institute for learning and education. Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands
- Department of Policy, Innovation and Quality, Amsterdam UMC, Vrije Universiteit Amsterdam, VUmc School of Medical Sciences , Amsterdam, the Netherlands
| | - Marianne Jonker
- At the time of the study: Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
- Present address:Department of Health Evidence, Radboud University Nijmegen, Medical Center, Nijmegen, the Netherlands
| | - Marian de Haan
- Department of Policy, Innovation and Quality, Amsterdam UMC, Vrije Universiteit Amsterdam, VUmc School of Medical Sciences , Amsterdam, the Netherlands
| | - Marleen A. Westerhof
- Department of Policy, Innovation and Quality, Amsterdam UMC, Vrije Universiteit Amsterdam, VUmc School of Medical Sciences , Amsterdam, the Netherlands
| | - Gerda Croiset
- Department of Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! research institute for learning and education. Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands
- UMC Groningen, Groningen, the Netherlands
| | - Rashmi A. Kusurkar
- Department of Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! research institute for learning and education. Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands
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Butani L, Bogetz A, Plant J. Illuminating exemplary professionalism using appreciative inquiry dialogues between students and mentors. MEDICAL TEACHER 2019; 41:325-331. [PMID: 29801424 DOI: 10.1080/0142159x.2018.1472371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To explore the types of exemplary professional behaviors and the facilitators and barriers to professional behavior discussed by student-mentor dyads during appreciative inquiry (AI) dialogs. MATERIALS AND METHODS We conducted a qualitative analysis of AI narratives discussing exemplary professional practice written by third-year medical students following a dialog with mentors. Narratives were thematically analyzed using directed content analysis to explore the types of exemplary professional behaviors discussed and the facilitators and barriers to professional practice. Narratives were coded independently by two investigators; codes were finalized, themes were derived, and a model on how exemplary professional behaviors are nurtured and reinforced was developed. RESULTS Themes addressed humanism toward others and excellence, with altruism being an underlying implicit guiding principle behind professional behavior. Humanism toward self was infrequently discussed as an aspect of professionalism, but when discussed, was perceived to foster resilience. Principle-based attitudes and emotional intelligence facilitated professional behaviors. Programmatic scaffolds facilitated professional behavior and included curricula on reflective practice, mentorship, promoting learner autonomy and connectedness, and a safe environment. CONCLUSIONS AI is an effective strategy that can be used to stimulate learner reflection on professionalism, humanism, and wellness and promote learner acknowledgement of positive aspects of the learning environment.
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Affiliation(s)
- Lavjay Butani
- a Department of Pediatrics , University of California Davis , Sacramento , CA , USA
| | - Alyssa Bogetz
- b Department of Pediatrics , Stanford University School of Medicine , Stanford , CA , USA
| | - Jennifer Plant
- a Department of Pediatrics , University of California Davis , Sacramento , CA , USA
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Patterson F, Roberts C, Hanson MD, Hampe W, Eva K, Ponnamperuma G, Magzoub M, Tekian A, Cleland J. 2018 Ottawa consensus statement: Selection and recruitment to the healthcare professions. MEDICAL TEACHER 2018; 40:1091-1101. [PMID: 30251906 DOI: 10.1080/0142159x.2018.1498589] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Selection and recruitment into healthcare education and practice is a key area of interest for educators with significant developments in research, policy, and practice in recent years. This updated consensus statement, developed through a multi-stage process, examines future opportunities and challenges in selection and recruitment. There is both a gap in the literature around and a compelling case for further theoretical and empirical literature to underpin the development of overall selection philosophes and policies and their enactment. More consistent evidence has emerged regarding the quality of different selection methods. Approaches to selection are context-dependent, requiring the consideration of an institution's philosophy regarding what they are trying to achieve, the communities it purports to serve, along with the system within which they are used. Diversity and globalization issues continue to be critically important topics. Further research is required to explore differential attainment and explain why there are substantial differences in culturally acceptable ways of approaching diversity and widening access. More sophisticated evaluation approaches using multi-disciplinary theoretical frameworks are required to address the issues. Following a discussion of these areas, 10 recommendations are presented to guide future research and practice and to encourage debate between colleagues across the globe.
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Affiliation(s)
- F Patterson
- a Work Psychology Group, Derby United Kingdom of Great Britain and Northern Ireland, UK
| | - C Roberts
- b Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - M D Hanson
- c Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - W Hampe
- d Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Eva
- e Centre for Health Education Scholarship and Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - G Ponnamperuma
- f Centre for Medical Education, Yong Loo Lin School of Medicine, Singapore
| | - M Magzoub
- g Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - A Tekian
- h Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - J Cleland
- i Centre for Healthcare Research and Innovation (CHERI), University of Aberdeen, UK
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Muthiah S, Wu K, Rajan N. Public engagement lectures targeting prospective medical students: an opportunity for dermatology. Clin Exp Dermatol 2018; 44:355-356. [PMID: 30280394 PMCID: PMC6446727 DOI: 10.1111/ced.13765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- S Muthiah
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - K Wu
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Department of Dermatology, The York Hospital, York, UK
| | - N Rajan
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Institute of Genetic Medicine, University of Newcastle upon Tyne, Newcastle upon Tyne, NE1 3BZ, UK
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30
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Wouters A. Effects of medical school selection on student motivation: a PhD thesis report. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:54-57. [PMID: 29256053 PMCID: PMC5807264 DOI: 10.1007/s40037-017-0398-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION High stakes are involved in student selection, for both medical schools and applicants. This thesis investigated the effects of selection on the medical student population and applicant pool in the Dutch setting. METHODS This thesis consists of six papers: two quantitative studies, one qualitative study, two mixed methods studies and one perspective paper based on a review of the literature. RESULTS (1) Compared with a lottery, selection does not result in a student population with better motivation, engagement and performance, both in the clinical and pre-clinical phases of the study. (2) Selection seems to have a temporary stimulating effect on student motivation through enhancing perceived autonomy, competence and relatedness. (3) Applicants adopt a strategic approach, based on the selection procedure, in their choice of medical school. (4) The description of an applicant's motivation is not a reliable and valid tool to assess motivation during selection. (5) Gaining healthcare experience is crucial for applicants' motivation, but inequalities in access to such experiences can demotivate certain student groups from applying to medical school. (6) The gains yielded from selection compared with a lottery seem to be small. Unintentionally induced self-selection among certain groups of students and biased selection procedures may compromise student diversity. DISCUSSION The added value of selection procedures compared with a weighted lottery for admitting students to medical school is questionable. Students are generally motivated and perform well, irrespective of how they enrolled in medical school. Selection yields only small gains, while student diversity may be hampered.
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Affiliation(s)
- Anouk Wouters
- Research in Education, VUmc School of Medical Sciences, Amsterdam, The Netherlands.
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands.
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Stegers‐Jager KM. Lessons learned from 15 years of non-grades-based selection for medical school. MEDICAL EDUCATION 2018; 52:86-95. [PMID: 28984374 PMCID: PMC5765503 DOI: 10.1111/medu.13462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/02/2017] [Accepted: 08/14/2017] [Indexed: 05/10/2023]
Abstract
CONTEXT Thirty years ago, it was suggested in the Edinburgh Declaration that medical school applicants should be selected not only on academic, but also on non-academic, attributes. The main rationale behind extending medical school selection procedures with the evaluation of (non-academic) personal qualities is that this will lead to the selection of students who will perform better as a doctor than those who are selected on the basis of academic measures only. A second rationale is the expectation that this will lead to a representative health workforce as a result of reduced adverse impact. The aims of this paper are (i) to describe what can be learned about the use of selection criteria other than grades from over 15 years of Dutch experience and (ii) to summarise current knowledge on the issue of adverse impact in relation to non-grades-based selection. METHODS A narrative review was undertaken of the (published) evidence that has resulted from non-grades-based school-specific selection procedures in the Netherlands and from recent explorations of the effect of the use of non-grades-based selection criteria on student diversity. RESULTS The Dutch evidence is grouped into five key themes: the effect of participation in voluntary selection procedures, the assessment of pre-university extracurricular activities, the use of work samples, Dutch experiences with situational judgement tests and the effects of changing circumstances. This is followed by several lessons learned for medical schools that aim to increase their student diversity. CONCLUSION Over the last 30 years, important steps towards reliable and valid methods for measuring non-academic abilities have been taken. The current paper describes several lessons that can be learned from the steps taken in the Dutch context. The importance of sharing evidence gathered around the globe and building on this evidence to reach our goal of predicting who will be a good doctor is acknowledged.
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Affiliation(s)
- Karen M Stegers‐Jager
- Institute of Medical Education Research Rotterdam, Erasmus MCUniversity Medical Centre RotterdamRotterdamThe Netherlands
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