The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning

Medical school origins of award-winning anaesthetists; analysis of a complete national dataset

BACKGROUND

The ultimate aim of medical education is to produce successful practitioners, which is a goal that educators, students and stakeholders support. These groups consider success to comprise optimum patient care with consequently positive career progression. Accordingly, identification of the common educational features of such high-achieving doctors will facilitate the generation of clinical excellence amongst future medical trainees. In our study we source data from British clinical merit award schemes and subsequently identify the medical school origins of anaesthetists who have achieved at least national distinction.

METHODS

Britain operates Distinction Award/Clinical Excellence Award schemes which honour National Health Service doctors in Scotland, Wales and England who are identified as high achievers. This quantitative observational study used these awards as an outcome measure in an analysis of the 2019-20 dataset of all 901 national award-winning doctors. Where appropriate, Pearson's Chi-Square test was applied.

RESULTS

The top five medical schools (London university medical schools, Edinburgh, Dundee, Aberdeen and Glasgow) were responsible for 56.4% of the anaesthetist award-winners, despite the dataset representing 85 medical schools. 93.6% of the anaesthetist merit award-winners were from European medical schools. 8.06% of the anaesthetist award-winners were international medical graduates compared with 11.5% non-anaesthetist award-winners being international medical graduates.

CONCLUSIONS

The majority of anaesthetists who were national merit award-winners originated from only five, apparently overrepresented, UK university medical schools. In contrast, there was a greater diversity of medical school origins among the lower grade national award-winners; tier 3 award-winners represented 20 different medical schools from three continents. As well as ranking educationally successful university medical schools, this study assists UK and international students, by providing a roadmap for rational decision making when selecting anaesthetist and non-anaesthetist medical education pathways that are more likely to fulfil their career ambitions.

Medical school origins of award-winning pathologists; analysis of a complete national dataset

BACKGROUND

The ultimate aim of medical education is to produce successful practitioners, which is a goal that educators, students and stakeholders support. These groups consider success to comprise optimum patient care with consequently positive career progression. Accordingly, identification of the common educational features of such high-achieving doctors will facilitate the generation of clinical excellence amongst future medical trainees. In our study we source data from British clinical merit award schemes and subsequently identify the medical school origins of pathologists who have achieved at least national distinction.

METHODS

Britain operates Distinction Award/Clinical Excellence Award schemes which honour National Health Service doctors in Scotland, Wales and England who are identified as high achievers. This quantitative observational study used these awards as an outcome measure in an analysis of the 2019-20 dataset of all 901 national award-winning doctors. Where appropriate, Pearson's Chi-Square test was applied.

RESULTS

The top five medical schools (London university medical schools, Aberdeen, Edinburgh, Oxford and Cambridge) were responsible for 60.4% of the pathologist award-winners, despite the dataset representing 85 medical schools. 96.4% of the pathologist merit award-winners were from European medical schools. 9.0% of the pathologist award-winners were international medical graduates in comparison with 11.4% of all 901 award-winners being international medical graduates.

CONCLUSIONS

The majority of pathologists who were national merit award-winners originated from only five, apparently overrepresented, UK university medical schools. In contrast, there was a greater diversity in medical school origin among the lower grade national award-winners; the largest number of international medical graduates were in these tier 3 awards (13.9%). As well as ranking educationally successful university medical schools, this study assists UK and international students, by providing a roadmap for rational decision making when selecting pathologist and non-pathologist medical education pathways that are more likely to fulfil their career ambitions.

Learning pathways composed of core subjects with features of reducing cognitive load have better learning outcomes

BACKGROUND

Changing the course duration or timing of subjects in learning pathways would influence medical students' learning outcomes. Curriculum designers need to consider the strategy of reducing cognitive load and evaluate it continuously. Our institution underwent gradual curricular changes characterized by reducing cognitive load since 2000. Therefore, we wanted to explore the impact of this strategy on our previous cohorts.

METHODS

This cohort study explored learning pathways across academic years of more than a decade since 2000. Eight hundred eighty-two medical students between 2006 and 2012 were included eventually. Learning outcomes included an average and individual scores of subjects in different stages. Core subjects were identified as those where changes in duration or timing would influence learning outcomes and constitute different learning pathways. We examined whether the promising learning pathway defined as the pathway with the most features of reducing cognitive load has higher learning outcomes than other learning pathways in the exploring dataset. The relationship between features and learning outcomes was validated by learning pathways selected in the remaining dataset.

RESULTS

We found nine core subjects, constituting four different learning pathways. Two features of extended course duration and increased proximity between core subjects of basic science and clinical medicine were identified in the promising learning pathway 2012, which also had the highest learning outcomes. Other pathways had some of the features, and pathway 2006 without such features had the lowest learning outcomes. The relationship between higher learning outcomes and cognitive load-reducing features was validated by comparing learning outcomes in two pathways with and without similar features of the promising learning pathway.

CONCLUSION

An approach to finding a promising learning pathway facilitating students' learning outcomes was validated. Curricular designers may implement similar design to explore the promising learning pathway while considering potential confounding factors, including students, medical educators, and learning design of the course.

Exploring Medical Student Attitudes Regarding Inter-university Learning: A Pilot Study

Introduction The United Kingdom needs to educate more medical students to meet workforce demands. With static numbers of clinical teachers available, novel and efficient approaches are required to prepare students for real-life work where doctors routinely work with colleagues from different medical schools. This innovative project was designed to investigate student attitudes towards inter-university learning (IUL), whereby two medical students from different universities learn together. Materials and methods Thirteen students at Great Western Hospital, Swindon, England, volunteered and were randomly paired with a student from another university. Pairs completed a 20-minute simulated clinical scenario and observed three others. Students completed pre- and post-session questionnaires adapted from the Readiness for Inter-Professional Learning scale. Seven students took part in semi-structured interviews which underwent thematic analysis. Results Quantitative analysis of post-session questionnaires demonstrated a positive response to IUL. Thematic analysis generated six themes: impact on learning, impact on career, working together, recognising differences, practical considerations, and psychosocial perspectives. Discussion Students enjoyed the social learning opportunity to practise team-working, communication, and role delegation with unknown peers whilst sharing different clinical approaches. Differences in course structure meant students displayed varying strengths, although unexpected findings centred around pre-conceptions of both universities and social comparison behaviours. Conclusion IUL's strength was deemed to be in non-technical skill development to prepare for real-life work, ultimately enhancing patient safety. Practicalities to consider include session design and psychological safety. IUL provides a novel solution to efficiently educate future healthcare professionals and further work to explore its benefits on a wider scale is suggested.

Medical school origins of award-winning physicians; analysis of a complete national dataset

BACKGROUND

Educators and medical students share the same objective of achieving success in medical practice. Both groups consider doctors' successes to include optimum patient care outcomes and positive career progressions. Accordingly, identifying common educational features of such high-achieving doctors facilitates the generation of excellence amongst future medical trainees. In this study we use data from the British clinical merit award schemes as outcome measures in order to identify medical school origins of doctors who have achieved national or international prominence.

METHODS

Britain has Clinical Excellence Awards/Distinction Awards schemes that financially reward all National Health Service doctors in England, Scotland and Wales who are classified as high achievers. We used these outcome measures in a quantitative observational analysis of the 2019-20 dataset of all 901 national award-winning doctors. Where appropriate, Pearson's Chi-Square test was applied.

RESULTS

The top five medical schools (London university medical schools, Glasgow, Edinburgh, Oxford and Cambridge) were responsible for 51.2% of the physician merit award-winners in the 2019-20 round, despite the dataset representing 85 medical schools. 91.4% of the physician merit award-winners were from European medical schools. The lowest national award-winners (tier 3) originated from 61 medical schools representing six continents. International medical graduates comprised 11.4% of all award-winners.

CONCLUSIONS

The majority of physicians who were national merit award-winners originated from only five, apparently overrepresented, UK university medical schools. In contrast, there was a greater diversity in medical school origin among the lower grade national merit awards; the largest number of international medical graduates were in these tier 3 awards (13.3%). As well as ranking educationally successful university medical schools, this study assists UK and international students, by providing a roadmap for rational decision making when selecting physician and non-physician medical education pathways that are more likely to fulfil their career ambitions.

Medical school origins of award-winning psychiatrists; analysis of a complete national dataset

BACKGROUND

Britain attracts doctors from all over the world to work in the National Health Service. Elucidating the educational backgrounds of award-winning doctors working in the country is potentially an important medical education issue and a merit award audit. Using the British clinical merit award schemes as outcome measures, we identify medical school origins of award-winning doctors who have been identified as having achieved national or international prominence.

METHODS

The Clinical Excellence Awards/Distinction Awards schemes select doctors in Britain who are classified as high achievers, with categories for national prominence and above. We used this outcome measure in a quantitative observational analysis of the 2019-20 dataset of all 901 award-winning doctors. Pearson's Chi-Square test was used where appropriate.

RESULTS

Five university medical schools (London university medical schools, Glasgow, Edinburgh, Aberdeen and Cambridge) accounted for 59.1% of the psychiatrist award-winning doctors in the 2019 round, despite the dataset representing 85 medical schools. 84.1% of the psychiatrist award-winners were from European medical schools, compared to 92.1% of the non-psychiatrist award-winners. International medical graduates accounted for 22.7% of the award-winning psychiatrists. Psychiatrists with the lower grade national awards came from a more diverse educational background of 17 medical schools. IMGs represented diverse medical schools from five continents and were most represented in the lowest grade of national merit awards at 24.2%.

CONCLUSIONS

The majority of the award-winning psychiatrists originated from only five medical schools. A greater diversity of medical school origin existed for the lowest grade national psychiatrist award-winners. International medical graduates contributed substantially to these award-winners; psychiatrist award-winners were more likely to be international medical graduates (22.7%) than non-psychiatrist award-winners (10.8%). This study not only indicates educational centres associated with the production of award-winners but also provides students with a roadmap for rational decision making when selecting medical schools.

How do medical students want to learn ENT? Perspectives from a consensus forum

OBJECTIVE

The UK Medical Licensing Assessment curriculum represents a consensus on core content, including ENT-related content for newly qualified doctors. No similar consensus exists as to how ENT content should be taught at medical school.

METHOD

A virtual consensus forum was held at the 2nd East of England ENT Conference in April 2021. A syllabus of ENT-related items was divided into 'Presentations', 'Conditions' and 'Practical procedures'. Twenty-seven students, 11 foundation doctors and 7 other junior doctors voted via anonymous polling for the best three of nine methods for teaching each syllabus item.

RESULTS

For 'Presentations' and 'Conditions', work-based or clinical-based learning and small-group seminars were more popular than other teaching methods. For 'Practical procedures', practical teaching methods were more popular than theoretical methods.

CONCLUSION

Students and junior doctors expressed a clear preference for clinical-based teaching and small-group seminars when learning ENT content. E-learning was poorly favoured despite its increasing use.

Evaluation of National Anaesthetics Teaching in Undergraduate Medicine (ENATUM)

BACKGROUND

During a global pandemic where anaesthetists play a pertinent role in treating coronavirus 2019 (COVID-19), it is crucial to inspire medical students to consider a career in anaesthetics and perioperative care. Where anaesthetic skills are vital for all surgical foundation doctors, regardless of whether they have a rotation in anaesthetics, this study seeks to establish the current level of exposure to anaesthetics in the UK medical schools' curriculum and evaluate if the current anaesthetic undergraduate curriculum is sufficient to prepare students to pass their exams and perform the duties expected of them as future junior doctors.

METHODS

A 35-item structured questionnaire, registered at University College London Hospital Research & Development (R&D), was distributed amongst foundation doctors who had graduated from UK universities within the previous 3 years between August and October 2020.

RESULTS

In total, 239 participants completed the questionnaire from 34 UK medical schools. Despite 90.0% of participants being allocated an 'anaesthesia' placement, 54.0% spent <15 hours shadowing an anaesthetist throughout their medical school. Of participants, 38.5% agreed that their anaesthetic teaching was sufficient compared to teaching of other specialities, with 48.6% of students not satisfied with the teaching provided to meet anaesthetic learning outcomes set by The Royal College of Surgeons of England; 72.4% said they would have benefited from additional anaesthetic teaching, with 80.7% stating it would have increased understanding into the speciality; and 71.5% stated a short course in anaesthetics alongside undergraduate training would have been beneficial.

CONCLUSIONS

Our results demonstrate that there is a lack of standardization in undergraduate anaesthetics teaching nationally and an additional undergraduate anaesthetic teaching programme is required to increase understanding and provide further insight into anaesthetics. Key messages:  The emergence of the coronavirus 2019 (COVID-19) pandemic has halted undergraduate medical education, in particular perioperative medicine and surgery.Exposure to anaesthesia is already limited in the medical undergraduate curriculum, with a limited number of anaesthesia-themed foundation rotations available for junior doctors.Recent UK graduates feel that undergraduate anaesthetics education is inadequate at medical school, reporting a lack of confidence in applying undergraduate anaesthesia learning outcomes.Additional anaesthetic teaching and online teaching methods are suggested ways of improving the delivery of undergraduate anaesthetic education.Can a national, standardized anaesthetics teaching curriculum improve the undergraduate knowledge base of anaesthesia?

Is the awarding gap at UK medical schools influenced by ethnicity and medical school attended? A retrospective cohort study

OBJECTIVES

To better characterise the Awarding Gap (AG) between black, Asian and other minority ethnic (BAME) and white students in UK undergraduate medical education by examining how it affects eight minority ethnicity subgroups (Bangladeshi, black, Chinese, Indian, Pakistani, mixed, other Asian background and other ethnic background) and whether the AG varies by medical school attended.

DESIGN

Retrospective cohort study.

SETTING

Data extracted from the UK Medical Education Database on students enrolled at 33 UK medical schools in the academic years starting 2012, 2013 and 2014.

PARTICIPANTS

16 020 'Home' tuition fee status students who sat the University Clinical Aptitude Test on entry to university and obtained a UK Foundation Programme (UKFP) application score on exit.

PRIMARY OUTCOME MEASURE

UKFP Z-scores on exit from medical school.

RESULTS

There were significant differences in UKFP Z-scores between ethnicity subgroups. After white students, mixed ethnicity students performed best (coefficient -0.15 standard deviations [SD]) compared with white students, (95% confidence interval [CI] -0.23 to -0.08, p<0.001) and Pakistani students scored lowest (coefficient -0.53 SD, 95% CI -0.60 to -0.46, p<0.001). In pairwise comparisons of scores between all nine individual ethnicity subgroups, 15/36 were statistically significant. The AG varied considerably across medical schools. The largest gap showed the coefficient for BAME was -0.83 SD compared with white students (95% CI -1.18 to -0.49, p<0.001), while the smallest demonstrated no statistically significant difference in performance between BAME and white students (+0.05 SD, 95% CI -0.32 to 0.42, p=0.792).

CONCLUSIONS

BAME students are significantly disadvantaged by the current UK medical education system. There are clear differences in medical school outcomes between students from different ethnicity subgroups, and the size of the AG also varies by medical school attended. Urgent and effective action must be taken to address the AG and achieve an equal learning environment for our future doctors.

Factors influencing medical students' decision to pursue a career in obstetrics and gynaecology

INTRODUCTION

The career intentions of medical students can exert influence on service provision and medical staffing in the health services. It is vital for a specialty's development and sustainability that it has a constant stream of trainees into it annually. An appreciation of how a specialty is viewed by medical students can be used as an opportunity for early intervention in order to improve perception of the specialty and reduce future workforce problems, such as retention and attrition within obstetrics and gynaecology (O&G). We aimed to analyse positive and negative factors of the specialty of O&G as perceived by medical students in order to gain insight into changes that need to be made to improve recruitment and retention into the specialty.

METHODS

A 70-item structured questionnaire consisting of demographic information and 5-point Likert scale questions relating to O&G was administered to final year medical students in the Republic of Ireland. Data were analysed with descriptive statistics, logistic regression, and odds ratios as appropriate.

RESULTS

Of 195 medical students approached, 134 completed the questionnaire, a response rate of 68.7%. The majority were female (55.2%, n = 74) and 76.1% of respondents (n = 102) were Direct Entry Medicine students, with the remainder Graduate Entry Medicine students. 30.8% (n = 41) of students who responded scored 6 or more on a 10-point Likert scale when asked about their likelihood of considering a career in O&G. Students' clerkship experience factored heavily into their perception of the specialty and was more likely to be positive if they experienced direct consultant engagement and the opportunity for hands-on experience. Lifestyle factors, litigation and media were found to be deterrents to considering the specialty after graduation.

CONCLUSIONS

This study demonstrates the importance of good clerkship experience in fostering an interest amongst undergraduates in O&G. Educators and those working within the specialty should showcase the strengths of the specialty during undergraduate education, and work on ameliorating deterrents to ultimately provide a structured approach to improving recruitment into O&G.

Engaging undergraduate medical and dental students with academic medicine: The Aberdeen INSPIRE summer school

UK medical and dental school curricula limit opportunities for students to gain experience in research. This parallels a decline in the number of clinical academics. To address this at grass roots level, we organised and arranged a residential summer taster week; INSPIRE (Introducing New Skills to Promote Inspirational Research Experience)-Aberdeen). The purpose was to give first and second year medical and dental students who wished to explore a potential clinical academic career a taste of wet laboratory research and to gain experience in basic research skills. Seventeen students from eight different UK medical and dental schools attended this free residential course and were exposed to various laboratory techniques with clinical translation and application in diagnostic and therapeutic medicine. Students were given access to relevant online learning tools of the techniques being used beforehand and seminar style presentations were used to emphasise their clinical application. Students met daily with clinical academics from different specialities to give them a flavour of potential clinical academic career pathways and options. All students felt that the summer school helped them consider academic medicine as a career thus achieving our aim to inspire clinical academics of the future.

Medical school origins of award-winning surgeons; analysis of a complete national dataset

BACKGROUND

Britain attracts doctors from all over the world to work in the National Health Service. Elucidating the educational backgrounds of award-winning doctors working in the country is potentially an important medical education issue and merit award audit. Using the British clinical merit award schemes as outcome measures, we identify medical school origins of award-winning doctors who have been identified as having achieved national or international prominence.

METHODS

The Clinical Excellence Awards/Distinction Awards schemes select doctors in Britain who are classified as high achievers, with categories for national prominence and above. We used this outcome measure in a quantitative observational analysis of the 2019 dataset of all 901 award-winning doctors. Pearson's Chi-Square test was used where appropriate.

RESULTS

Seven medical schools (London university medical schools, Glasgow, Edinburgh, Aberdeen, Oxford, Cambridge and Manchester) accounted for 52.7% of the surgical award-winning doctors in the 2019 round, despite the dataset representing 85 medical schools. Surgeons with the lower grade national awards came from a more diverse educational background of 43 medical schools. International medical graduates accounted for 16.1% of the award-winning surgeons and 9.8% of the award-winning non-surgeons. 87.1% of the surgical award-winners were from European medical schools, whereas 93.2% of the non-surgical award-winners were from European medical schools.

CONCLUSIONS

The majority of the award-winning surgeons originated from only seven, overrepresented, medical schools. A greater diversity of medical school origin existed for the lowest grade national merit awards. These comprised 43 medical schools and indicated greater globalization effects in this category. International medical graduates contributed substantially to these award holders; surgical award-winners were more likely to be international medical graduates (16.1%) than non-surgical award-winners (9.8%). This study not only indicates educational centres associated with the production of award-winners but also provides students with a roadmap for rational decision making when selecting medical schools.

A national analysis of the medical schools of training for merit award-winning laboratory medical doctors working in Britain

AIMS

To inform the discussion regarding the origins of Laboratory Medical Consultant clinical merit award holders (LMC) whether the awards came from the Clinical Excellence Awards (CEA) or Distinction Awards (DA) schemes.

METHODS

Setting - CEA is a scheme to financially reward senior doctors in England and Wales who are assessed to be working over and above the standard expected of their role. The DA scheme is the parallel and equivalent scheme in Scotland. Participants - All of the merit award holders in the 2019 round. Design - This involved a secondary analysis of the complete 2019 published dataset of award winners. Statistical analyses were performed with Chi-square tests set at p < 0.05 level for statistical significance.

RESULTS

The top five medical schools (London University, Glasgow, Edinburgh, Aberdeen and Oxford) were responsible for 68.4% of the LMC merit award holders in the 2019 round. 97.9% of the LMC merit award holders were from European medical schools, whereas 90.9% of the non-LMC award holders were from European medical schools. The LMCs with A plus or platinum awards came from only six medical schools: Aberdeen, Edinburgh, London University, Oxford, Sheffield and Southampton. In contrast, the B or silver/bronze LMC award holders came from a more diverse background of 13 medical schools.

CONCLUSIONS

The majority of LMC merit award holders originated from only five university medical schools. All the LMCs with A plus or platinum awards came from only six university medical schools. There is an apparent overrepresentation of a small number of medical schools of origin amongst those LMCs that hold national merit awards.

Medical leadership training varies substantially between UK medical schools: Report of the leadership in undergraduate medical education national survey (LUMENS)

BACKGROUND

Doctors are increasingly expected to demonstrate medical leadership and management (MLM) skills. The Faculty of Medical Leadership and Management (FMLM) has published an indicative undergraduate curriculum to guide the development of MLM content at UK medical schools.

METHOD

Students from 30 medical schools were surveyed to determine their understanding of MLM teaching at their school. Timetables for 21 schools were searched for MLM-related keywords. Student-reported teaching and timetabled teaching were coded according to predefined themes. Aggregated demographic and postgraduate performance data were obtained through collaboration with the Medical Student Investigators Collaborative (msico.org).

RESULTS

Whilst 88% of medical students see MLM teaching as relevant, only 18% believe it is well integrated into their curriculum. MLM content represented ∼2% of timetabled teaching in each 5-year undergraduate medical course. Most of this teaching was dedicated to teamwork, performance/reflection and communication skills. There was minimal association between how much of a topic students believed they were taught, and how much they were actually taught. We found no association between the volume of MLM teaching and performance in postgraduate examinations, trainee career destinations or fitness to practice referrals.

CONCLUSION

Our findings demonstrate limited and variable teaching of MLM content. Delivery was independent of broader teaching and assessment factors.

A Bibliometric Analysis of the Landscape of Problem-Based Learning Research (1981-2021)

Background

Problem-Based Learning (PBL) is an instructional method of hands-on, active learning centered on investigating and resolving messy, real-world problems. This study aims to systematically analyze the current status and hotspots of PBL research and provide insights for research in the field.

Methods

Problem-based learning-related publications were retrieved from the Web of Science Core Collection using "Problem-Based Learning". Annual publications, countries, institutions, authors, journals, references, and keywords in the field were visually analyzed using the R, VOSviewer, and Microsoft Excel 2019 software.

Results

A total of 2,790 articles and reviews were analyzed, with a steady increase in publications in the field of PBL. Overall, the United States was the major contributor to the study of PBL. Van Der Vleuten CPM was the key researcher in this field. Moreover, most of the publications were published in Medical Education. Keyword analysis showed that current research hotspots focus on the extensions of PBL teaching mode, application of PBL teaching method, and reform of PBL.

Conclusion

Research on PBL is flourishing. Cooperation and exchange between countries and institutions should be strengthened in the future. These findings will provide a better understanding of the state of PBL research and inform future research ideas.

Does performance at the intercollegiate Membership of the Royal Colleges of Surgeons (MRCS) examination vary according to UK medical school and course type? A retrospective cohort study

OBJECTIVES

The knowledge, skills and behaviours required of new UK medical graduates are the same but how these are achieved differs given medical schools vary in their mission, curricula and pedagogy. Medical school differences seem to influence performance on postgraduate assessments. To date, the relationship between medical schools, course types and performance at the Membership of the Royal Colleges of Surgeons examination (MRCS) has not been investigated. Understanding this relationship is vital to achieving alignment across undergraduate and postgraduate training, learning and assessment values.

DESIGN AND PARTICIPANTS

A retrospective longitudinal cohort study of UK medical graduates who attempted MRCS Part A (n=9730) and MRCS Part B (n=4645) between 2007 and 2017, using individual-level linked sociodemographic and prior academic attainment data from the UK Medical Education Database.

METHODS

We studied MRCS performance across all UK medical schools and examined relationships between potential predictors and MRCS performance using χ2 analysis. Multivariate logistic regression models identified independent predictors of MRCS success at first attempt.

RESULTS

MRCS pass rates differed significantly between individual medical schools (p<0.001) but not after adjusting for prior A-Level performance. Candidates from courses other than those described as problem-based learning (PBL) were 53% more likely to pass MRCS Part A (OR 1.53 (95% CI 1.25 to 1.87) and 54% more likely to pass Part B (OR 1.54 (1.05 to 2.25)) at first attempt after adjusting for prior academic performance. Attending a Standard-Entry 5-year medicine programme, having no prior degree and attending a Russell Group university were independent predictors of MRCS success in regression models (p<0.05).

CONCLUSIONS

There are significant differences in MRCS performance between medical schools. However, this variation is largely due to individual factors such as academic ability, rather than medical school factors. This study also highlights group level attainment differences that warrant further investigation to ensure equity within medical training.

Predictive validity of A-level grades and teacher-predicted grades in UK medical school applicants: a retrospective analysis of administrative data in a time of COVID-19

OBJECTIVES

To compare in UK medical students the predictive validity of attained A-level grades and teacher-predicted A levels for undergraduate and postgraduate outcomes. Teacher-predicted A-level grades are a plausible proxy for the teacher-estimated grades that replaced UK examinations in 2020 as a result of the COVID-19 pandemic. The study also models the likely future consequences for UK medical schools of replacing public A-level examination grades with teacher-predicted grades.

DESIGN

Longitudinal observational study using UK Medical Education Database data.

SETTING

UK medical education and training.

PARTICIPANTS

Dataset 1: 81 202 medical school applicants in 2010-2018 with predicted and attained A-level grades. Dataset 2: 22 150 18-year-old medical school applicants in 2010-2014 with predicted and attained A-level grades, of whom 12 600 had medical school assessment outcomes and 1340 had postgraduate outcomes available.

OUTCOME MEASURES

Undergraduate and postgraduate medical examination results in relation to attained and teacher-predicted A-level results.

RESULTS

Dataset 1: teacher-predicted grades were accurate for 48.8% of A levels, overpredicted in 44.7% of cases and underpredicted in 6.5% of cases. Dataset 2: undergraduate and postgraduate outcomes correlated significantly better with attained than with teacher-predicted A-level grades. Modelling suggests that using teacher-estimated grades instead of attained grades will mean that 2020 entrants are more likely to underattain compared with previous years, 13% more gaining the equivalent of the lowest performance decile and 16% fewer reaching the equivalent of the current top decile, with knock-on effects for postgraduate training.

CONCLUSIONS

The replacement of attained A-level examination grades with teacher-estimated grades as a result of the COVID-19 pandemic may result in 2020 medical school entrants having somewhat lower academic performance compared with previous years. Medical schools may need to consider additional teaching for entrants who are struggling or who might need extra support for missed aspects of A-level teaching.

National, collaborative evaluation of medical student and faculty perspectives on global surgery - Survey of undergraduate respondents on global surgery education (SURGE): A cross-sectional study

INTRODUCTION

It is estimated that 28-32% of the global burden of disease can be treated with surgery. Most of this burden is concentrated in low and middle-income countries, underpinning the importance of the topic of global surgery (GS). The multidisciplinary principles of GS are increasingly recognised as being key to modern practice and as such, must be fostered at early stages of medical training. However, it is unclear whether medical students are being exposed to GS. This study aimed to assess the importance of GS and its presence in medical curricula.

METHODS

A novel, 22-item online questionnaire was developed and disseminated to medical students and faculty members using social media platforms. Data collection was conducted by a collaboration of medical students, who acted as regional leads at their institutions.

RESULTS

795 medical students and 141 faculty members representing 38/42 (90.4%) of UK medical schools completed the questionnaire. Only 84 students (10.6%) were previously exposed to GS. Most students (66.3%) and faculty (60.6%) agreed that GS should be an integral part of the curriculum. Only 20 students (2.5%) were familiar with what a career in GS means.

CONCLUSION

Approximately two-third of students and faculty agree that global surgery should be an integral part of the mandatory curriculum. Findings of this study should underpin further incorporation of GS into curricula, as high-income countries can decisively contribute to achieving the global surgery 2030 targets, by training a new generation of clinicians who are ready for the challenges of the 21st century.

Medical School Education on Myalgic Encephalomyelitis

Background and objectives: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex multi-system disease with a significant impact on the quality of life of patients and their families, yet the majority of ME/CFS patients go unrecognised or undiagnosed. For two decades, the medical education establishment in the UK has been challenged to remedy these failings, but little has changed. Meanwhile, there has been an exponential increase in biomedical research and an international paradigm shift in the literature, which defines ME/CFS as a multisystem disease, replacing the psychogenic narrative. This study was designed to explore the current UK medical school education on ME/CFS and to identify challenges and opportunities relating to future ME/CFS medical education. Materials and methods: A questionnaire, developed under the guidance of the Medical Schools Council, was sent to all 34 UK medical schools to collect data for the academic year 2018–2019. Results: Responses were provided by 22 out of a total of 34 medical schools (65%); of these 13/22 (59%) taught ME/CFS, and teaching was led by lecturers from ten medical specialties. Teaching delivery was usually by lecture; discussion, case studies and e-learning were also used. Questions on ME/CFS were included by seven schools in their examinations and three schools reported likely clinical exposure to ME/CFS patients. Two-thirds of respondents were interested in receiving further teaching aids in ME/CFS. None of the schools shared details of their teaching syllabus, so it was not possible to ascertain what the students were being taught. Conclusions: This exploratory study reveals inadequacies in medical school teaching on ME/CFS. Many medical schools (64% of respondents) acknowledge the need to update ME/CFS education by expressing an appetite for further educational materials. The General Medical Council (GMC) and Medical Schools Council (MSC) are called upon to use their considerable influence to bring about the appropriate changes to medical school curricula so future doctors can recognise, diagnose and treat ME/CFS. The GMC is urged to consider creating a registered specialty encompassing ME/CFS, post-viral fatigue and long Covid.

Radiology for medical students: Do we teach enough? A national study

OBJECTIVE

A recent study has shown that the averaged time tabled teaching for a medical student across 5 years in the UK was 4629 hours. Radiology has been demonstrated to be an excellent teaching source, yet the number of hours allocated to this has never been calculated.The aims of this study were to evaluate and quantify the hours allocated to radiology teaching in Scottish Medical Schools and to evaluate if they can fulfil requirements expected from other Clinical disciplines and the upcoming General Medical Council Medical Licensing Assessment (GMC MLA).

METHODS

Data pertaining to timetabled teaching for Radiology in Scottish Universities were obtained from the authors of the Analysis of Teaching of Medical Schools (AToMS) survey. In addition, University Lead Clinician Teachers were surveyed on the radiological investigations and skills medical students should have at graduation.

RESULTS

Medical students in Scottish Universities were allocated 59 h in Radiology (0.3%) out of a total 19,325 h of timetabled teaching. Hospital-based teaching was variable and ranged from 0 to 31 h. Almost half (15 of 31) of Clinician Teachers felt that there was insufficient radiology teaching in their specialty. Thirteen of 30 conditions included in the GMC MLA were listed by Clinician Teachers, while 23 others not listed by the GMC were considered important and cited by them.

CONCLUSION

This study demonstrates that medical students do not receive enough radiology teaching. This needs to be addressed by Universities in collaboration with the NHS in an effort to bring up this up to line with other developed countries and prepare students for the GMC MLA.

ADVANCES IN KNOWLEDGE

(1) There is insufficient time allocated in Medical Students' curriculum to Radiology.(2) Radiology teaching in medical schools fall short of University Lead Clinician Teachers' and GMC expectations of medical students at graduation.

Radiology and the medical student: do increased hours of teaching translate to more radiologists?

Objectives:

The UK has a shortage of Radiologists to meet the increasing demand for radiologic examinations. To encourage more medical students to consider Radiology as a career, increased exposure at undergraduate level has been advocated. The aim of this study was to evaluate if formal Radiology teaching hours at medical school had any association with the number of qualified Radiologists joining the General Medical Council Specialist Register.

Methods:

Total number of doctors joining the GMC Specialist Register as Clinical Radiologists, and those with a primary medical qualifications awarded in Scotland, was obtained from the GMC (2010–2020). Graduate numbers from all four Scottish Medical Schools (2000–2011) were also obtained. Hours of Radiology teaching for medical schools in Scotland were obtained from validated AToMS study.

Results:

Two hundred and twenty three (6.6%) of 3347 Radiologists added to the GMC Specialist Register between 2010 and 2020 received their primary medical qualification (PMQ) from Scottish Universities. The number of Radiologists from Scottish Universities joining the GMC specialist register was 2.6% of the total number of Scottish Medical Graduates. There was no association between the number of hours (Range 1–30) Radiology was taught to medical students and the number that joined the specialist register as Radiologists (p = 0.54 chi square trend).

Conclusion:

Increased exposure to Radiology teaching does not influence medical students’ decision to take up Radiology as a career. While continued Radiology exposure remains important, other strategies are required in both the short and long term to ensure radiology services are maintained without detriment to patients.

Advances in knowledge:

Increased hours of Radiology teaching in medical school was not associated with increased radiologists joining the profession.

Medical student assessments-frequency of radiological images used: a national study

Objectives:

Assessments are a key part of life for medical students at University. We know there is variation in these assessments across Universities. The aims of this study were to expatiate summative assessments in Scottish Medical Schools and to examine how frequently radiological images feature in them.

Methods:

All Scottish medical schools were invited to participate in the study. Data on objective structured clinical examinations (OSCEs; 5 years) and written assessments (3 years) were retrospectively collected for each university and results were collated. Each University was randomly assigned a letter from A to E and anonymised for data presentation.

Results:

10,534 multiple choice questions (MCQ) and 1083 OSCE stations were included in this study. There was wide variation in the number, type and timing of assessments across Scottish medical schools. There were highly significant differences in the number of OSCE stations and the number of MCQs set over the study period (p < 0.0001). Radiological images were used on average 0.6 times (range 0–1.1) in each OSCE examination and 2.4 times (range 0.1–3.7) for written assessments.

Conclusion:

In this detailed study, we demonstrated significant differences in medical student assessments across Scottish Universities. Given the importance of Radiology in modern medicine, the frequency and differences in which radiological images were used in assessments across Universities should be addressed.

Advances in knowledge:

This is the first national longitudinal study to quantify the role of radiological images in summative Medical Student Assessments. Great variability exists in the extent and how (clinical versus written assessments) radiological images are used to assess Scottish medical students. Radiological images are used infrequently in clinical assessments, but are present in every written assessment. These findings could help inform medical schools and academic radiologists as they prepare medical students for the imminent unified medical licensing examination, where Clinical Imaging is a subject with one of the highest number of associated conditions examinable.

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise

BACKGROUND

Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors.

METHOD

Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail.

RESULTS

Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs.

CONCLUSIONS

Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety.