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Objectives The practice of having medical students see patients in a general practice setting, in their own consulting rooms, prior to the GP preceptor joining the consultation does not increase general practitioner (GP) consultation time. How do GPs meet the needs of both patient and student without extending consultation time? This study sought to quantify and compare GP consultation activities with and without students. Methods This was a prospective cohort study of 523 videotaped consultations. Consultations were analysed in 15-second intervals using a modified Davis observation code to define GP activity. Estimated marginal means were calculated using mixed model analysis accounting for confounding factors. Results In comparison with consulting alone, GPs precepting a student spent 37 seconds less time examining patients ( P = 0.001), 41 seconds less on patient management, and 1 minute, 31 seconds less on clerical and other activities ( P < 0.001). This created time for GPs to take a history from both the student and patient (39 seconds longer; P = 0.002) and to teach students (1 minute, 10 seconds; P < 0.001). Discussion General practitioner activity in the consultation changes significantly when precepting a student; GPs spend longer exploring the history in order to unpack the student’s clinical reasoning, verify the patient’s story and resynthesise the information. They spend less time on examination, management and clerical activities and presumably delegate or defer these activities. Conclusions This organising of clinical activities in order to meet the needs of both patient and student is likely to require different processing skills to solo consulting. [ABSTRACT FROM AUTHOR]

Objectives Students from lower socio-economic circumstances remain under-represented in UK medical schools despite recent shifts in other demographic variables and specific policy emphasis on widening participation (WP). This study aimed to further understanding of the reasons for this. Methods Volunteer participants at three English medical schools took part in narrative-style, in-depth interviews examining their pathways into medicine and the relationships between these pathways and participants’ socio-cultural, educational and family backgrounds. This analysis uses findings from interviews with 12 mature students from working-class backgrounds. It employs theoretical work from the wider field of education sociology that has investigated the relationship between higher education decision making and class. Results This study demonstrates how ‘normal working-class biographies’, constructed by the majority of students targeted by WP activity, result from the influences of socio-cultural context, as well as familial and institutional habitus. The resultant influence on habitus as identity and, in particular, the disjuncture between working-class perceptions of medicine and individual identities are key to understanding the reasons behind the low number of working-class applicants to medical school. Conclusions Interventions that aim to increase participation rates in medicine must address this disjuncture. This might be achieved by re-orienting working-class identities and perceptions of medicine as a profession. However, it should be acknowledged that ‘identity conflict’ is related to the elite image that medicine maintains within contemporary society and, as such, efforts to re-orient individual working-class identities may have only a limited impact on overall participation rates. [ABSTRACT FROM AUTHOR]

Objectives Communication skills training in undergraduate medical education is considered to play an important role in medical students’ formation of their professional identity. This qualitative study explores Year 1 students’ perceptions of their identities when practising communication skills with real patients. Methods A total of 23 individual semi-structured interviews and two focus group discussions were conducted with 10 students during their first year of communication skills training. All interviews and discussions were audio-recorded, transcribed and analysed for emergent themes relating to identity. Results Students struggled to communicate professionally with patients because of a lack of clinical knowledge and skills. Consequently, students enacted other identities, yet patients perceived them differently, causing conversational ambiguities. Discussion Students’ perceptions challenge educational goals, suggesting that there is limited potential for the formation of professional identity through early training. Teacher-doctors must acknowledge how students’ low levels of clinical competence and patients’ behaviour complicate students’ identity formation. [ABSTRACT FROM AUTHOR]

Objectives Little is known about specific personal and professional factors influencing student distress. The authors conducted a comprehensive assessment of how learning environment, clinical rotation factors, workload, demographics and personal life events relate to student burnout. Methods All medical students ( n = 3080) at five medical schools were surveyed in the spring of 2006 using a validated instrument to assess burnout. Students were also asked about the aforementioned factors. Results A total of 1701 medical students (response rate 55%) completed the survey. Learning climate factors were associated with student burnout on univariate analysis (odds ratio [OR] 1.36–2.07; all P ≤ 0.02). Being on a hospital ward rotation or a rotation requiring overnight call was also associated with burnout (ORs 1.69 and 1.48, respectively; both P ≤ 0.02). Other workload characteristics (e.g. number of admissions) had no relation to student burnout. Students who experienced a positive personal life event had a lower frequency of burnout (OR 0.70; P ≤ 0.02), whereas those who experienced negative personal life events did not have a higher frequency of burnout than students who did not experience a negative personal life event. On multivariate analysis personal characteristics, learning environment and personal life events were all independently related to student burnout. Conclusions Although a complex array of personal and professional factors influence student well-being, student satisfaction with specific characteristics of the learning environment appears to be a critical factor. Studies determining how to create a learning environment that cultivates student well-being are needed. [ABSTRACT FROM AUTHOR]

Objectives Although peer-assisted learning (PAL) is widely employed throughout medical education, its effectiveness for training in technical procedures in skills laboratories has been subject to little systematic investigation. We conducted a prospective, randomised trial to evaluate the hypotheses that PAL is effective in technical skills training in a skills laboratory setting, and PAL is as effective as faculty staff-led training. Methods Volunteer Year 3 medical students were randomly assigned to one of three groups. Two of these received regular skills training from either cross-year peer tutors or experienced faculty staff. Following training, both groups were assessed using an objective structured clinical examination (OSCE) (three stations assessing various injection techniques) which was video-recorded. Two independent video assessors scored the OSCEs using binary checklists and global ranking forms. A third student group was assessed prior to training and served as a control group. Results A total of 89 students (mean age 23.0 ± 0.2 years; 41 male, 48 female) agreed to participate in the trial. Confounding variables including prior training as a paramedic or previous experience in performing the technical procedures did not significantly differ between the three study groups. In the OSCE, PAL (58.1 ± 1 binary points, 4.9 ± 0.1 global ranking points) and faculty-led groups (58.3 ± 1 binary points, 4.7 ± 0.1 global ranking points) scored significantly higher than the control group (33.3 ± 1 binary points, 2.7 ± 0.1 global ranking points; all P < 0.0001). There was no significant difference between the PAL and faculty-led groups ( P = 0.92 for binary checklists, P = 0.11 for global rankings). Conclusions Peer-assisted learning is a successful method for learning technical procedures in a skills laboratory setting and can be just as effective as the training provided by experienced faculty staff. [ABSTRACT FROM AUTHOR]

Objectives Depression is more frequently experienced and induces more severe consequences in medical students than in the general population. However, treatment rates for depression in medical students are still low. In this study, the authors investigated factors that affect treatment for depression and dispositions towards treating depression among South Korean medical students. Methods A nationwide, cross-sectional survey was administered to medical students attending all 41 medical schools in South Korea (14 095 students). The questionnaire included the Beck Depression Inventory (BDI) and asked for data on socio-demographic variables, history of diagnosis or treatment for depression, knowledge of mental health problems and disposition to use mental health care. Results A total of 7357 students (52.2%) from 36 schools responded to the survey. Of these, 689 (9.4%) were identified as being depressed via a BDI score higher than 16. Of the depressed respondents, only 61 (8.9%) had been diagnosed with depression and 67 (9.7%) had been treated for depression. Age was significantly associated with treatment behaviour for depression. Correct knowledge about the aetiology of depression and psychiatric medicine was significantly related to students’ disposition to use psychiatric services and to receive psychopharmacotherapy as an option to resolve depression. Conclusions Accurate knowledge of depression and appropriate medication seems to be relevant to students seeking appropriate treatment for depression. The development of education programmes designed to improve medical students’ knowledge of mental health problems and treatments would facilitate treatment seeking in medical students. [ABSTRACT FROM AUTHOR]

Objectives The lack of published studies into effective skills teaching in clinical skills centres inspired this study of student views of the teaching behaviours of skills teachers. Methods We organised focus group discussions with students from Years 1–3 of a 6-year undergraduate medical curriculum. A total of 30 randomly selected students, divided into three groups, took part in two sessions. They discussed what teaching skills helped them to acquire physical examination skills. Results Students’ opinions related to didactic skills, interpersonal and communication skills and preconditions. Students appreciated didactic skills that stimulate deep and active learning. Another significant set of findings referred to teachers’ attitudes towards students. Students wanted teachers to be considerate and to take them seriously. This was reflected in student descriptions of positive behaviours, such as: ‘responding to students’ questions’; ‘not exposing students’ weaknesses in front of the group’, and ‘[not] putting students in an embarrassing position in skill demonstrations’. They also appreciated enthusiasm in teachers. Important preconditions included: the integration of skills training with basic science teaching; linking of skills training to clinical practice; the presence of clear goals and well-structured sessions; good time management; consistency of teaching, and the appropriate personal appearance of teachers and students. Conclusions The teaching skills and behaviours that most facilitate student acquisition of physical examination skills are interpersonal and communication skills, followed by a number of didactic interventions, embedded in several preconditions. Findings related to interpersonal and communication skills are comparable with findings pertaining to the teaching roles of tutors and clinical teachers; however, the didactic skills merit separate attention as teaching skills for use in skills laboratories. The results of this study should be complemented by a study performed in a larger population and a study exploring teachers’ views. [ABSTRACT FROM AUTHOR]

Objectives We aimed to discover, through a controlled experiment, whether cognitive and non-cognitive assessment would select higher-achieving applicants to medical school than selection by lottery. Methods We carried out a prospective cohort study to compare 389 medical students who had been admitted by selection and 938 students who had been admitted by weighted lottery, between 2001 and 2004. Main outcome measures were dropout rates, study rate (credits per year) and mean grade per first examination attempt per year. Study rates in the 4 pre-clinical years of medical school were used to categorise students’ performance as average or optimal. Results Pre-admission variables did not differ between the two groups. The main outcome of the selection experiment was that relative risk for dropping out of medical school was 2.6 times lower for selected students than for lottery-admitted controls (95% confidence interval 1.59–4.17). Significant differences between the groups in the percentage of optimally performing students and grade point average for first examination attempts were found only in the 2001 cohort, when results favoured the selected group. The results of the selection process took into account both the assessment procedure involved and the number of students who withdrew voluntarily. Conclusions This is the first controlled study to show that assessing applicants’ non-cognitive and cognitive abilities makes it possible to select students whose dropout rate will be lower than that of students admitted by lottery. The dropout rate in our overall cohort was 2.6 times lower in the selected group. [ABSTRACT FROM AUTHOR]

Context Peer physical examination (PPE) has been employed for several decades as part of the formal curriculum for learning clinical skills. Most of the existing studies exploring students’ attitudes towards PPE are single-site and use quantitative methods. Currently, there is a lack of theoretical underpinning to PPE as a learning method. Methods Using an adaptation of the Examining Fellow Students questionnaire, we captured qualitative data from Year 1 medical students about their views and concerns around learning using PPE. The study was set in six schools across five countries (the UK, Australia, New Zealand, Japan and Hong Kong). Students provided free text comments that were later transcribed and analysed using framework analysis. Results A total of 617 students provided comments for analysis. This paper focuses on several related themes about the complexities of students’ relationships within the context of PPE and their reflections on peer examination in comparison with genuine patient examination. Students drew parallels and differences between the peer examiner–examinee relationship and the doctor–patient relationship. They explained how these two types of relationship differed in nature and in terms of their levels of interaction. Discussion Our findings illuminate the interactional and complex nature of PPE, drawing out concerns and ambiguities around relationships, community and rules. We discuss our results in light of Engeström’s model of activity theory (AT) and provide recommendations for educational practice and further research based on the principles of AT. [ABSTRACT FROM AUTHOR]

Context There is little empirical evidence in the literature regarding the nature of the experiences of medical students during war. In this study we set out to assess and analyse the experiences of medical students and residents in Beirut, Lebanon during the 2006 Lebanon–Israel war. Methods Students and residents working at the American University of Beirut Medical Center and the Beirut Government University Hospital during the July 2006 war were invited to participate. A total of 21 students or residents took part in either a focus group or one of 11 semi-structured interviews. These were recorded, transcribed and analysed to bring out common themes. Results Although the wartime experience was stressful, medical students and residents reported many largely positive effects of war on their medical training. Students adapted to the difficult conditions and became more resourceful. Participants connected emotionally with their patients and were able to show more compassion. They felt pride in their chosen profession and had higher levels of motivation for dealing with the normally irksome aspects of medical practice. Practical skills associated with the treatment of wartime injuries were learned, as were more general lessons about life priorities. Conclusions Despite the curtailing of formal educational activities, participants benefited from positive learning experiences in a wartime environment. Strikingly, participants ‘cared’ more for their patients. Further research looking at the underlying cause of this increased level of compassion may be useful in the education of all medical students, not just those involved in conflict. [ABSTRACT FROM AUTHOR]

Context Patient-centredness is an accepted guiding principle for health system reform, patient care and medical education. Although these attitudes are strongly linked with cultural values, few studies have examined attitudes towards patient-centredness in a cross-cultural setting. Objectives This prospective study evaluated attitudes towards patient-centredness in a cohort of Asian medical students and examined changes in these attitudes in the same students on completion of their junior clinical clerkships. Methods The study was conducted in a cohort of 228 medical students entering Year 3 in medical school. The Patient–Practitioner Orientation Scale (PPOS), a validated instrument which scores an individual’s level of patient-centredness, was used. Results Being female and having personal experience of continuing care were significantly associated with higher scores. Students in the USA were previously reported to have similar ‘caring’ but higher ‘sharing’ scores on the same scale. At the end of the junior clinical clerkship, there were improvements in the ‘caring’ subscale, but no change or a reduction in ‘sharing’. Students who did not have previous personal experience with continuing care experienced a greater increase in overall PPOS score. Conclusions When compared with students in the USA, the students in our study appear to have a lower propensity to view the doctor–patient relationship as a partnership. This may be a reflection of differences in cultural norms and expectations of doctor–patient interaction in different societies. Our finding that attitudes towards patient-centredness did not decline over the course of the year, which contrasts with findings of other studies, may be attributed to various factors and warrants further study. [ABSTRACT FROM AUTHOR]

Context Historically, medical students report receiving little formative feedback. Reports of feedback processes are generally limited to a single course or specialty. There is a paucity of research detailing feedback across the core clerkship year. Objectives We aimed to determine the feasibility of a cross-clerkship feedback encounter card system, describe the content of feedback requested and received during the core clerkships, and examine student satisfaction with the feedback card system. Methods Students ( n = 127) enrolled in six mandatory clerkships were required to complete feedback cards, twice weekly during inpatient rotations and once weekly during outpatient rotations. Students checked-off areas in which they wanted to receive feedback and gave the card to a supervisor, who indicated areas in which feedback was provided. Descriptive statistics summarised completeness and feedback content. A two-factoranova estimated differences between students’ perceptions of feedback usefulness pre- and post-feedback card implementation. Results A total of 5369 feedback cards were completed in 2006 (78% of the target). Feedback about presentation skills (57% of cards) and fund of knowledge (48% of cards) were most frequently requested. On approximately 80% of the cards, students received feedback in the area(s) they had requested. During each clerkship, students requested feedback in most areas at least once. The mean rating of feedback usefulness was significantly lower after feedback card implementation (mean 3.6, standard deviation [SD] 1.1) than before implementation (mean 3.7, SD 1.0) ( F = 11.022, P < 0.001, effect size = − 17). Conclusions Despite evidence that students received feedback multiple times, satisfaction was low. Research identifying factors that improve satisfaction with feedback during clinical training is needed. [ABSTRACT FROM AUTHOR]

Context Self-reflection, the practice of inspecting and evaluating one’s own thoughts, feelings and behaviour, and insight, the ability to understand one’s own thoughts, feelings and behaviour, are central to the self-regulation of behaviours. The Self-Reflection and Insight Scale (SRIS) measures three factors in the self-regulation cycle: need for reflection; engagement in reflection, and insight. Methods We used structural equation modelling to undertake a confirmatory factor analysis of the SRIS. We re-specified our model to analyse all of the data to explain relationships between the SRIS, medical student characteristics, and responses to issues of teaching and learning in professionalism. Results The factorial validity of a modified SRIS showed all items loading significantly on their expected factors, with a good fit to the data. Each subscale had good internal reliability (> 0.8). There was a strong relationship between the need for reflection and engagement in reflection ( r = 0.77). Insight was related to need for reflection (0.22) and age (0.21), but not to the process of engaging in reflection (0.06). Conclusions Validation of the SRIS provides researchers with a new instrument with which to measure and investigate the processes of self-reflection and insight in the context of students’ self-regulation of their professionalism. Insight is related to the motive or need for reflection, but the process of reflection does not lead to insight. Attending to feelings is an important and integral aspect of self-reflection and insight. Effective strategies are needed to develop students’ insight as they reflect on their professionalism. [ABSTRACT FROM AUTHOR]

Context Medical students have long been perceived as socially segregated from other students. However, the evidence for this is mainly anecdotal. This study investigates this issue by comparing medical students with economics students. Methods Questionnaires measuring objective and subjective social life patterns were completed by 149 medical and 149 economics students at a campus-based university in the UK. Results Medical students drew significantly more of their close friends and housemates from among students on the same course than economics students. Significantly more medical than economics students had a partner on the same course, participated in departmental sports clubs and societies, and felt separated from the rest of university life. Commonly reported reasons for this separation among medical students were high workloads, that the medical school was located outside the main campus, and high numbers of contact hours, some of which took place at sites outside the university. Discussion Medical students are more socially exclusive than economics students, which may lead to ‘in-group’ attitudes and behaviours. This is educationally important and may affect their future professionalism. Universities should be aware of the issues involved when planning curricula, timetables, welfare initiatives and campus design. Prospective medical students should be informed of the social consequences of studying medicine. [ABSTRACT FROM AUTHOR]

Context Ber’s Comprehensive Integrative Puzzle aims to assess analytical clinical thinking in medical students. We developed a paediatric version, the MATCH test, in which we added two irrelevant options to each question in order to reduce guessing behaviour. We tested its construct validity and studied the development of integrative skills over time. Methods We administered a test (MATCH 1) to subjects from two universities, both with a 6-year medical training course. Subjects included 30 students from university 1 who had completed a paediatric clerkship in Year 4, 23 students from university 2 who had completed a paediatric clerkship in Year 5, 13 students from both universities who had completed an advanced paediatric clerkship in Year 6, 28 paediatric residents and 17 paediatricians. We repeated this procedure using a second test with different domains in a new, comparable group of subjects (MATCH 2). Results Mean MATCH 1 scores for the respective groups were: Year 4 students: 61.2% (standard deviation [SD] 1.3); Year 5 students: 71.3% (SD 1.6); Year 6 students: 76.2% (SD 1.5); paediatric residents: 88.5% (SD 0.7), and paediatricians: 92.2% (SD 1.1) (one-wayanova F = 104.00, P < 0.0001). Students of both universities had comparable scores. MATCH 1 and 2 scores were comparable. Cronbach’s α-values in MATCH 1 and 2 were 0.92 and 0.91, respectively, for all subjects, and 0.82 and 0.87, respectively, for all students. Conclusions Analytical clinical thinking develops over time, independently of the factual content of the course. This implies that shortened medical training programmes could produce less skilled graduates. [ABSTRACT FROM AUTHOR]

Objectives Peer-assisted learning (PAL) has been reported to have educational benefits in cross-year, small-group teaching in other contexts. Accordingly, we explored whether senior medical students are effective tutors for their junior peers in clinical skills education, and how the participants in the learning triad (tutors, learners and simulated patients [SPs]) perceive the learning environment created in PAL. Methods Year 2 students were randomly allocated to one of two groups for skills training. Group 1 ( n = 64) were tutored by volunteer Year 6 students, and Group 2 ( n = 67) by paid doctors. The results of both groups in a clinical skills examination were compared using an independent samples t-test. Qualitative data, obtained from Year 2 students ( n = 125) by written questionnaire and Year 6 students ( n = 11) and SPs ( n = 3) by focus group interviews, were analysed for themes. Results Students receiving PAL did at least as well in the clinical skills examination as students with qualified tutors (difference in mean total score: 0.7 marks out of 112; 95% confidence interval − 3.8 to 2.4). The PAL environment was perceived as ‘comfortable’ and fostered the development of confidence in all participants. Peer tutors created a more active learning environment than doctor tutors for both learners and SPs and reported personal benefits from teaching. Conclusions With appropriate support, volunteer Year 6 student tutors are as effective as graduate doctors for small-group structured tutorials in clinical skills. Educational relationships were forged between all participants in the learning triad. [ABSTRACT FROM AUTHOR]

Context Teaching and evaluating professionalism remain important issues in medical education. However, two factors hinder attempts to integrate curricular elements addressing professionalism into medical school training: there is no common definition of medical professionalism used across medical education, and there is no commonly accepted theoretical model upon which to integrate professionalism into the curriculum. Objectives This paper proposes a definition of professionalism, examines this definition in the context of some of the previous definitions of professionalism and connects this definition to the attitudinal roots of professionalism. The problems described above bring uncertainty about the best content and methods with which to teach professionalism in medical education. Although various aspects of professionalism have been incorporated into medical school curricula, content, teaching and evaluation remain controversial. We suggest that intervening variables, which may augment or interfere with medical students’ implementation of professionalism knowledge, skills and, therefore, attitudes, may go unaddressed. Discussion We offer a model based on the theory of planned behaviour (TPB), which describes the relationships of attitudes, social norms and perceived behavioural control with behaviour. It has been used to predict a wide range of behaviours, including doctor professional behaviours. Therefore, we propose an educational model that expands the TPB as an organisational framework that can integrate professionalism training into medical education. We conclude with a discussion about the implications of using this model to transform medical school curricula to develop positive professionalism attitudes, alter the professionalism social norms of the medical school and increase students’ perceived control over their behaviours. [ABSTRACT FROM AUTHOR]

Context Medical students are at risk of occupational exposure to blood-borne viruses following needlestick injuries (NSIs) during medical school. The reporting of NSIs is an important step in the prevention of further injuries and in the initiation of early prophylaxis or treatment. The objective of this study was to describe the mechanisms whereby medical students experience occupational percutaneous blood exposure through NSIs and to discuss rational strategies for prevention. Methods Incidents of exposure to blood-borne pathogens among medical students at a large German university were analysed. Year 6 medical students completed a written survey immediately before the clinical part of their training began, describing incidents that had occurred during the previous 5 years. Results In our study, 58.8% (183/311) of participating medical students recalled at least one NSI that had occurred during their studies. Overall, 284 NSIs were reported via an anonymous questionnaire. Discussion Occupational exposure to blood is a common problem among medical students. Efforts are required to ensure greater awareness of the risks associated with blood-borne pathogens among German medical students. Proper training in percutaneous procedures and how to act in the event of injury should be given in order to reduce the number of injuries. [ABSTRACT FROM AUTHOR]

Objective This study sought to determine the relative contributions made by transferable skills and content-specific skills to Year 2 medical student performance in a clinical skills examination. Methods Correlated trait-correlated method models were constructed to describe the performance of 2 year groups of students in examinations held in the summers of 2004 and 2005 at Peninsula Medical School in the UK. The transferable skills components of the models were then removed to indicate the contribution made to the fit of the models to the data. Results Although content-specific skills made the greater contribution to the 2 models of student performance (accounting for averages of 54% and 43% of the variance, respectively), transferable skills did make an important but smaller contribution (averages of 13% and 16%, respectively). When the transferable skills components of the models were removed, the fit was not as good. Conclusions Both content-specific skills and transferable skills contributed to performance in the clinical skills examination. This challenges current thinking and has important implications, not just for those involved in clinical skills examinations, but for all medical educators. [ABSTRACT FROM AUTHOR]

Objective Clinical experiences and gender have been shown to influence medical students’ specialty choices. It remains unclear, however, which aspects of experiences make students favour some specialties and reject others. This study aimed to clarify the effects of clerkships on specialty choice and to identify explanatory factors. Methods We carried out a longitudinal cohort study to collect data on career preferences and attitudes towards future careers among 3 cohorts of students before and after clerkships in surgery ( n = 200), internal medicine ( n = 277) and general practice ( n = 184). Regression analyses were performed to identify the determinants of career choice and the role of gender. Results Exposure to clinical settings encourages students to opt for a career in the corresponding specialty. Men were more stimulated than women by the general practice clerkship. Gender had no clear role as a predictor of career preference. The major predictor of career choice in all 3 specialties was positive evaluation of work-intrinsic factors. A preference for working with acute patients and technology-oriented work, prestige orientation and insignificance of a controllable lifestyle were determinants of a preference for surgery. Students with a preference for general practice had almost opposite preferences. Those who chose internal medicine favoured a controllable lifestyle. Discussion Factors other than gender appear to drive specialty decisions. Work content, type of patients and lifestyle options play major roles. Consequently, along with teaching about the practice of medicine, the matching of specialty preferences with reality is an essential outcome of clerkships. [ABSTRACT FROM AUTHOR]

Context There is ongoing discussion within the medical education community about dissection as an educational strategy and as a professional training tool in technical and emotional skills training. Objectives This study aimed to discover the emotional reactions, attitudes and beliefs of new students faced with human cadaver dissection; to evaluate the changes produced in these variables by the exhibition and practice of dissection; to analyse the level of anxiety students feel when faced with death, and to elucidate the possible relationships between these items. Methods The study used a sample of 425 students who were first-time enrolees in a human anatomy course. Three new instruments were designed, with items covering emotional reactions (cognitive, physiological and motor reactions), beliefs and attitudes related to what the student expects to experience or has experienced in dissection. Death anxiety was measured using the Death Anxiety Inventory. Results As students gained more experience of dissection, their emotional reactions were reduced and their attitudes and beliefs changed. Statistically significant differences in the level of death anxiety emerged, depending on the perceptions students had of their degree of preparation for dissection, and emotional control and deeper thoughts about life and death during dissection. Discussion The practice of anatomy allows the student to learn how to face up to and adapt his or her emotional reactions and attitudes; this gives human cadaver dissection great importance as an educational strategy and as a professional training tool in technical and emotional skills training. [ABSTRACT FROM AUTHOR]

Context Sexual harassment of medical students has been the focus of many international studies. Prevalence rates from 18% to over 60% have been reported. However, a Dutch study at Nijmegen Medical School found the prevalence rate to be lower (13.3% in the total group; 20% among female students only). Objectives We aimed to identify whether Nijmegen constitutes a positive sample of Dutch medical schools or whether incidents of sexual harassment are less prevalent in the Netherlands than elsewhere, and to establish if and how these experiences impact the professional lives of students. Methods Students received a semi-structured questionnaire containing questions about their experiences of sexual harassment during clerkships. The questions referred to students’ reactions to any incidents, the possible consequences for their wellbeing or professional functioning and the way cases of sexual harassment were handled. Results The prevalence of sexual harassment was significantly higher in Utrecht than in Nijmegen. In both studies rates were relatively low compared with international data. Nevertheless, 1 in 3–5 Dutch female medical students had experienced unwelcome sexual attention from patients, colleagues or supervisors. Three of 10 students who had experienced such an incident stated that it had a negative impact on their functioning afterwards. Conclusions Prevalence rates of sexual harassment in medical schools in the Netherlands are low compared with international rates. However, the number of women students who experience sexual harassment is still 1 in 3–5. The occurrence of and ways to deal with these incidents should be important topics in the training of medical students and supervisors. [ABSTRACT FROM AUTHOR]

Context Interprofessional learning activities in health care are being gradually introduced on an international basis and therefore cross-cultural and internationally collaborative research into the outcomes of these activities is needed. Hence, it is necessary not only to translate research instruments into the language of the culture in which they are to be used, but also to adapt them culturally if they are to fulfil the testing purposes for which they are intended. It is also necessary to test a translated instrument in order to ensure that it retains its intended psychometric properties. Methods In the present study, the Readiness for Interprofessional Learning Scale (RIPLS) was adapted for use in a Swedish student population. Cross-cultural adaptation was performed according to recommended guidelines. The Swedish version was tested on a group of students from various health care professions ( n = 214). Cronbach’s alpha coefficient was adopted to ensure internal consistency. Results Minor discrepancies during the different translation processes were identified and corrected. Confirmatory factor analysis suggests that the model had an acceptable fit, implying that the factor structure of the scale did not undergo any significant changes by being subjected to translation. The psychometric qualities of the instrument were comparable with those of the English-language version. Conclusions This study presents the cross-cultural adaptation of the RIPLS and demonstrates that its subscale Teamwork and Collaboration is the only reliable subscale. The other 2 subscales (Professional Identity, and Roles and Responsibilities) probably require further scrutiny and development, at least in the Swedish population. [ABSTRACT FROM AUTHOR]

Objective This study aimed to explore the effect of gender on medical students’ aspirations. Methods The study design included purposive sampling and interim data interpretation to guide recruitment of medical students with a wide spectrum of opinions. Data were collected through audio-recorded, semi-structured, in-depth exploratory interviews, which were transcribed verbatim. Qualitative analysis was carried out by a female medical student researcher. Her evolving interpretation was constantly compared against the original data by male (doctor) and female (pharmacist) staff researchers in a systematic search for internal corroboration or disconfirmation. Causal associations consistently present in the data are reported. Results Six male and six female medical students in Years 3 and 4 shared a wish to achieve a work−life balance that allowed them to devote time to bringing up children while contributing usefully to society as doctors. However, women were readier to compromise professional attainment within their personal work−life balances. Their readiness derived from gendered stereotypes of women’s social and professional roles, a lack of female professional role models, womens' greater awareness of the tensions between career and family, various other informal social influences, and a lack of positive career advice to counterbalance these influences. Conclusions Better career advice and more flexible work opportunities are needed if the two-thirds of medical students who are women are to contribute specialist as well as generalist expertise to the medical workforce. [ABSTRACT FROM AUTHOR]

Context Globalisation has profoundly affected health care by increasing the diversity of clinicians and their patients. Worldwide, medical schools highlight the need for students to understand and show respect for patients and peers of different ethnicities. Yet a sound theoretical approach and robust methods for learning about cultural awareness are lacking. The reasons for this are unclear. Objective To explore Year 2 medical students’ understanding of the concepts of race, ethnicity and culture. Methods This study was set in 2 universities in the north of England. The student population of each was of a similar ethnic mix but the universities differed in terms of local demography (a wide patient ethnic mix versus a predominantly White patient population with experience of social deprivation) and curricula (a curriculum involving problem-based learning and paper-based cases versus a curriculum involving early contact with patients). Participants comprised 49 Year 2 medical students (mean age 20·8 years), 40% of whom came from ethnic minority groups. Seven focus groups were held across the 2 universities to explore students’ understanding of cultural awareness. Students were asked to discuss the terms ‘race’, ‘ethnicity’, ‘culture’ and ‘cultural diversity’. Interviews were transcribed and analysed qualitatively using grounded theory. Themes were identified and validated by an independent researcher. Results Four overarching themes emerged: ‘White fears’ at discussing race-related issues; ethnic minority discomfort at being viewed as ‘different’; difficulties in relating to professional boundaries, and barriers against talking about race beyond legitimate disease-related discourse. Conclusions For students, discussion of race beyond the confines of medical discourse was problematic. If students are to develop professional holistic values towards patient care, they need more support in understanding their own personal values and uncertainties. [ABSTRACT FROM AUTHOR]

Context The quality of medical undergraduate operating theatre-based teaching is variable. Preparation prior to attending theatre may support student learning. Identifying and agreeing key skills, competences and objectives for theatre-based teaching may contribute to this process of preparation. Methods We carried out a cross-sectional survey of consultant surgeons and students using a forced choice questionnaire containing 16 skills and competences classified as ‘essential’, ‘desirable’ or ‘not appropriate’, and a choice of 6 different teaching methods, scored for perceived effectiveness on a 5-point Likert scale. Questionnaire content was based on the findings from an earlier qualitative study. Results Comparative data analyses (Mann– Whitney and Kruskal–Wallis tests) were carried out usingspss Version 14. A total of 42 consultant surgeons and 46 students completed the questionnaire (46% and 100% response rates, respectively). Knowledge of standard theatre etiquette and protocols, ability to scrub up adequately, ability to adhere to sterile procedures, awareness of risks to self, staff and patients, and appreciation of the need for careful peri-operative monitoring were considered ‘essential’ by the majority. Student and consultant responses differed significantly on 5 items, with students generally considering more practical skills and competences to be essential. Differences between students on medical and surgical attachments were also identified. Conclusions Consultant surgeons and medical students agree on many aspects of the important learning points for theatre-based teaching. Compared with their teachers, students, particularly those on attachment to surgical specialties, are more ambitious – perhaps overly so – in the level of practical skills and risk awareness they expect to gain in theatre. [ABSTRACT FROM AUTHOR]

Context The conceptualisation and measurement of competence in patient care are critical to the design of medical education programmes and outcome assessment. Objective We aimed to examine the major components and correlates of postgraduate competence in patient care. Methods A 24-item rating form with additional questions about resident doctors' performance and future residency offers was used. Study participants comprised 4560 subjects who graduated from Jefferson Medical College between 1975 and 2004. They pursued their graduate medical education in 508 hospitals. We used a longitudinal study design in which the rating form was completed by programme directors to evaluate residents at the end of the first postgraduate year. Factor analysis was used to identify the underlying components of postgraduate ratings. Multiple regression, t-test and correlational analyses were used to study the validity of the components that emerged. Results Two major components emerged, which we labelled ‘Knowledge and Clinical Capabilities’ and ‘Professionalism’, and which addressed the science and art of medicine, respectively. Performance measures during medical school, scores on medical licensing examinations, and global assessment of Medical Knowledge, Clinical Judgement and Data-gathering Skills showed higher correlations with scores on the Knowledge and Clinical Capabilities component. Global assessments of Professional Attitudes and ratings of Empathic Behaviour showed higher correlations with scores on the Professionalism component. Offers of continued residency and evaluations of desirable qualities were associated with both components. Conclusions Psychometric support for measuring the components of Knowledge and Clinical Capabilities, and Professionalism provides an instrument to empirically evaluate educational outcomes to medical educators who are in search of such a tool. [ABSTRACT FROM AUTHOR]

Context Placements are an integral component of the medical, nursing and allied health curricula. However, apart from the relocation costs associated with placements, little research on students' understandings and experiences of the financial implications of placements has been carried out. Objectives We report on students' financial concerns associated with placements, which emerged as a main theme in a broader study we conducted on the impact of undergraduate student placement experiences on graduate practice. Methods We conducted a qualitative study which included focus group discussions ( n = 17), individual interviews ( n = 48) and written responses ( n = 2) with undergraduate students ( n = 103) and graduates ( n = 27) from a tertiary institution in Victoria, Australia. Results Students identified that income generation and the costs associated with transport and placement location contributed to the financial burden of placements. Students also spoke of the implications of high financial strain impacting on their accumulation of debt as well as on their health and wellbeing. Discussion Our study advances our understanding of the implications of financial hardship experienced by medical, nursing and allied health students. In our study, students, regardless of their placement location, experienced increased demands and associated stress as a result of managing placements, paid employment and limited financial resources. We recommend that further quantitative research be conducted to measure the variables identified as emerging themes in this study. [ABSTRACT FROM AUTHOR]

Objectives To examine whether peer assessment can enhance scores on professional behaviour, with the expectation that students who assess peers score more highly on professional behaviour than students who do not assess peers. Methods Undergraduate medical students in their first and second trimesters were randomly assigned to conditions with or without peer assessment. Of the total group of 336 students, 278 students participated in the first trimester, distributed over 31 tutorial groups, 17 of which assessed peers. The second trimester involved 272 students distributed over 32 groups, 15 of which assessed peers. Professional behaviour was rated by tutors on 3 dimensions: Task Performance; Aspects of Communication, and Personal Performance. The rating scale ranged from 1 (poor) to 10 (excellent). Data were analysed using multivariate repeated measures multilevel analysis. Results Assessment scores were found to have generally increased in the second trimester, especially the personal performance scores of students who assessed peers. In addition, female students were found to have significantly higher scores than male students. Conclusions In undergraduate medical education, peer assessment has a positive influence on professional behaviour. However, the results imply that peer assessment is only effective after students have become adjusted to the complex learning environment. [ABSTRACT FROM AUTHOR]

Context Achieving competence in ‘practice-based learning’ implies that doctors can accurately self- assess their clinical skills to identify behaviours that need improvement. This study examines the impact of receiving feedback via performance benchmarks on medical students' self-assessment after a clinical performance examination (CPX). Methods The authors developed a practice-based learning exercise at 3 institutions following a required 8-station CPX for medical students at the end of Year 3. Standardised patients (SPs) scored students after each station using checklists developed by experts. Students assessed their own performance immediately after the CPX (Phase 1). One month later, students watched their videotaped performance and reassessed (Phase 2). Some students received performance benchmarks (their scores, plus normative class data) before the video review. Pearson's correlations between self-ratings and SP ratings were calculated for overall performance and specific skill areas (history taking, physical examination, doctor−patient communication) for Phase 1 and Phase 2. The 2 correlations were then compared for each student group (i.e. those who received and those who did not receive feedback). Results A total of 280 students completed both study phases. Mean CPX scores ranged from 51% to 71% of items correct overall and for each skill area. Phase 1 self-assessment correlated weakly with SP ratings of student performance ( r = 0.01–0.16). Without feedback, Phase 2 correlations remained weak ( r = 0.13–0.18; n = 109). With feedback, Phase 2 correlations improved significantly ( r = 0.26–0.47; n = 171). Low-performing students showed the greatest improvement after receiving feedback. Conclusions The accuracy of student self-assessment was poor after a CPX, but improved significantly with performance feedback (scores and benchmarks). Videotape review alone (without feedback) did not improve self-assessment accuracy. Practice-based learning exercises that incorporate feedback to medical students hold promise to improve self-assessment skills. [ABSTRACT FROM AUTHOR]

Context Although examiners are a large source of variability in the objective structured clinical examination (OSCE), the exact causes of examiner variance remain understudied. Objective This study aimed to determine whether examiner familiarity with candidates influences candidate scores. Methods A total of 24 candidates from 4 neonatal-perinatal training programmes participated in a 10-station OSCE. Sixteen trainees and 7 examiners came from a single centre (site A) and 8 candidates and 5 examiners came from the other 3 centres. Examiners completed station-specific binary checklists and an overall global rating; standardised patients (SPs) and standardised health professionals (SHPs) completed 4 process ratings and the overall rating. A fixed-effect, 2-way analysis of variance was performed to ascertain whether there was interaction between examiner site and candidate site. Results Interstation Cronbach's α was 0.80 for the examiner checklist, 0.88 for the examiner global rating and 0.88 for the SP or SHP global rating. Although the checklist scores awarded by site A examiners were significantly higher than those awarded by non-site A examiners, there was no significant interaction between examiner and candidate site ( P = 0.124). Similarly, the interaction between examiner and candidate site for the global rating was not significant ( P = 0.207). Global ratings awarded by SPs and SHPs were also higher in stations where site A faculty examined site A candidates, suggesting the observed differences may have been related to performance. Conclusions Results from this small dataset suggest that examiner familiarity with candidates does not influence how examiners score candidates, confirming the objective nature of the OSCE. Confirmation with a larger study is required. [ABSTRACT FROM AUTHOR]

Context It is sometimes claimed that self-assessment is inaccurate and that clinicians over-rate their performance. There is a need to find out why this should be. Is poor self-assessment caused by some clinicians' inability to accurately judge performance? Or does over-scoring result from a desire to convey a more favourable impression? Peer assessment is widely advocated and is said to be of benefit to both assessor and assessee. Methods In this study, we wanted to see if postgraduates were able to peer-assess and if this form of assessment was more reliable than self-assessment when compared with assessment by a trainer. We used checklist and global rating scales to evaluate surgical skills in removing a mandibular third molar tooth. Results There was no statistically significant difference between peer-assessed and trainer-assessed scores. We found that, on average, peer assessment (especially global rating scales) reflected trainer scores more accurately than self-assessment of surgical skills. Self-assessment scores were significantly higher on average than those given in peer assessment. Discussion Although peers and trainee surgeons came from the same group, the surgeons were more likely to over-score when measuring their own performances. The greatest variability (and over-scoring) between assessor and trainee surgeon appeared to occur in those with lower mean scores. Formative peer assessment may be a useful and less stressful mechanism for encouraging reflection. [ABSTRACT FROM AUTHOR]

Context We addressed the assessment of professional behaviour in tutorial groups by investigating students' perceptions of the frequency and impact of critical incidents that impede this assessment and 5 factors underlying these critical incidents. Methods A questionnaire asking students to rate the frequency and impact of 40 critical incidents relating to effective assessment of professional behaviour on a 5-point Likert scale was developed and sent to all undergraduate medical students in Years 2–4 of a 6-year undergraduate curriculum. Results The response rate was 70% ( n = 393). Important factors underlying critical incidents are: lack of effective interaction; lack of thoroughness; tutors' failure to confront students with unprofessional behaviour; lack of effort to find solutions, and lack of student motivation. Confirmatory factor analysis showed a good model fit. Because the relationship between frequency of occurrence and degree of impediment varies, the best information about the true impact of critical incidents and the underlying factors is provided by the product of frequency and degree of impediment. Frequency of occurrence remains stable and degree of impediment increases in Years 2–4. Conclusions The results of this study can be used to design and improve faculty development programmes aimed at improving assessment of professional behaviour. Training programmes should motivate tutors by providing background information as to why and how sound assessment of professional behaviour is to be performed and encourage tutors to confront students with and discuss all aspects of professional behaviour, as well as provide appropriate feedback. [ABSTRACT FROM AUTHOR]

Objectives Learning to perform physical examination of the abdomen is a challenge for medical students. Medical educators need to find engaging, effective tools to help students acquire competence and confidence in abdominal examination techniques. This study evaluates the added value of ultrasound training when Year 1 medical students learn abdominal examination. Methods The study used a randomised trial with a wait-list control condition. Year 1 medical students were randomised into 2 groups: those who were given immediate ultrasound training, and those for whom ultrasound training was delayed while they received standard instruction on abdominal examination. Standardised patients (SPs) used a clinical skills assessment (CSA) checklist to assess student abdominal examination competence on 2 occasions − CSA-1 and CSA-2 − separated by 8 weeks. Students also estimated SP liver size for comparison with gold-standard ultrasound measurements. Students completed skills confidence surveys. Results Proficiency in abdominal examination technique acquired from traditional instruction boosted with ultrasound training showed no advantage at CSA-1. However, at CSA-2 the delayed ultrasound training group showed significant improvement. Students uniformly underestimated SP liver sizes and the estimates were not affected by ultrasound training. Student confidence in both groups improved from baseline to CSA-1 and CSA-2. Conclusions Ultrasound training as an adjunct to traditional means of teaching abdominal examination improves students' physical examination technique after students have acquired skills with basic examination manoeuvres. [ABSTRACT FROM AUTHOR]

Context The use of simulated patients (SPs) in teaching communication and practical skills at medical schools is mostly limited to single-case use: a student has 1 consultation with an SP and receives feedback afterwards. Very little literature is available that describes consecutive consultations between the same student and SP. In this study, we explored the experiences of SPs in a new, longitudinal SP programme in which SPs met the same Year 3 students (‘GP’) in 4 consecutive consultations during the year. The SPs suffered from a chronic disease in their patient roles. Methods Four focus group discussions were conducted with 23 SPs (8 men, 15 women; average age 60.9 years) who had performed in the new programme. Discussions were semi-structured and followed a pre-established interview guide. Data were categorised by 3 independent raters. Results The SPs described the development of a more familiar relationship with students under the new programme, compared with single-case consultations. They developed specific expectations of students' performances. The SPs enjoyed participating in the programme and felt it was more realistic than single-case consultations. Feedback changed and became more detailed as SPs were able to compare consultations; students' response to feedback could be experienced during the next consultation. Discussion Practising the development of a realistic, longitudinal doctor−patient relationship may help prepare students for real practice. Longitudinal feedback is now possible; it may be of higher quality and of benefit to SPs as well. These findings suggest new possibilities for SP-based education and research. Future studies should focus on quantitative analysis and students' perspectives. [ABSTRACT FROM AUTHOR]

Objectives Personality types (combinations of traits) that take into account the interplay between traits give a more detailed picture of an individual's character than do single traits. This study examines whether both personality types and traits predict stress during medical school training. Methods We surveyed Norwegian medical students ( n = 421) 1 month after they began medical school (T1), at the mid-point of undergraduate Year 3 (T2), and at the end of undergraduate Year 6 (T3). A total of 236 medical students (56%) responded at all time-points. They were categorised according to Torgersen's personality typology by their combination of high and low scores on the ‘Big Three’ personality traits of extroversion, neuroticism and conscientiousness. We studied the effects of both personality types (spectator, insecure, sceptic, brooder, hedonist, impulsive, entrepreneur and complicated) and traits on stress during medical school. Results There was a higher level of stress among female students. The traits of neuroticism ( P = 0.002) and conscientiousness ( P = 0.03) were independent predictors of stress, whereas female gender was absorbed by neuroticism in the multivariate model. When controlled for age and gender, ‘brooders’ (low extroversion, high neuroticism, high conscientiousness) were at risk of experiencing more stress ( P = 0.02), whereas ‘hedonists’ (high extroversion, low neuroticism, low conscientiousness) were more protected against stress ( P = 0.001). Conclusions This is the first study to show that a specific combination of personality traits can predict medical school stress. The combination of high neuroticism and high conscientiousness is considered to be particularly high risk. [ABSTRACT FROM AUTHOR]

Context Previous research has consistently found a relationship between students' attitudes towards peer physical examination (PPE) and their gender. Male students are more comfortable with PPE than females and students are more comfortable with same- rather than mixed-gender PPE. Despite these findings, previous research has not discussed the gender−attitude relationship in any meaningful depth. Objectives This discussion paper examines why a relationship exists between student attitudes towards PPE and student gender using insights from feminist body image theory. Discussion According to the feminist theory of objectified body consciousness, females experience their bodies differently from males. Females may be less comfortable with PPE because they have higher levels of body shame and body surveillance than males. They may also be more likely than males to fear critical and teasing comments and sexual objectification by the opposite sex. Conclusions Capitalising on what we already know about psychoeducational and activism approaches to the prevention and change of negative body image, I recommend that body image issues are discussed as part of students' PPE and professionalism programmes. Further research is needed to examine medical students' body image alongside their attitudes towards PPE. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to review current knowledge on burnout in medical residents, including reported prevalence rates, and to establish which risk and resistance factors contribute to or prevent burnout in medical residents. Methods We conducted a comprehensive search of the literature published between 1975 and 2005, using the Medline, EMBASE (from 1989) and PsychINFO databases. Results A total of 19 studies met our inclusion criteria. Only 5 studies appeared to meet more than 2 of the Cochrane quality criteria. The different studies report widely varying burnout rates among medical residents, ranging from 18% to 82%. Predictors of burnout can be characterised as either occupational or individual. Inconsistent results were reported with regard to the effects of some of these factors on burnout. Four of the 16 occupational risk factors appeared to be strongly related to burnout. The 11 individual risk factors examined were only weakly or moderately related to burnout. Conclusions Research on burnout among medical residents is scarce. The weak quality of the studies, the wide variety and limited predictive power of the predictor variables included and the inconsistent findings illustrate the need for a more systematic design with regard to future research among medical residents. A future research model should take account of the individual, occupational and training demands experienced by medical residents. [ABSTRACT FROM AUTHOR]

Objectives This research aims to identify the influences contributing to students' decisions to study medicine and to apply the findings to the design and targeting of outreach activities aimed at widening participation. Methods Semi-structured interviews were carried out with 15 medical students at a UK medical school. Framework analysis was used to identify themes and subthemes and findings relating to becoming a doctor were analysed further in the context of a theory of career decision making. Results Five themes and subthemes were identified. We report the results for the 3 main aspects relating to becoming a doctor from the theme School to Medical School Transition: early motivation; inhibitory factors, and facilitating factors. Many students spoke about having always wanted to study medicine. Early exposure to the possibility of being a doctor allowed the idea to flourish and motivated students to achieve high academic goals. Inhibitory factors included discouragement from application by teachers on the grounds of not being ‘doctor material’. Factors which facilitated access to medicine included the support of family members, particularly mothers, and other close friends, and having positive role models. Conclusions Our analysis provides evidence of important factors in career decision making for medicine which can be used to inform widening participation interventions in 3 areas, namely, those of school support, home support and raising aspirations. [ABSTRACT FROM AUTHOR]

Context Faculty members often use global rating scales as a method of assessing various characteristics of medical students' clinical performance. The purpose of this study was to determine if some performance characteristics are more highly associated with the overall faculty grade than others. Methods The clinical performance of 211 surgery clerkship students was evaluated by 2 or 3 faculty preceptors. Faculty rated students on 10 specific performance characteristics, using a 5-point scale. Faculty then assigned a numerical grade summarising the faculty's view of the student's performance. Reliability of the ratings was estimated by the intraclass correlation, and 1-way (analysis of variance)anova was used to test for differences among the students' mean ratings. Logistic regression was employed to determine the accuracy of each performance measure in predicting students' grades (A or B). Stepwise logistic regression was used to determine if there was a combination of performance characteristics that best predicted students' grades. Results The inter-rater reliabilities were low (≤ 0.33). Four of the 10 performance characteristics were each found to predict the assigned grade most accurately (80%). However, the least predictive characteristic achieved 75% accuracy. The stepwise logistic regressions indicated that combinations of 2 or 3 of the 10 performance characteristics increased prediction accuracy by ≤ 4%. Conclusions The rating on any single characteristic predicts a student's overall grade very accurately. Additional measures do not greatly increase the accuracy of prediction. Our results suggest that faculty make a relatively undifferentiated judgement in assigning student grades, and there is little to be gained by using multi-item forms in assessing medical students' clinical performance. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this study was to develop a better understanding of how medical trainees define medical errors and what factors influence medical trainees' perceptions of medical errors. Methods We surveyed 423 medical students and house staff at an urban academic medical centre to learn about how they defined medical errors, their experiences with medical errors, their beliefs about when a patient should be informed of an error, and their attitudes towards medical errors with differing severity of outcomes. Results Trainees stated that an event could be considered an error regardless of outcome, negligence, intention or consent. Definitions did not vary according to gender or level of training. Trainees had increasing feelings of guilt and fear as the outcomes related to errors worsened. Respondents were more likely to feel guilty and angry at themselves, and be afraid of accusations of malpractice, losing their licence, damaging their reputation, or losing confidence when errors were made while working individually versus in a team setting. Female trainees were more likely than male trainees to feel guilty and angry at themselves, and were afraid of losing confidence if they made an error. Conclusions Trainees' perceptions and attitudes towards errors vary depending on whether they are in their clinical years, the severity of outcome, and whether the error is attributable to an individual or a team. These factors will have to be explored in greater depth if we are adequately to prepare young doctors for the errors they will inevitably make. [ABSTRACT FROM AUTHOR]

Objectives To summarise survey results for the quality of medical students' personal health care, characterise the results according to the demographics and career orientations of the students, and evaluate the relationship between the perceived quality of health care received and the degree of emphasis on prevention in the health care provided. Methods We carried out a cross-sectional study with 2316 medical students in the class of 2003 from 16 medical schools, surveyed at 3 points during their training. We used a self-administered questionnaire designed to assess personal health care and related variables in medical students. Results The majority (92%) reported receiving health care that was at least good, but only a minority (23%) said they received excellent health care. Half had a regular doctor. Health care quality was rated more highly at Year 1 orientation than at later timepoints by students who had a regular personal doctor, and especially by those with personal doctors who emphasised prevention. Conclusions The majority of medical students perceived that they had received health care that was good or better, but most did not believe it was excellent. As the provision of preventive care is important to students, increasing the amount of preventive care provided to students may both increase their personal satisfaction with their health care and model good clinical preventive practices for them. [ABSTRACT FROM AUTHOR]

Objective To ascertain any differences in knowledge and perceptions of generic medicines between senior (final year) medical students and pharmacy pre-registrants in Australia. Methods National web-based surveys containing 16 common questions were administered to each group. Responses were compared using Mann–Whitney U-test. Results Responses were received from 400 medical students (response rate 26.7%) and 289 pharmacy pre-registrants (response rate 30.5%). Both groups scored poorly on the allowable bioequivalence limits when comparing a brand-name medicine with a generic medicine, with pharmacy pre-registrants scoring better ( P < 0.001). Pharmacy pre-registrants were more likely ( P < 0.001) to report having been introduced to bioequivalence during their courses, and less likely ( P < 0.001) to desire more information on bioequivalence testing. Both groups correctly agreed that generic medicines are bioequivalent to corresponding brand-name medicines but not necessarily to each other, and that generic medicines are cheaper. Pharmacy pre-registrants were more aware that generic medicines must be in the same dosage form ( P < 0.001) and contain the same dose ( P < 0.001) as the comparator brand-name medicine. Both groups incorrectly believed that generic medicines are required to meet higher safety standards, are inferior in quality, are less effective and produce more side-effects. Both groups agreed that it is easier to recognise a drug's therapeutic class from its generic name and that they needed more information about the safety and efficacy of generic medicines, with medical students feeling more strongly about this ( P < 0.001). Conclusions Although there were some differences in responses, both groups had knowledge deficits about the quality, safety and effectiveness of generic medicines, which need to be addressed by educators in order to increase the future use of generic medicines in Australia. [ABSTRACT FROM AUTHOR]

Context There is considerable interest in the attributes other than cognitive ability that medical students need in order to be professionally successful, with a particular focus on empathy and emotional intelligence (EI). Selection considerations have also motivated interest in such attributes as predictors of academic success. There are reports of declines in empathy in US medical students, but no comparative information is available for UK students. Objectives This study aimed to compare empathy levels in medical students in Years 2, 3 (pre-clinical) and 5 (clinical), to examine gender differences in empathy and EI, and to investigate whether EI and empathy are related to academic success. Methods Questionnaires assessing EI and empathy were completed by students. Previous empathy scores for the Year 2 cohort were also available. Empathy trends were examined usinganova; trends for the Year 2 group for whom Year 1 scores were available were examined using repeated-measuresanova. Associations of EI and empathy with academic success were examined using Pearson correlation. Results A significant gender × cohort effect was found, with male empathy scores increasing between Years 1 and 2, whilst female scores declined. Peer ratings in Year 2 problem-based learning (PBL) groups were positively correlated with EI. Conclusions Trends in levels of empathy differed by gender. The reasons for this require further investigation, particularly in relation to course content. Associations between academic performance and EI were sparse, and there were none between academic performance and empathy, but the effects of EI (and other characteristics) on PBL group functioning represent a promising area for future study. [ABSTRACT FROM AUTHOR]

Objectives The effect of introducing professional skills training on students' patient-centred attitudes and perceptions of ability to communicate was examined. The professional skills training included weekly training in communication skills, ethics and law, and clinical skills. Methods Consecutive cohorts of medical students receiving a traditional pre-clinical curriculum ( n = 199) and a new curriculum including professional skills training ( n = 255) were compared. Students completed the Doctor−Patient Scale to assess patient-centred attitudes and an 11-item scale to assess confidence in their ability to communicate with patients. Students completed the measures at the start of Year 1 and the end of Year 2. Results Students receiving the professional skills training showed increased confidence in communicating with patients and increases in 2 dimensions of patient-centredness (‘holistic care’ and ‘patient decision making’). Students receiving the traditional curriculum showed increased nervousness in talking to patients. Gender and ethnic differences were found in patient-centredness and confidence in communicating, which were maintained over time. Conclusions The introduction of professional skills training was successful in improving students' confidence in their ability to perform specific communicative behaviours and increasing patient-centredness relative to a traditional curriculum. [ABSTRACT FROM AUTHOR]

Objectives To determine whether doctors in their first year after qualification wanted career advice, and, if so, whether they thought they had been able to obtain useful advice, and whether older doctors thought that adequate career advice had been available to them. Methods We carried out a postal questionnaire survey of all UK medical graduates of 1988, 1993, 1996, 1999 and 2002, and a 25% random sample of the graduates of 2000. Results The response rate was 67.4% (24 261/35 976 mailed questionnaires). Of doctors in the first postgraduate year, 95% agreed that: ‘It is important to be given career advice at this stage of training.’ A total of 38% disagreed with the statement: ‘I have been able to obtain useful career advice since graduation.’ Of more experienced doctors surveyed between 3 and 11 years after graduation, 34% agreed that: ‘Making career choices has been made more difficult by inadequate career advice.’ Conclusions The great majority of junior doctors want career advice after qualification. It cannot be assumed that they are able to seek it out for themselves satisfactorily. Career advice needs to be planned into postgraduate work and training. [ABSTRACT FROM AUTHOR]

Objective To explore junior medical students' notions of a ‘good doctor’, given their ideas about: success in Year 1, house jobs, and their attraction to medicine. Methods Study participants were junior medical students (1999 and 2001 entry cohorts studied thrice and twice, respectively) and prospective students of the University of Liverpool's 5-year, problem-based, community-orientated curriculum. Data collection and analysis used a ‘mixed methods’ approach, cross-sectional design, and brief questionnaire surveys. In an index survey, open questions (analysed inductively) explored house jobs and Year 1 success. They also generated ‘good doctor’ themes, which a second survey confirmed and 3 surveys ranked. A sixth survey explored motivation for choosing medicine (open question). Good doctor rankings were analysed by postcode for prospective medical students classified as school-leaver residents of England and Wales. Results Response rates were: 91.4% (973) of the 2001−02 admission candidates, on interview days; 68.0% (155), 61.2% (137) and 77.9% (159) of the 1999 cohort (at entry, end-Year 1 and mid-Year 3, respectively), and 71.0% (201) and 71.0% (198) of the 2001 cohort (at entry and end-Year 1, respectively). From 9 themes generally compatible with self-reported motivations and expectations, junior and prospective medical students consistently valued a good doctor as a ‘compassionate, patient-centred carer’ and a ‘listening, informative communicator’ over an ‘exemplary, responsible professional’. Prospective students from less affluent English and Welsh postcodes valued ‘efficient, organised self-manager’ very slightly more highly ( rs = − 0.140, P = 0.003). Conclusions This research provided empirical evidence to support ongoing commentary about patients mostly seeking qualities related to communication, caring, and competence in doctors. Weak evidence that socio-economic status might affect notions of a good doctor is worth pursuing. [ABSTRACT FROM AUTHOR]

Objective Recent UK policy has been to increase substantially the number of graduate entrants to medical schools. Our aim was to study whether graduate and non-graduate entrants have different long-term career preferences. Methods We conducted postal questionnaire surveys of medical qualifiers from all UK medical schools in 1999, 2000 and 2002, surveyed 1 year after qualification, and qualifiers of 1999 and 2000, surveyed 3 years after qualification. Results By Year 3 after qualification, general practice was the choice of 33% of men graduate entrants and 21% of men non-graduates ( = 12.5, P < 0.001) and of 43% of women graduates and 38% of women non-graduates ( = 1.6, P = 0.2). Surgery was a much less popular choice for men graduate entrants than for men non-graduates; but similar percentages of women graduate and non-graduate entrants chose surgery. A lower percentage of graduate entrants than of non-graduates favoured paediatrics. Other differences between graduates and non-graduates were generally small. General practice was the preferred career for a much lower percentage of those who took an intercalated degree while at medical school, than of those who did not. Conclusions Increasing graduate entry to medical school is likely to increase the percentage of doctors who want to become general practitioners, but only modestly so. It may also lead to a decline in the percentages choosing surgery and paediatrics. Otherwise, at least on the current criteria used for selecting students, increasing graduate entry will probably not make much difference to the percentage of newly qualified doctors seeking careers in different branches of practice. [ABSTRACT FROM AUTHOR]

Objectives To assess the effectiveness of a stress reduction elective on Year 2 medical students and to assess the sustainability of any noted improvement. Methods A new elective entitled ‘Mind−Body Medicine: an Experiential Elective’ was offered to Year 2 medical students. It was based on a course developed by the Center for Mind−Body Medicine. Enrolled students were surveyed on the first (time 1) and last (time 2) days of the elective and again 3 months later (time 3). Four validated self-report instruments were used to examine effects on anxiety, stress, mood states and depression. A comparison group of non-enrolled classmates completed the same instruments during the same timeframes. The study began in autumn 2004 and ended in June 2005. Results Participating students had higher initial anxiety scores than students in the comparison group. Anxiety in the study group declined significantly during the course, with enrolled students becoming indistinguishable from non-enrolled counterparts. These decreased anxiety levels were sustained for 3 months following the conclusion of the course. Conclusions This elective was successful in attracting students who were more anxious than their peers. Enrolees had higher baseline anxiety levels than their peers. The course decreased anxiety levels. The significant drop in anxiety scores of the study group suggests that this mind−body elective was an effective way to decrease anxiety in these pre-clinical medical students. Decreases in anxiety were sustained 3 months after the course ended, indicating that the benefits of the course may be longlasting. [ABSTRACT FROM AUTHOR]

Objective To compare Year 1 medical students' perceptions of their educational environment at the end of Year 1, with their expectations at the beginning of the year using the Dundee Ready Education Environment Measure (DREEM). Methods Year 1 students ( n = 130) at the University of East Anglia Medical School were asked to complete the DREEM during their induction week at the beginning of Year 1, thinking about the educational environment they expected to encounter (Expected DREEM), and again as part of a compulsory evaluation at the end of Year 1, thinking about the educational environment they had actually experienced (Actual DREEM). A total of 87 students (66.92% of the starting cohort) completed the DREEM on both occasions and gave permission for their data to be published. Results The Expected DREEM score was 153 out of a maximum of 200, and the Actual DREEM score was 143. Student's expected perceptions of learning and teachers, and their expected academic self- and social self-perceptions were all more positive than their actual perceptions. There was no difference between expected and actual perceptions of atmosphere. Specific aspects of the educational environment showing dissonance were identified. In some areas students' low expectations had been matched by their actual experience. Conclusions Medical students had started Year 1 with expectations about the educational environment that had not been met. However, areas showing dissonance received low item scores on the Actual DREEM and as such would be picked up for remediation, even without information about student expectations. [ABSTRACT FROM AUTHOR]