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Summary: Background: Medical specialist workforces are not representative of the society they serve, partially due to loss of diversity in the path from student to specialist. We investigated which demographic characteristics of bachelor students of medicine (BSM) are associated with becoming a physician and (particular type of) medical specialist; and whether this suggests ‘cloning’ (reproduction of sameness) of the existing workforce. Methods: We used a retrospective cohort design, based on Statistics Netherlands data of all first-year BSM in 2002–2004 in The Netherlands (N = 4503). We used logistic regression to analyze the impact of sex, migration background, urbanity of residence, parental income and assets categories, and having healthcare professional parents, on being registered as physician or medical specialist in 2021. We compared our results to the national pool of physicians (N = 76,845) and medical specialists (N = 49,956) to identify cloning patterns based on Essed’s cultural cloning theory. Findings: Female students had higher odds of becoming a physician (OR 1.87 [1.53–2.28], p

Selection for higher education (HE) programs may hinder equal opportunities for applicants and thereby reduce student diversity and representativeness. However, variables which could play a role in inequality of opportunity are often studied separately from each other. Therefore, this retrospective cohort study conducts an innovative intersectional analysis of the inequality of opportunity in admissions to selective HE programs. Using a combination of multivariable logistic regression analyses and descriptive statistics, we aimed to investigate 1) the representativeness of student populations of selective HE programs, as compared to both the applicant pool and the demographics of the age cohort; 2) the demographic background variables which are associated with an applicant's odds of admission; and 3) the intersectional acceptance rates of applicants with all, some or none of the background characteristics positively associated with odds of admission. The study focused on all selective HE programs (n = 96) in The Netherlands in 2019 and 2020, using Studielink applicant data (N = 85,839) and Statistics Netherlands microdata of ten background characteristics. The results show that student diversity in selective HE programs is limited, partly due to the widespread inequality of opportunity in the selection procedures, and partly due to self-selection. Out of all ten variables, migration background was most often (negatively) associated with the odds of receiving an offer of admission. The intersectional analyses provide detailed insight into how (dis)advantage has different effects for different groups. We therefore recommend the implementation of equitable admissions procedures which take intersectionality into account.

Objectives Health professions education (HPE) students are often not representative of the populations they will serve. The underrepresentation of non-traditional students is problematic because diversity is essential for promoting excellence in health education and care. This study aimed to understand the perceptions of traditional and non-traditional students regarding facilitators and barriers in preparing for HPE selection procedures, and to determine the role of social networks in their decision-making and preparations to apply.Methods A qualitative study was conducted with 26 Dutch youth who were interested in university-level HPE programmes. Semistructured interviews and sociograms were analysed using thematic analysis, adopting a constructivist approach.Results Twenty-six high school students participated, with traditional and non-traditional backgrounds, with and without social networks in healthcare and higher education. Two themes were constructed. First, four high-impact facilitators helped to overcome barriers to apply and in preparation for selection: access to a social network connection working or studying in healthcare, to correct information, to healthcare experience and to a social network connection in higher education. Lack of information was the main barrier while access to social network connections in healthcare was the main facilitator to overcome this barrier. However, this access was unevenly distributed. Second, access alone is not enough: the need for agency to make use of available facilitators is also essential.Conclusions The themes are discussed using intersectionality. Traditional students with access to facilitators develop their self-efficacy and agency within social structures that privilege them, whereas non-traditional students must develop those skills without such structures. Our findings provide recommendations for the ways in which universities can remove barriers that cause unequal opportunities to prepare for the selection of HPE programmes. Along with equitable admissions, these recommendations can help to achieve a more representative student population and subsequently a better quality of health education and care.

Abstract Background To be in alignment with the increasing diversity in the patient population, ethnic minorities should have appropriate representation in health care professions. Medical students from ethnic minorities therefore need to be successful in their medical studies. The current literature highlights that they underperform in comparison with the ethnic majority. The aim of the present study is to gain insight into what medical students from ethnic minorities experience during their education and what they need to become or stay motivated and to perform to their full potential. Methods Medical students from ethnic minorities from year 1 to 6, enrolled at Amsterdam UMC, Faculty of Medicine, Vrije Universiteit, the Netherlands, were invited via email to participate in this study. Semi-structured interviews were conducted, using an interview guide, from August–October 2018. A constructivist paradigm was adopted. Results Eighteen medical students from ethnic minorities (three from year 1, three from year 2, one from 3, four from year 4, two from year 5, and three from year 6) participated in this study. Students’ negative experiences could be categorized as follows: (1) the effect of discrimination (2) lack of representation of ethnic minority role models, (3) lack of a sense of belonging, (4) lack of a medical network, (5) differences and difficulties in cultural communication and language, and (6) examiner bias in clinical assessments. Examples of support tips relating to these experiences are: increasing awareness about diversity and other religions, providing support groups, having visible ethnic minority role models, and facilitating support in networking. Conclusions Findings of this study suggest that medical students from ethnic minorities have negative experiences that influence their education. Supporting these students is essential for creating a good and safe educational and practical environment for ethnic minority students.

Abstract Background Continuing professional development and lifelong learning are crucial to secure safe and good quality healthcare. Lack of motivation has been found to be among the most important barriers for participation in lifelong learning. This study was conducted to investigate the relationships between medical specialists’ work motivation, lifelong learning motivation, autonomy, competence and relatedness satisfaction. Methods Self-Determination Theory was used as a theoretical framework for this study. Data were collected through an online survey, that was sent to all (N = 1591) medical specialists in four Dutch hospitals. The survey measured background characteristics, autonomy, competence, and relatedness satisfaction, autonomous and controlled work motivation, and lifelong learning motivation. Two step factor path analysis with the method of Croon was used to analyze the data from 193 cases. Results Autonomy need satisfaction was positively associated with autonomous work motivation which in turn was positively associated with lifelong learning motivation. Competence need satisfaction and age were negatively associated with controlled work motivation. Competence need satisfaction was also positively related with lifelong learning motivation. No significant nor any hypothesized associations were found for relatedness. Conclusions Our findings, in line with Self-determination Theory literature, show that autonomy and competence need satisfaction are the important factors as they were positively associated with medical specialists’ motivation for work and for lifelong learning.

Abstract Background Evidence for the effectiveness of the selection of medical students is weak. This study aimed to examine the added value of a two-step selection procedure (first step non-academic, second step academic tests) to a pre-university GPA-based lottery procedure. Because previous research has suggested that participation in selection (regardless of the outcome) is a predictor of study success, this study is the first to include students who initially applied for selection, then refrained from (actively) participating in selection and were eventually admitted through lottery. Methods Bachelor completion and dropout rates of selected (n = 416) and lottery-admitted students from four cohorts (2006–2009) were compared using logistic regression analysis. Four groups of lottery-admitted students were distinguished: students who were rejected after step 2 (n = 57), were rejected after step 1 (n = 169), withdrew during selection step 1 (n = 42) and students who only applied for lottery (n = 366). Covariates included gender, age, pre-university GPA and cohort. Results There was a significant association between admission group and obtaining a bachelor degree in three years. Selected students were more likely to obtain a bachelor degree within three years (64.2% versus 51.6%; OR = 1.7) or four years (81.5% versus 74.3%; OR = 1.6) than students who only applied to a lottery (p

Special efforts in rotations are necessary to have students from different professions learn with, from and about each other to improve their collaboration and the quality of care. The twelve tips derived from the lived experiences and research from the authors, are intended to stimulate motivation for interprofessional education in students and their supervisors. Internalization of the value students place on interprofessional learning will improve their readiness for future interprofessional collaboration. While creating an autonomy-supportive learning environment, supervisors are capable of both scaffolding the learning of students from all professions, and learning themselves from these authentic situations. The authors promote a central place for the clinical reasoning of each profession in both the profession specific skills as well as in the communication, collaboration and team skills, thus enhancing the 'T shaped-professional' (Visser, 2018).

Purpose: Interprofessional education (IPE) on a ward supports students to generate interprofessional patient care plans as a means to learn about the roles, responsibilities, and clinical reasoning of other professions. We investigated how clinicians guide the clinical reasoning of students from their own and other professions and whether clinicians from nursing, midwifery, and medicine could scaffold students from all professions, that is, by providing just-in-time and tailored support. Methods: Nine supervising clinicians from medicine, nursing, and midwifery were interviewed and a repeat interview held 3 to 15 weeks later; one nurse supervisor was interviewed only once. Using conventional content analysis, themes were identified inductively. Next, we applied an existing scaffolding framework to conceptualise how clinicians supported the clinical reasoning in an IPE setting. Results: Themes were clinicians’ interventions and intentions, results of interventions and of IPE, characteristics of students and clinicians, interactions between clinicians and students, and logistics. Clinicians applied various interventions and expressed several intentions to guide the learning of students from all professions. Clinicians stimulated students’ clinical reasoning by structuring meetings, asking students to explain their thoughts to each other and through giving group assignments. Thus, clinicians used peer-assisted learning for the students. By collaborating with other supervising clinicians regarding the form and amount of guidance to give to the students, clinicians applied peer-assisted learning for themselves as well. Conclusion: Clinicians can learn to scaffold the clinical reasoning of students from different professions, when they are provided with training, good examples, and structures. An existing scaffolding framework can serve as an overview of aims and interventions to provide just-in-time guidance to students from all professions. The scaffolding framework is useful for training clinicians and for depicting the pedagogical approach for IPE wards.

Abstract Background The objective of this study was to determine the optimal positioning of the research internship, either before clinical clerkships, at the beginning of the medical Master’s programme, or at the end. Methods A mixed methods study was carried out. We compared characteristics such as duration, location and grades for internships performed and students’ motives for choosing to perform their research internship before or after clinical clerkships. We analysed students’ answers to open-ended questions about the reasons for their choices, using the Self-Determination Theory of motivation. Results Students performing their research internship before clinical clerkships (n = 338) opted more often for an extended internship (OR = 3.16, 95% CI = 2.32–4.31) and an international location (OR = 2.22, 95% CI = 1.46–3.36) compared to those performing their research internships after clinical clerkships (n = 459). Neither the internship grades nor the number of international publications differed significantly between the two groups. Most of the students’ motives (102 participants) were classified as extrinsic motivation for research. Students performing research before clinical clerkships more often showed intrinsic motivation for research, students performing research after clinical clerkships were mainly motivated by their career choice. Conclusion To accommodate both groups of students, offering research internships before and after clinical clerkships, is recommended.

Abstract Background The Readiness for Interprofessional Learning Scale is among the first scales developed for measurement of attitude towards interprofessional learning (IPL). However, the conceptual framework of the RIPLS still lacks clarity. We investigated the association of the RIPLS with professional identity, empathy and motivation, with the intention of relating RIPLS to other well-known concepts in healthcare education, in an attempt to clarify the concept of readiness. Methods Readiness for interprofessional learning, professional identity development, empathy and motivation of students for medical school, were measured in all 6 years of the medical curriculum. The association of professional identity development, empathy and motivation with readiness was analyzed using linear regression. Results Empathy and motivation significantly explained the variance in RIPLS subscale Teamwork & Collaboration. Gender and belonging to the first study year had a unique positive contribution in explaining the variance of the RIPLS subscales Positive and Negative Professional Identity, whereas motivation had no contribution. More compassionate care, as an affective component of empathy, seemed to diminish readiness for IPL. Professional Identity, measured as affirmation or denial of the identification with a professional group, had no contribution in the explanation of the variance in readiness. Conclusions The RIPLS is a suboptimal instrument, which does not clarify the ‘what’ and ‘how’ of IPL in a curriculum. This study suggests that students’ readiness for IPE may benefit from a combination with the cognitive component of empathy (‘Perspective taking’) and elements in the curriculum that promote autonomous motivation.

Abstract Background Medical students from ethnic minorities underperform in knowledge and skills assessments both in pre-clinical and clinical education compared to the ethnic majority group. Motivation, which influences learning and academic performance of medical students, might play an important role in explaining these differences, but is under-investigated. This study aimed to compare two types of motivation (autonomous and controlled) of ethnic minority (Western and non-Western) and majority (Dutch) students, and their association with academic performance. Methods In a cross-sectional study, all students of a Dutch medical school were invited to complete a survey including the Academic Self-Regulation Questionnaire, measuring autonomous and controlled motivation, in the academic year 2015–2016. Motivation was compared using Kruskal-Wallis test and performance was compared using One-Way ANOVA. Linear regression analysis was used to determine the association between motivation and performance (grade point average; GPA). Results The response rate was 38.6% (n = 947). Autonomous motivation (AM) of non-Western students was higher than that of Dutch students in pre-clinical and clinical education (p

Abstract Background Developing professionalism is a core task in medical education. Unfortunately, it has remained difficult for educators to identify medical students’ unprofessionalism, because, among other reasons, there are no commonly adopted descriptors that can be used to document students’ unprofessional behaviour. This study aimed to generate an overview of descriptors for unprofessional behaviour based on research evidence of real-life unprofessional behaviours of medical students. Methods A systematic review was conducted searching PubMed, Ebsco/ERIC, Ebsco/PsycINFO and Embase.com from inception to 2016. Articles were reviewed for admitted or witnessed unprofessional behaviours of undergraduate medical students. Results The search yielded 11,963 different studies, 46 met all inclusion criteria. We found 205 different descriptions of unprofessional behaviours, which were coded into 30 different descriptors, and subsequently classified in four behavioural themes: failure to engage, dishonest behaviour, disrespectful behaviour, and poor self-awareness. Conclusions This overview provides a common language to describe medical students’ unprofessional behaviour. The framework of descriptors is proposed as a tool for educators to denominate students’ unprofessional behaviours. The found behaviours can have various causes, which should be explored in a discussion with the student about personal, interpersonal and/or institutional circumstances in which the behaviour occurred. Explicitly denominating unprofessional behaviour serves two goals: [i] creating a culture in which unprofessional behaviour is acknowledged, [ii] targeting students who need extra guidance. Both are important to avoid unprofessional behaviour among future doctors.

Abstract Background To identify facilitators and barriers that residents, medical and nursing students perceive in their Interprofessional Education (IPE) in a clinical setting with other healthcare students. Methods A systematic review was carried out to identify the perceptions of medical students, residents and nursing students regarding IPE in a clinical setting. PubMed, CINAHL, ERIC and PsycInfo were searched, using keywords and MeSH terms from each database’s inception published prior to June 2014. Interprofessional education involving nursing and medical students and/or residents in IPE were selected by the first author. Two authors independently assessed studies for inclusion or exclusion and extracted the data. Results Sixty-five eligible papers (27 quantitative, 16 qualitative and 22 mixed methods) were identified and synthesized using narrative synthesis. Perceptions and attitudes of residents and students could be categorized into ‘Readiness for IPE’, ‘Barriers to IPE’ and ‘Facilitators of IPE’. Within each category they work at three levels: individual, process/curricular and cultural/organizational. Readiness for IPE at individual level is higher in females, irrespective of prior healthcare experience. At process level readiness for IPE fluctuates during medical school, at cultural level collaboration is jeopardized when groups interact poorly. Examples of IPE-barriers are at individual level feeling intimidated by doctors, at process level lack of formal assessment and at cultural level exclusion of medical students from interaction by nurses. Examples of IPE-facilitators are at individual level affective crises and patient care crises situations that create feelings of urgency, at process level small group learning activities in an authentic context and at cultural level getting acquainted informally. These results are related to a model for learning and teaching, to illustrate the implications for the design of IPE. Conclusions Most of the uncovered barriers are at the cultural level and most of the facilitators are at the process level. Factors at the individual level need more research.

An amendment to this paper has been published and can be accessed via the original article.

Concerns related to fairness of medical school admissions through selection have led some scholars to consider selection as an expensive lottery and suggest that lottery may be fairer. This paper considers the issue of selection versus lottery from the perspectives of three groups of stakeholders: 1) applicants, 2) medical schools, and 3) society. This paper contributes to the discussion by addressing advantages and disadvantages of the use of selection and lottery for these stakeholder groups, grounded in the findings from research. Themes that are discussed are reliability and validity issues, perceived influence on selection outcomes and student uptake, effects on student diversity, financial costs, impact on rejected applicants, transparency, and strategic behaviour. For each stakeholder group both lottery and selection yield a combination of advantages and disadvantages, which implies that none of the currently available admissions strategies completely fulfils stakeholders’ needs. Research indicates that selection yields only small gains compared to a lottery procedure, while the student diversity, necessary for serving the increasingly diverse patient population, may be compromised. We argue that society’s needs should drive admissions policies rather than institutional gains, which means that until a selection procedure is developed that does not disadvantage certain types of students, a lottery procedure should be preferred.

The aim of this study to create a comprehensive overview of factors that may influence motivation of ethnic minority students from their own perspective. A systematic review was conducted in PubMed, ERIC, and PsycINFO to find studies in which the motivation of ethnic minority students was studied. The articles reviewed were qualitatively synthesized by means of meta-ethnography, and were subjected to a quantitative meta-analysis where appropriate. Forty-five articles were included. Several factors were found to have either a positive or a negative influence on academic motivation, which can be classified into individual, family-related, school-related, and social factors. These factors should be taken into account when developing interventions aimed at enhancing motivation, which is expected to improve. However, evidence for the influence of most identified factors is weak, given that almost every factor was investigated in a single study only. Based on the outcomes of the current overview an integrative model, that provides a structure of the identified factors in relation to motivation which can be used for interventions, cannot be generated; thus, further research is needed.

Background: Medical students often study only to fare well in their examinations or pursue a specific specialty, or study only those topics that they perceive to be useful in medical practice. The motivation for study in these cases comes from external or internal pressures or from the desire to obtain rewards. Self-determination theory (SDT) classifies this type of motivation as controlled motivation and the type of motivation that comes from genuine interest or personal value as autonomous motivation. Autonomous motivation, in comparison with controlled motivation, has been associated with better learning, academic success, and less exhaustion. SDT endorses autonomous motivation and suggests that autonomy support is important for autonomous motivation. The meaning of autonomy is misinterpreted by many. This article tries to focus on how to be autonomy-supportive in medical education. Discussion: Autonomy support refers to the perception of choice in learning. Some of the ways of supporting autonomy in medical education are small group teaching, problem-based learning, and gradual increase in responsibility of patients. Autonomy-supportive teaching behavior is not a trait and can be learned. Autonomy support in medical education is not limited to bringing in changes in the medical curriculum for students; it is about an overall change in the way of thinking and working in medical schools that foster autonomy among those involved in education. Research into autonomy in medical education is limited. Some topics that need to be investigated are the ideas and perceptions of students and teachers about autonomy in learning. Conclusion: Autonomy support in medical education can enhance autonomous motivation of students for medical study and practice and make them autonomy-supportive in their future medical practice and teaching.

Abstract This Critical Synthesis Package contains: (1) a Critical Analysis of the psychometric properties and the application to health science education of the Schwartz Value Survey (SVS), and (2) copies of the SVS instrument and scoring key developed by Shalom H. Schwartz, PhD. SVS is a self-report questionnaire developed for assessing individual differences in values, with values being defined as desirable, trans-situational goals, varying in importance, that serve as guiding principles in people's lives. SVS has 57 items grouped into 11 subscales: Conformity, Tradition, Benevolence, Universalism, Self-Direction, Stimulation, Hedonism, Achievement, Power, Security, and Spirituality. A responder indicates how important each value is for him/her as a guiding principle in his/her life on a 9-point Likert-type scale (−1 = opposed to my values, 7 = of extreme importance). The survey appears to have moderate reliability and good construct, content, and concurrent validity. It has also been validated across 47 languages. Although the survey has been used in health professions, it has been used less frequently in health professions education. In this context the survey offers several potential uses for researchers and educators, as measuring the values of health professions students could provide valuable information to advisors on how to guide their students towards the development of the appropriate attitudes and behaviors.