Real engagement improving paramedic attitudes towards the elderly

by Linda Ross and Brett Williams

Clinical Teacher, February 2015.  Link to article here.

Background

Negative attitudes adversely impact on patient care and outcomes. Given the aging population in Australia, it is inevitable that paramedic attendance to this demographic of patients will also rise. It is therefore imperative that undergraduate paramedic attitudes towards elderly patients are investigated, along with pedagogical approaches to maintain or enhance them.

Methods

Eleven second-year paramedic students enrolled in Monash University’s Bachelor of Emergency Health (Paramedic) degree, came together with 11 independently living elderly residents from Patterson Lakes Village and participated in an engagement activity. The Aging Semantic Differential (ASD) survey and focus groups were used to analyse the students’ attitudes towards the elderly, before and after the activity.

Negative attitudes adversely impact on patient care and outcomes

Results

Students showed improved attitudes toward the elderly across two of the three ASD dimensions. Focus group discussions suggested that students found the elderly participants to be more independent and capable than they had first thought, but were unchanged on their attitude with regard to elderly people being inflexible.

Conclusion

Students were presented with an opportunity to actively engage with independently living elderly patients. This experience challenged their preconceived ideas about the elderly and their capabilities, and at a minimum increased awareness, which will assist future paramedics in their interactions and care of these patients.

Article first published online: 20 JAN 2015 | DOI: 10.1111/tct.12226

Discuss the article below!

Does a high ranking mean success in the Situational Judgement Test?

by Elizabeth Simon, Keith Walsh, Flora Paterson-Brown and David Cahill

Clinical Teacher, February 2015.  Link to article here.

Summary

Background and purpose
The selection of medical students to the foundation programme has undergone several changes since its introduction in 2005, with the latest being the introduction of the Situational Judgement Test (SJT) in 2013. The SJT, a 2–hour exam that uses a multiple-choice format to assess an individual’s judgement when presented with clinically related scenarios, now accounts for 50 per cent of the application process. The remaining 50 per cent is made up of the Educational Performance Measure (EPM) score, which includes the medical student’s performance at medical school, allocated by points attributed according to decile ranking. Coming out of its pilot year, there is little research into the results of the SJT. This project aims to discover whether there is a correlation between high-performing students who succeeded at medical school (i.e. by decile ranking) and those who scored high in the SJT.

This project aims to discover whether there is a correlation between high- performing students and those whoscored high in the SJT

Method
A survey was circulated to fifth-year medical students across the UK applying to the foundation programme in 2013, and who had sat the pilot year of the SJT. Students were asked to enter numerical values for their EPM and SJT scores.

Results
A total of 239 students from 12 UK medical schools responded to the questionnaire. In addition to their EPM, academic and SJT scores, all participants provided data on gender, duration of course (i.e. 4 or 5 years) and whether or not additional resources were used for the SJT. There was no correlation between the SJT and the academic scores (Spearman’s = 0.0458; probability of any relationship = 0.4865).
Article first published online: 20 JAN 2015 | DOI: 10.1111/tct.12239

Comment and discuss below!

Comparing general practice and hospital rotations

by Katrina Anderson, Emily Haesler, Alison Stubbs and Kate Molinari

From Clinical Teacher, February 2015.  Link to article here.

Summary
Background
The Prevocational General Practice Placement programme (PGPPP) aims to provide junior doctors with professional, well-supervised, educational rotations in general practice. There is a paucity of literature evaluating the educational effectiveness of the PGPPP. This study aims to compare general practice rotations with hospital rotations, with respect to teaching and support, acquisition of skills and knowledge, and role autonomy.

Methods
All junior doctors who participated in a PGPPP rotation were invited to complete a voluntary anonymous online survey using the Postgraduate Hospital Educational Environment Measure (PHEEM) inventory. The PHEEM presents Likert scales grouped into four subscales for participants to rate statements about their rotations. Surveys were completed at the end of the year in which doctors undertook a PGPPP rotation, and covered all rotations. These survey findings were used to compare general practice and hospital rotations.

The general practice rotation performed as well as, or better than, hospital rotations

Results
In all four subscales of teaching, clinical skills, social support and role autonomy, the general practice rotation performed as well as, or better than, hospital rotations in the areas of emergency, medicine, and surgery. General practice outperformed all other rotations in 15 out of 20 statements across all subscales.

Discussion
This study demonstrates the educational value of a general practice placement in comparison with hospital placements. Expansion of the PGPPP should be considered to provide all junior doctors with the benefits of exposure to generalist skills in the community.

Article first published online: 20 JAN 2015 | DOI: 10.1111/tct.12224

Comment and discuss below!

Departmental induction and the simulated surgical ward round

by Christopher Gee, Natasha Morrissey and Samantha Hook

Clinical Teacher Article in February, 2015.  Link to article here.

Background

Departmental induction for junior doctors is a very important part of the process of handover, so as to facilitate continuity of care and patient safety. Historically this is led by senior doctors within the department, and may not cover the topics that are most needed.

Context

An audit of induction of our junior doctors highlighted concerns, including inadequate training on surgical ward rounds and preparedness for their role. Consultant feedback suggested ward rounds were often of poor quality, causing delays, potentially affecting patient care and limiting the time for teaching.

Innovation

A new near-peer induction including simulated ward rounds was introduced. An updated written survival guide was also developed. The induction included a presentation of common cases. The simulated ward round included the use of a high-fidelity simulation suite to allow realistic scenarios. Results demonstrated an improvement in the perceived preparedness of junior doctors for their role within the department. Overall preparedness improved from 5.80/10 to 8.75/10 (0, not prepared at all; 10, fully prepared for all day-to-day tasks). Overall satisfaction at the end of the placement was high, with all juniors recommending the placement. Consultant feedback demonstrated an 83 per cent improvement in their ward rounds.

An audit of induction of junior doctors highlighted concerns

Implications

A near-peer departmental induction using simulated ward rounds may improve the preparedness of junior doctors for their role within a new department, potentially improving patient care and the junior doctors’ learning experiences.

Article first published online: 20 JAN 2015 | DOI: 10.1111/tct.12247

Comment and discuss below!

Ethnic and social disparities in performance on medical school selection criteria

By Karen M Stegers-Jager, Ewout W Steyerberg, Susanna M Lucieer and Axel P N Themmen

Link to article here

Context

Medical schools in Western societies seek measures to increase the diversity of their student bodies with respect to ethnicity and social background. Currently, little is known about the effects of different selection procedures on student diversity.

Objectives

This prospective cohort study aimed to determine performance differences between traditional and non-traditional (i.e. ethnic minority and first-generation university candidates) medical school applicants in academic and non-academic selection criteria.

Methods

Applicants in 2013 (n = 703) were assessed on academic and non-academic selection criteria. They also completed a questionnaire on ethnicity and social background. Main outcome measures were ‘not selected’ (i.e. failure on any criteria), ‘failure on academic criteria’ and ‘failure on non-academic criteria’. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by logistic regression analysis for ethnic subgroups (Surinamese/Antillean, Turkish/Moroccan/African, Asian, Western) compared with Dutch applicants, adjusted for age, gender, additional socio-demographic variables (first-generation immigrant, first-generation university applicant, first language, medical doctor as parent) and pre-university grade point average (pu-GPA). Similar analyses were performed for first-generation university applicants.

Results

Compared with Dutch applicants, Surinamese/Antillean applicants underperformed in the selection procedure (failure rate: 78% versus 57%; adjusted OR 2.52, 95% CI 1.07–5.94), in particular on academic criteria (failure rate: 66% versus 34%; adjusted OR 3.00, 95% CI 1.41–6.41). The higher failure rate of first-generation university applicants on academic criteria (50% versus 37%; unadjusted OR 1.66, 95% CI 1.18–2.33) was partly explained by additional socio-demographic variables and pu-GPA. The outcome measure ‘failure on non-academic criteria’ showed no significant differences among the ethnic or social subgroups.

Conclusions

The absence of differences on non-academic criteria was promising with reference to increasing social and ethnic diversity; however, the possibility that self-selection instigated by the selection procedure is stronger in applicants from non-traditional backgrounds cannot be ruled out. Further research should also focus on why cognitive tests might favour traditional applicants.

DOI: 10.1111/medu.12536

Bridging the gap: the roles of social capital and ethnicity in medical student achievement

By Suzanne Vaughan, Tom Sanders, Nick Crossley, Paul O’Neill and Val Wass

Link to article here.

Objectives

Within medical education, there is a discrepancy between the achievement level of White students and that of their ethnic minority peers. The processes underlying this disparity have not been adequately investigated or explained. This study utilises social network analysis to investigate the impact of relationships on medical student achievement by ethnicity, specifically by examining homophily (the tendency to interact with others in the same group) by ethnicity, age and role.

Methods

Data from a cross-sectional social network study conducted in one UK medical school are presented and are analysed alongside examination records obtained from the medical school. Participants were sampled across the four hospital placement sites; a total of 158 medical students in their clinical phase (Years 3 and 4) completed the survey. The research was designed and analysed using social capital theory.

Results

Although significant patterns of ethnic and religious homophily emerged, no link was found between these factors and achievement. Interacting with problem-based learning (PBL) group peers in study-related activities, and having seniors in a wider academic support network were directly linked to better achievement. Students in higher academic quartiles were more likely to be named by members of their PBL group in study activities and to name at least one tutor or clinician in their network. Students from lower-achieving groups were least likely to have the social capital enabling, and resulting from, interactions with members of more expert social groups.

Conclusions

Lower levels of the social capital that mediates interaction with peers, tutors and clinicians may be the cause of underperformance by ethnic minority students. Because of ethnic homophily, minority students may be cut off from potential and actual resources that facilitate learning and achievement.

DOI: 10.1111/medu.12597

 

The interaction of socio-economic status and gender in widening participation in medicine

By Barbara Griffin and Wendy Hu

Link to article here

Context

The lack of representation of people from low socio-economic and socio-educational backgrounds in the medical profession is of growing concern and yet research investigating the problem typically studies recruitment and selection in isolation. This study examines the impacts of home and school socio-economic status (SES) from application to selection in an undergraduate medical degree. Socio-cognitive career theory and stereotype bias are used to explain why those from backgrounds of low SES may be disadvantaged, especially if they are female.

Methods

Home and high school SES information for 2955 applicants and 202 medical students at one Australian medical school was related to application rates and performance on three selection tests (high school matriculation, the Undergraduate Medical and Health Sciences Admissions Test [UMAT] cognitive ability test, a multiple mini-interview) and academic performance in medical school. Interactions between gender and SES were assessed using moderated regression analyses.

Results

Applicants from backgrounds of low SES were under-represented. They were further disadvantaged at selection by the use of high school matriculation and cognitive ability tests, but not by the interview. They did not perform more poorly in medical school. Although females applied in greater numbers, a significant interaction between SES and gender indicated that female applicants of low SES were the most disadvantaged by the use of cognitive ability testing at selection. A targeted allowance of applicants from regions of low SES overcame this adverse impact to some extent.

Conclusions

Efforts to widen participation that focus on recruitment are insufficient when selection tests have adverse impacts on people from backgrounds of low SES. The addressing of low self-efficacy that arises from socio-cultural factors, together with reductions in stereotype threat, may reduce the current disadvantages imposed by SES in the medical profession

DOI: 10.1111/medu.12480

Textual analysis of internal medicine residency personal statements: themes and gender differences

By Nora Y Osman, Cheryl Schonhardt-Bailey, Jessica L Walling, Joel T Katz and Erik K Alexander

Link to article here

Context

Applicants to US residency training programmes are required to submit a personal statement, the content of which is flexible but often requires them to describe their career goals and aspirations. Despite their importance, no systematic research has explored common themes and gender differences inherent to these statements.

Objectives

This study was conducted to analyse US applicants’ Electronic Residency Application Service (ERAS) personal statements using two automated textual analysis programs, and to assess for common themes and gender-associated differences.

Methods

A retrospective cohort study of 2138 personal statements (containing 1 485 255 words) from candidates from 377 national and international medical schools applying to US internal medicine (IM) residency programmes through ERAS was conducted. A mathematical analysis of text segments using a recursive algorithm was performed; two different specifications of the text segments were used to conduct an internal validation.

Results

Five statistically significant thematic classes were identified through independent review by the researchers. These were best defined as referring to: the appeal of the residency programme; memorable patients; health care as public policy; research and academia, and family inspiration. Some themes were common to all applications. However, important gender-specific differences were identified. Notably, men were more likely to describe personal attributes and to self-promote, whereas women more frequently expressed the communicative and team-based aspects of doctoring. The results were externally validated using a second software program. Although these data comprise part of the national pool, they represent applicants to a single specialty at a single institution.

Conclusions

By applying textual analysis to material derived from a national cohort, we identified common narrative themes in the personal statements of future US physicians, noting differences between men and women. Together, these data provide novel insight into the dominant discourse of doctoring in this generation of students applying for further training in US IM residency programmes, and depict a diverse group of applicants with multiple motivations, desires and goals. Furthermore, differences seen between men and women add to the growing understanding of bias in medical education. Training programmes may benefit by adapting curricula to foster such diverse interests.

10.1111/medu.12487

Ensuring a fair and equitable selection of students to serve society’s health care needs

By Jorge A Girotti, Yoon Soo Park and Ara Tekian

Link to article here

Objectives

This study aimed to evaluate a selection and programmatic intervention designated ‘Conditional Admissions’ (CA), which is intended to expand access to medical education for individuals from under-represented ethnic, racial and rural groups. Further aims were to establish principles of practice designed to increase access for under-represented groups based on an empirical comparison of programmatic changes made to CA in 2005, and to quantify the costs associated with its implementation.

Methods

Data for all students admitted between 1999 and 2009 (n = 3227) were compiled; these included demographic data, undergraduate college performance grades, medical school performance indicators, and information on honours, residency placement and md degree completion. To examine the outcomes of the CA intervention, students were divided into two cohorts of those admitted through the CA initiative during 1999–2004 and 2005–2009, respectively, and analysed for differences. Costs associated with CA were also calculated.

Results

There were 274 students admitted through CA (8.5% of all admittances) during 1999–2009; of these, 81.4% were from under-represented ethnic or racial backgrounds and 18.6% were from rural backgrounds. These students had more hours of science coursework, lower science and cumulative grade point averages (GPAs), and lower mean Medical College Admission Test (MCAT) scores than non-CA students. However, first-time pass rates and mean scores on the US Medical Licensing Examination (USMLE) Step 1 and USMLE Step 2 Clinical Knowledge increased significantly in the CA cohort during 2005–2009. Additional costs incurred per student ranged between US$849 and US$3801.

Conclusions

Interventions such as CA can significantly increase diversity in the physician workforce. Interventions must be based on careful assessment of academic preparedness, as well as on non-academic factors that contribute to ability to successfully manage the rigors of medical education. Furthermore, the selection and subsequent professional development of students must nurture commitment to addressing the health care needs of diverse communities. Equity must be viewed as a means of increasing fairness for both prospective medical students and the residents of communities that may benefit from the eventual service.

DOI: 10.1111/medu.12506

Disadvantage and the ‘capacity to aspire’ to medical school

By Erica Southgate, Brian J Kelly and Ian M Symonds

Link to article here

Objectives

This study was designed to elucidate why students from backgrounds of lower socio-economic status (SES) and who may be first in their family (FIF) to enter university continue to be under-represented in medical schools.

Methods

Academically able high school students (n = 33) from a range of socio-economic backgrounds participated in focus groups. School careers advisors (n = 5) were interviewed. Students discussed their career and education plans and ideas about a medical career. Careers advisors discussed enablers and barriers to a medical career for their students.

Results

Students of lower SES and of FIF status attending schools situated in poorer geographic locations had limited access to suitable work experience and, despite their participation in gifted and talented classes, were considered to be at greater risk of not achieving the high level of academic achievement required for admission to medical school.

Conclusions

There is utility in exploring intersecting differences and Appardurai’s theory of the ‘capacity to aspire’ for the purpose of understanding the causes of the under-representation of disadvantaged students in medical schools. A focused materialist approach to building the aspirations of disadvantaged students, particularly those attending schools located in poorer areas, is required if effective pre-entry equity programmes are to be developed and evaluated. Alternatively, medical schools might rethink their reliance on very high academic attainment in the admission process.

DOI: 10.1111/medu.12540