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PubMed1994

Resolving inconsistencies in tutor expertise research: does lack of structure cause students to seek tutor guidance?

PURPOSE: To investigate under what conditions tutors' subject-matter expertise influences student achievement. METHOD: Data were analyzed from 1,800 University of Limburg Faculty of Health Sciences students who in 1989-90 participated in tutorial groups led by content-expert staff tutors, non-expert staff tutors, or student tutors. Each student participated in an average of 4.1 tutorial groups. Overall, 4,111 data records were available for analysis. The basic analyses were of (1) students' achievement scores as a function of tutors' levels of subject-matter expertise and students' prior knowledge; (2) students' achievement scores as a function of tutors' levels of subject-matter expertise and educational units' levels of structure; and (3) differences in achievement between students guided by tutors of different levels of expertise in either high- or low-structure units. Statistical methods included analyses of variance. RESULTS: The level of subject-matter expertise of tutors had a positive influence on student achievement. Similar results were found for the students' prior knowledge and the levels of structure of the units; the more prior knowledge students had, the better were their performances on the end-of-unit test; and the higher the level of structure of the unit, the better the achievement. More important, interactions were found between tutor expertise on the one hand and prior knowledge and unit structure on the other, tutor expertise being mainly important if the unit was poorly structured or students reported lack of prior knowledge. CONCLUSION: The results suggest that students need a minimum level of structure in order to profit from problem-based instruction. This structure can be internally provided through prior knowledge available for understanding the new subjects, or offered by the environment in the form of cues of what is relevant and what should be the focus of the activities. If prior knowledge falls short, or if the environment lacks structure, students will turn to their tutors for help and direction. Under those conditions, students who are guided by a subject-matter expert tutor may benefit more than students guided by a non-expert staff tutor or by a student tutor. These findings may explain the widely divergent results of tutor-expertise research.

Achievement↗
PubMed1994

Obstetric patients who select and those who refuse medical students' participation in their care.

PURPOSE: To assess attitudes and expectations of obstetric patients toward the involvement of medical students in their care. METHOD: At the Medical Center Hospital of Vermont in 1991, questionnaire responses were collected from 222 obstetric patients who had been assisted by clerkship students from the University of Vermont College of Medicine and 78 patients who had refused the participation of students. The responses were analyzed for differences in demographic backgrounds, prior hospital experiences, and general expectations of student involvement, using chi-square, two-tailed t-tests and analysis of variance. RESULTS: Both groups of respondents consisted primarily of young, well-educated, married women, who appear to have made their decisions about student participation by balancing their personal needs and their sense of altruism. For example, 61% of those who had refused the participation of students ranked the desire for privacy as their primary reason, whereas 73% of those who had accepted student participation ranked as their primary reason the desire to contribute to a student's education. Although both groups of patients expected the students to perform few clinical procedures, the patients who had refused student participation expected the students to be more involved in patient care than did the patients who had allowed participation. Of the 25% of the patients who had had students involved in prior pregnancy care, those who had currently refused student participation had less positive views of prior student care. CONCLUSION: Patients' needs for privacy, past experiences with student care, and expectations of student performance should be considered to ensure the respectful incorporation of student involvement in obstetric care.

Altruism↗
PubMed2001

Assessing medical students' awareness of and sensitivity to diverse health beliefs using a standardized patient station.

PURPOSE: To assess students' performances on a health-beliefs communication OSCE station to determine whether there were differences in cultural competence based on the students' ethnic backgrounds. METHOD: A total of 71 students completed a health-beliefs communication OSCE station in which they were required to address the health beliefs and cultural concerns of a standardized patient (SP) portraying an African American woman with diabetes. The SPs rated students' performances on a ten-item interview assessment checklist. Scores on the station were standardized within SPs to adjust for differences in their use of the rating scale. A factor analysis was performed to determine conceptual constructs on the interview assessment checklist. Subscale means were computed for each student. T-tests of these subscale scores were conducted to investigate gender and ethnic differences between subgroups of students. The underrepresented minority (URM) students (five African Americans and three Mexican Americans) were compared with all other students, and the white students were compared with all others. To assess the magnitudes of the differences between subgroups, effect sizes (ES(m)) were computed for means comparisons. RESULTS: Factor analysis formed two factors: Disease Beliefs and Management, and Cultural Concerns. Two remaining items loaded on a third factor that had reliability too low to support further analysis. Meaningful differences were found in cultural sensitivity based on students' ethnic backgrounds. The URM students performed better than did all other students in addressing the patient's concerns about altering culturally-based dietary behaviors for diabetes self-care [URM students' mean standardized score (SD) = 0.42 (0.15); all others = -0.01 (0.67); ES(m) = 1.05]. White students performed better than did all other students in assessing the patient's concerns about using insulin to control her blood sugar levels [white students' mean standardized score (SD) = 0.13 (0.40); all others = -0.10 (0.64); ES(m) = 0.4]. CONCLUSION: Cultural competency deficits and differences were measurable using a health-beliefs communications station, and these differences were meaningful enough to warrant faculty discussion and research about how to ensure that students master this competency.

Cultural Diversity↗
PubMed2001

Evaluating the psychometric properties of a scale to measure medical students' career-related values.

PURPOSE: To develop and validate a survey instrument to measure medical students' career-related values. METHOD: A literature review yielded seven content domains that consistently correlated with medical students' career choices: biosocial orientation, bioscientific orientation, academic interest, prestige, income, desire to avoid role strain, and desire for role support. Item pools for the content domains were developed by examining previously published questionnaires and research and by interviewing health professionals, medical students, and premedical students. The instrument was tested in two phases. In phase 1, a 96-item questionnaire was mailed to all 847 students at the University of Minnesota School of Medicine. Results were submitted to item analysis and exploratory factor analysis. Construct validity of the questionnaire was assessed by (1) seeing if the seven scales correlated to one another in expected directions, (2) correlating students' survey responses with their self-reported interests in primary care, surgery, or radiology, and (3) seeing if anticipated sex differences were realized across the seven content domains. In phase 2, a random subgroup of 134 students was sent the final 46-item instrument twice to determine its short-term test-retest reliability. RESULTS: In phase 1, 670 students (79.2%) returned usable questionnaires. Seven scales corresponding to the content domains emerged from factor analyses. Cumulatively, they accounted for 43.9% of the variance in students' responses, and their internal consistency coefficients ranged from.71 to.87. All scales correlated with one another in the directions expected and, with two exceptions, at highly significant levels. High scores on bioscientific orientation, prestige, and income scales correlated positively with students' interest in surgery or radiology careers, but correlated negatively with their interest in primary care. High scores on biosocial orientation and avoid role strain scales correlated positively with students' interest in primary care, but correlated negatively with students' interest in surgery or radiology. Women had higher scores than did men on biosocial orientation, avoid role strain, and role support scales and lower scores on bioscientific orientation, academic interest, prestige, and income. Of these, all but the difference in role support scores were highly significant. In phase 2, 89 students (66%) returned questionnaires. Test-retest reliability for the seven scales ranged from.83 to.92. CONCLUSIONS: The seven scales pertaining to students' career-related values collectively demonstrated high internal consistency, short-term test-retest reliability, and evidence of construct validity. If predictive validity can be demonstrated in future research, the scales could have important applications for researchers, guidance counselors, and students, and they might also be useful to administrators who wish to identify students interested in primary care earlier in the students' training.

Adult↗
PubMed2002

Linking cultural competency and community service: a partnership between students, faculty, and the community.

OBJECTIVE: The purpose of the migrant health initiative is to give medical students the opportunity to provide clinical services, at appropriate levels of training, to a population that reflects a different ethnic and economic background than medical students typically see in the clinical setting. This initiative integrates concepts of cultural competency with experiential learning. DESCRIPTION: The migrant health initiative provides an infrastructure for a cultural competency educational program in the first two years of medical school within an essentials of clinical medicine course (ECM). The ECM course emphasizes the impacts of family, society, and community on the delivery of patient health care. Experience in the provision of clinical care to migrant workers provides an exceptional opportunity to expose students to a medically underserved, diverse group of people and to provide care to persons with a different language. The program was developed from grass-roots initiatives of students and the region's Area Health Education Center (AHEC). Historically, migrant workers provide the majority of the labor for harvesting onions in southeast Georgia. In April 2000, the regional AHEC organized a one-day clinic for migrant workers, staffed by one local physician and allied health students. Care was provided to over 400 laborers. As a result of the response by the migrant workforce, the AHEC developed a partnership with the local community to expand the health care services to this underserved group. Five medical students, working with the school's associate dean for curriculum and local AHEC, had observed a migrant health clinic organized by the AHEC and were seeking ongoing community service opportunities. Based on the interest and enthusiasm of the students, a faculty-supervised migrant health elective was developed for first- and second-year students. The number of students who wanted to take the elective exceeded the available opportunities. The ECM course will be enhanced with an integrated and longitudinal curriculum that focuses on migrant health care; the revised ECM course will provide students with the knowledge, skills, attitudes, and behaviors to care for individuals from different cultures. First-year students will be able to volunteer to work in the program. Second-year students will participate in at least one migrant health clinic, traveling only three hours but providing a different world with medical care. In addition, the opportunities for medical students to participate in a community health initiative and to work with nursing and allied health students will enhance their public health knowledge and their team and leadership skills. DISCUSSION: The partnership between students, faculty, and the community provides the mechanism to thoughtfully develop and integrate cultural issues and experiences into the curriculum. Students have recently received a Caring for Community five-year grant from the Association of American Medical Colleges. Program expansions will continue into the third-year medicine clerkship and include a senior elective. The program expansions will result in a migrant health initiative that will be coordinated; comprehensive; and expand student knowledge, skills, and experiences in cultural health care.

Community Health Services↗
PubMed2004

Medical students' exposure to pharmaceutical industry marketing: a survey at one U.S. medical school.

PURPOSE: While much is known about the interactions between the pharmaceutical industry and physicians, very little is known about pharmaceutical marketing directed toward medical students. This study sought to characterize the extent and forms of medical students' exposure to pharmaceutical industry marketing. METHOD: In 2001-02, an anonymous, 17-item questionnaire was distributed to 165 preclinical and 116 clinical students at the University of Minnesota Medical School-Twin Cities. The main outcome measures were the number and forms of exposures to pharmaceutical industry marketing reported by medical students and whether students had discussed these exposures with teachers or advisors. Preclinical and clinical students were compared using chi(2) analysis (p < .05). RESULTS: One hundred fourteen (69.1%) preclinical students and 107 (92.2%) clinical students responded. Nearly all students reported at least one exposure to pharmaceutical industry marketing. Seventy-six (71.7%) clinical students compared to 38 (33.3%) preclinical students recalled over 20 exposures (p < .005). Clinical students were more likely to have received a free meal (p < .01), textbook (p < .005), pocket text (p < .005), or trinket (p < .005) than were their preclinical colleagues. Most students (68.2%) had not discussed pharmaceutical marketing with an instructor or advisor; 59 (55.7%) clinical students as compared to 87 (80.6%) preclinical students recalled no such discussion (p < .005). CONCLUSION: Medical students have extensive exposure to pharmaceutical industry marketing during their early years of training. Given existing evidence that such exposure influences physicians' practice and prescribing patterns, the authors propose that medical school curricula include formal instruction to prepare students to critically assess these contacts.

Adult↗
PubMed2004

Effect of medical students' ethnicity on their attitudes towards consultation skills and final year examination performance.

AIM: The study had two aims. The first aim was to examine the relationship between final year medical students' ethnicity and their attitudes towards consultation skills. The second aim was to investigate the relationship between ethnicity and final year performance. METHOD: A cross-sectional study was undertaken of all final year medical students in 1995 and 1996, both before and after their attachment through the Department of General Practice at Monash University, Australia. A questionnaire was designed to assess students' attitudes (views of importance and confidence) towards consultation skills. Also, records of final year performance were obtained from the University. RESULTS: Five clusters of consultation skills were formed through factor analysis: communication skills, difficult consultations, traditional diagnostic methods, routine management and life threatening conditions. There were no significant differences in students' attitudes towards these consultation skills based on country of birth, language, or student status preattachment. The only significant postattachment difference was that students born in non-Western countries placed a significantly higher importance on communication skills and the traditional diagnostic method than students born in Western countries. There were significant differences in final year performance between students across all three parameters of ethnic diversity. Non-Western born students performed worse than Western born students. Students who preferred using a language other than English also performed worse than those students preferring English. International students performed worse than students with Australian citizenship or permanent residency., CONCLUSIONS: The only significant difference regarding attitudes to consultation skills was that non-Western born students placed significantly greater importance on communication skills and the traditional diagnostic method postattachment than Western born students. No significant differences were found in attitudes preattachment. There were significant differences in performance, with students of ethnic background performing consistently poorer in all the final year assessment parameters analysed.

Adult↗
PubMed2003

Student retention of course content is improved by collaborative-group testing.

We recently reported that collaborative testing (i.e., group test taking) increased student performance on quizzes. It is unknown, however, whether collaborative testing improves student retention of course content. Therefore, this study was designed to test the hypotheses that collaborative-group testing improves student retention of course content. To test this hypothesis, our undergraduate exercise physiology class of 38 students was randomly divided into two groups: group A (n = 19) and group B (n = 19). During exam 1, students from both groups answered questions in the traditional format as individuals. Immediately after completing the exam as individuals, students from group A answered a randomly selected subset of questions from exam 1 in groups of two (1 group had 3 students) to test the effectiveness of collaborative-group testing on test performance and level of student retention. On the next exam (exam 2, 4 wk later), students from both groups answered questions in the traditional format as individuals and responded to the same subset of questions from exam 1. The subset of questions was analyzed to determine the level of retention of the original test material. In addition, immediately after completing the exam as individuals, students from group B answered a randomly selected subset of questions from exam 2 in groups of two (1 group had 3 students). Finally, on the next exam (exam 3, 4 wk later), students from both groups answered questions in the traditional format as individuals and responded to the same subset of questions from exam 2. This protocol followed a randomized crossover design to control for time and order effects. Student retention of course content was reduced when students completed the original examinations individually. In sharp contrast, student retention was improved (P < 0.05) when students completed the original examinations in groups. Results suggest that collaborative testing is an effective strategy to enhance learning and increase student retention of course content.

Cooperative Behavior↗
PubMed2006

Survey on cellular phone usage on students in Thailand.

The number of cellular phone subscribers is increasing every year and there have been reports of health disorders related to the high-frequency radio waves. This paper considers the dependence of Thai university and high school students on cellular phones. A survey form (cellular phone dependence questionnaire: CPDQ) was distributed to 181 female and 177 male Thai university students and to 240 female and 140 male Thai high school students. The surveys were collected, Cronbach alpha coefficient was calculated, and a factor analysis was performed using the principal factor method and varimax rotation. The total scores were 16.54 to 20.04 and the Cronbach's alpha coefficients were 0.808 to 0.930. According to a factor analysis of 20 scored items, 4 factors were extracted for both male and female high school students, and the cumulative correlation coefficients of the male and female groups were 64.85% and 62.70%, respectively. Five factors were extracted for male university students and 6 factors were extracted for female university students, and the cumulative correlation coefficients were 58.08% and 57.91%, respectively. The W value results of the Shapiro-Wilk W-test for male university students, female university students, male high school students and female high school students were 0.969, 0.984, 0.964, and 0.913 respectively, thus verifying the normality of the score distributions. The total scores for the Thai university students were higher than the scores for the Thai high school students. The factor analysis of female high school students confirmed a large difference compared to male university students, male high school students, and Japanese female university students. (The Japanese students were surveyed in an earlier study by Toda et al.). Also, the CPDQ total score was high, which indicated a strong tendency toward dependence.

Adolescent↗
PubMed2002

Development of a Web-based question database for students' self-assessment.

OBJECTIVE: Computer-based testing (CBT) for the purpose of the national licensure examination has increased interest among medical students in this modality of testing. The advent of Web-based question-delivery systems for self-assessment and learning has made it possible for students to practice this technology and participate in self-directed learning. Test Pilot(TM) is a Web-based program that provides a fast and easy tool for the development and deployment of online testing. Our objectives for introducing the program were to (1) develop a large database of questions for students' practice and self-assessment; (2) include multimedia tools such as illustrations and short videos to enhance learning; (3) provide a feedback tool for clerkship and site directors regarding student performance; and (4) evaluate this tool in terms of students' frequency of use, students' satisfaction, and its potential effectiveness in enhancing learning. DESCRIPTION: The Obstetrics and Gynecology clerkship at the University of Michigan is held at four different sites. In the past, students have been provided with access to floppy disks that contain about 500 self-assessment questions. These questions have been reformatted, updated, and transferred to Test Pilot. Visual illustrations have been added to the questions along with more varied formats, including extended matching, fill-in, and essay questions. The questions are divided into ten-question quizzes. The students get immediate feedback after answering each question and a summary of performance at the end of each quiz. Security, access, and analysis are facilitated because the questions and responses are stored centrally. In addition, Test Pilot captures information regarding individual and collective students' performances. At the end of the rotation, students fill out a form evaluating the Test Pilot program and comparing it with the quiz disks. In addition, we are collecting data regarding the actual use of Test Pilot, which will be compared with the students' surveys and final exam scores. DISCUSSION: Test Pilot has many benefits, including access control, immediate feedback, automated scoring, interactive learning, and data analysis. The enhancement of material permitted by a Web-based system increases the depth and variety of the learning experience by adding perceptual dimensions. Test Pilot also provides the clerkship director with the capability to obtain improved measurements of student performance and captures the student's self-learning and testing process. It can potentially identify weaknesses or inconsistencies across the different sites and recognize students who may need additional help early in the rotation. Over a one-year period, most students have switched from the quiz disks to Test Pilot. The students reported satisfaction with the Web-based format and found it user friendly. They especially liked the immediate feedback. The students have requested more questions and multimedia options be added. We plan to continue the development and assessment of this learning tool.

Databases, Factual↗
PubMed2002

Medical students as health coaches.

OBJECTIVES: The purpose of this project was to teach students how to work effectively with patients in the area of health-behavior change. As part of the patient-doctor course, first-year medical students worked with diabetic patients who were selected by their primary physicians. In preparation for their patient interactions, students were taught basic communication concepts and the role of the relationship in improving patient outcomes, and continuity issues were addressed as students learned to collaboratively develop behavioral-change plans with their patients and then followed their patients' progress over the course of the year. DESCRIPTION: An educational research trial was conducted to compare the traditional community placement track (shadowing) with the health-coaches track. Students were randomly assigned to the two educational tracks. Health coaches were assigned in pairs to a family medicine patient with diabetes. Under supervision by the patient's medical provider, student pairs worked with the patient in an area of health-behavior change (i.e., weight loss, smoking cessation, exercise, or adherence to medication regimen). Students were required to have at least six patient contacts over the course of a year, consisting of at least three face-to-face visits and including one home visit. Didactic sessions with health coaches taught by either a behavioral consultant or health educator covered the basics of diabetes and behavior-change areas appropriate to respective patients. Students were also given reading assignments from communication and health-behavior change literature and handouts for patients. Behavior-change specialists were available as needed for consultation. In support of the health coaching process, students participated in eight small-group discussion sessions (eight students each) led by a behavioral change specialist. Small-group sessions lasted approximately 90 minutes each and contained didactic and experiential elements. Topics were: "Getting Started" (interviewing, the patient's story), "Fundamentals of a Home Visit," "Changing Behaviors" (stages of change, relapse prevention), "Home Visit Feedback" (report and reflections), "Challenging Patients to Change" (difficulties, challenging irrational ideas), "Giving Direct Guidance," "Non-verbal Skills," "Ending and Celebrating" (terminating the helping relationship). Evaluation methods included a pre- and post-physician belief scale completed by students, pre- and post-provider's evaluation of patient, and a patient-completed health behavior questionnaire. As available, patients' HbA1C levels were compared pre- and post-intervention. DISCUSSION: As expected, initially some health coach students complained about their perceived increased workloads compared with the workloads of students in the shadowing track. Some students also expressed reservations about their abilities to be effective with their patients, but these complaints diminished as students made contact with patients. For many, this opportunity to establish continuity relationships with patients helped students begin to understand difficulties inherent in effecting health-behavior change. Some students expressed appreciation for the opportunity to discuss their increased self-awareness about communication as well as relationship difficulties and strengths during the small-group sessions. Data analysis is under way. Lessons learned from this project influenced a major first-year curriculum revision the following year, resulting in increased emphasis on basic communication skills and the use of small groups to reach a variety of curricular objectives.

Communication↗
PubMed2002

Coverage and perceptions of Medical Sciences students towards hepatitis B virus vaccine in Sana'a City, Yemen.

OBJECTIVE: The present study was conducted to estimate vaccination coverage against hepatitis B virus and the perceptions of 1198 medical sciences students in Sana'a City, Yemen. METHODS: Only those who practice clinical training or are in contact with body fluids were included. The students were enrolled in the Faculty of Medicine and Health Sciences, Sana'a University, Republic of Yemen. Data was collected from 1999-2000. Arabic pre-tested questionnaire forms were completed by 840 students at a response rate of 70.6%. RESULTS: The study revealed a reported vaccination rate of 29.5%. The rate among Faculty of Medicine and Health Sciences students was 32.3%, whereas only 21.3% among the students of High Institute of Health Sciences. Students of dentistry attained the highest rate of vaccination (38.8%), while nursing students of the High Institute of Health Sciences achieved the lowest rate (17.1%). Rate of vaccination (46.6%) among female students was significantly higher than male students (22.3%) with a P- value of 0.0001. Medical assistants of the High Institute of Health Sciences scored the best (56%) in terms of knowledge, medical laboratory sciences students achieved the highest (43.6%) in attitude and dentistry students had the highest scores (35.5%) in practices. The mean knowledge of females and males was comparable, however, females achieved higher attitudes and practices. Final stage students attained better attitude scores than the pre-final and intermediate students. CONCLUSION: Vaccination coverage of medical sciences students in Sana'a City, Yemen is low. Knowledge of medical assistants is the best, attitude of medical laboratory sciences students and practices of dental students is the highest. Attitudes and practices of female students are better than that of males.

Health Knowledge, Attitudes, Practice↗
PubMedDate not supplied

Which patients are most challenging for second-year medical students?

BACKGROUND AND OBJECTIVES: Fostering appropriate attitudes toward patients begins with recognition of the physician's personal biases and preferences about patients. We sought to assist second-year medical students to identify those patient attributes that may influence their clinical behavior, especially in difficult patient encounters. This study's objectives were (1) to identify the principal patient characteristics reported by students to evoke negative or positive affective reactions sufficient to compromise the quality of patient care and (2) to examine differences between male and female students on these patient characteristics. METHODS: An anonymous survey was made of all second-year medical students attending a seminar on medical errors. Students recorded the three principal patient characteristics that might evoke in them a negative personal reaction sufficient to compromise the quality of clinical care. Students then recorded three principal patient characteristics that might evoke a positive reaction sufficient to compromise the quality of clinical care. The data were analyzed to identify the primary concerns of the entire group of students and any significant differences between male and female students. RESULTS: Information on negative attitudes was provided by 67 of 71 (94%) students and on positive attitudes by 70 of 71 (99%). Content analysis identified four general categories of patient characteristics associated with negative attitudes (patients who are rude, contributed to medical problem, are abusive to others, and other attributes). Five general categories (patients with whom students have personal connection or patients who have physical and/or social attractiveness, vulnerability, power/influence, and other) were associated with positive attitudes by the students. The leading patient attributes reported as likely to influence clinical behavior were the positive attributes of "personal connection" and "attractiveness." These were reported by 60% and 53% of the class, respectively, compared to the leading negative attributes of "rudeness" and "contributed to own condition," each reported by 51% of students. Significant differences between male and female students only occurred in the categories of "rude" and "attractive." CONCLUSIONS: Students are willing to disclose specific, personal attitudes toward patients that they perceive as sufficiently serious to influence the quality of clinical care. More than half of the students anticipated difficulty in providing optimal care to patients who exhibit certain characteristics. More students reported concerns about positive affective reactions to patients than about negative reactions. Medical education should address these issues in strategies to adequately prepare students for practice.

Attitude of Health Personnel↗
PubMed2005

[The international comparative study of the health status of medical university students in Lodz and Hanover].

During the academic year 2002/2003, we participated in a nation-wide research project aiming at the evaluation of the health status, lifestyle, social and material situation of medical university students. 285 surveys filled in by third-year students, including 167 Medical Faculty students, were subject to our analysis at the Medical University in Lodz. During the academic year 2003/2004, a similar research study was conducted among all third-year students of the Medical Faculty in Hanover. It was based on the translated questionnaire, which was adapted to the German realities. 281 surveys were qualified for further analysis. This paper presents selected elements of the health status of medical faculty students in both universities. They concern in particular the self-rated health status of students under study as well as the prevalence of certain disorders. Out of 167 medical faculty students in Lodz, 34 persons (20.4%) defined their health status as very good, 79 (47.3%) as good, 45 (27.0%) as average, and 8 persons (4.8%) thought it bad. Out of 281 medical faculty students in Hanover, 136 persons (48.4%) considered their health status to be very good, 129 (45.9%) good and 16 (5.7%) average. No student reported having a bad health status. The students from Lodz pointed out 991 disorders taking place during 4 weeks preceding the study (5.9 per student), whereas their German counterparts reported 2872 disorders (10.2 per student). The Lodz students cited most often: fatigue (83.8%), nervousness (73.1%), irritation (69.5%) and headaches (47.3%), while their Hanover colleagues suffered from fatigue (89.7%), headaches (80.4%), physical exhaustion in the evening (79.0%) and irritation (76.2%). 58.1% of the Lodz students never smoked, 12.6% smoked every day, and 9.6% smoked from time to time. 53.8% of the Hanover students never smoked, 14.6% smoked every day, and 20.6% smoked occasionally. Our anxiety was aroused by the reported frequent consumption of alcohol. Only 6.0% of the Lodz students did not drink at all, while it was 22.4% in Hanover. The share of everybody drinkers was similar in both samples (1.2% in Lodz, and 1.4% in Hanover). 32.9% of the Lodz students and 33.5% of this Hanover counterparts reported drinking alcohol at least once a week.

Adult↗
PubMed2006

An exploration of when urban background medical students become interested in rural practice.

INTRODUCTION: While it is well recognized that rural background medical students are more likely to enter rural practice than urban background, students' research shows that 34% to 67% of rural doctors have urban backgrounds. This article explores the factors influencing urban background medical students' interest in rural practice. METHOD: The study used a qualitative design employing focus groups and semi-structured interviews. Data were collected at three Australian universities and a national student rural health conference, and the participants were 82 first and final year medical students who participated in focus groups, and 49 who were interviewed individually. Data were analysed using the N6 computer package to manage the data. Forty-three urban background students indicated an interest in rural practice and the data presented in this article relate to this group of students. RESULTS: This article presents an analysis of data from one part of a larger project conducted from 2002 to 2004 investigating medical student career choice. The students' level of interest in rural practice depends on an interaction between student and location factors and other external influences with students seeking to match their needs and interests with locations. Some are 'predisposed' to develop interest in rural practice via their familiarity with rural areas, level of altruism, interest in generalist work, and interest in certain leisure activities. Exposure to rural locations provides knowledge about different places. Students recognize differences between rural locations in relation to the size of town and the remoteness of the town, and they seek specific rural locations which will match their values and interests. Existing social relationships can be enabling or limiting factors in the student's ability to follow through their interest in rural practice and to enter rural practice, and are important in the students finding a match between themselves and an appropriate location. CONCLUSIONS: Exposure of urban background students to rural practice and a range of rural locations generates an interest in rural practice among many urban background students. This exposure may increase the number of students who become interested in rural practice and decide to enter rural practice. Further quantitative research is required to test the findings from this exploratory qualitative study.

Adolescent↗
PubMed1998

The relationship between preceptor expectations and student performance on 2 pediatric objective structured clinical examination stations.

BACKGROUND: We designed 2 pediatric objective structured clinical examination stations, 1 anemia case associated with lead exposure and 1 failure-to-gain-weight case associated with extended breast-feeding, to evaluate third-year medical students who had studied in pediatric community preceptors' offices as part of a 12-week multidisciplinary ambulatory clerkship rotation. OBJECTIVE: To examine the relationship between preceptor expectations and student performance on these 2 objective structured clinical examination stations. METHODS: To elicit community preceptors' expectations of student performance, we constructed a 46-item survey replicating checklists filled out by simulated patients evaluating student performance on the objective structured clinical examination stations. The percentage agreement among preceptors for each checklist item as well as the percentage agreement between preceptor responses and student responses on each checklist item were calculated. A summary score of preceptor responses across all checklist items and a summary score for student responses across all checklist items on each station were calculated. The correlation coefficients between preceptor and student summary scores were then examined. RESULTS: Fifty-nine preceptor surveys were mailed and 38 were returned (64% response rate). Data were usable from 37 surveys. Eighty-nine percent (33 of 37)of the preceptors agreed that a third-year clerkship student should have the knowledge to care for the patient with anemia and 92% (34 of 37)of the preceptors agreed similarly for the growth-delay case. Agreement among preceptors on individual checklist items varied widely for both cases. Fifty-seven students studied at the anemia station and 34 students studied at the growth-delay station. The mean+/-SD agreement across the 26 items on the anemia case between preceptor responses and student responses was 62%+/-23% and, for the 21 items on the growth-delay case, 60%+/-17%. The mean+/-SD preceptor summary score for the anemia case was 17.4+/-3.8 (maximum, 26) and 16.0+/-3.6 (maximum, 21) for the growth-delay case. The mean student score on the anemia case was 15.5+/-3.7 (maximum, 26) and, for the growth-delay case, 10.0+/-4.5 (maximum, 21). The Pearson correlation coefficient between the preceptor and student scores on the anemia case was 0.19 (P=.15), and for the growth-delay case,-0.41 (P=.06). CONCLUSIONS: These data suggest community preceptors agree on topic areas in which students should be clinically competent. There was, however, considerable variation in agreement among preceptors about what preceptors believe students should be able to do and how the students actually perform. The overall percentage agreement between preceptor expectations and student performance appears to be no better than chance.

Attitude of Health Personnel↗
PubMed2004

Labor and delivery nurses: a survey of attitudes toward third-year medical students and their education.

OBJECTIVE: Forty-six percent of third-year medical students at the University of Alberta rated labor and delivery nurses as a negative influence on their obstetrics and gynecology rotation. We hypothesized that the nurses would have mostly negative opinions toward students and their education. STUDY DESIGN: Labor and delivery nurses were surveyed with regard to their views on the following: (1) student learning objectives, (2) factors causing a patient to reject or accept a student, and (3) the role of the nurse in medical student education. RESULTS: Eighty-nine nurses ranked student tasks (objectives) as very appropriate, appropriate, neutral, inappropriate, and very inappropriate. History and physical examination, witnessing deliveries, assisting at deliveries, and following up women in labor were rated very appropriate or appropriate by more than 96% of nurses; 85% approved of students doing supervised deliveries. Nursing staff were equally divided in approving or disapproving of pelvic exams in labour and outpatient assessment by students. Artificial rupture of membranes, fetal scalp electrode application, and episiotomy repair were not approved of by more than 70% of nurses. The most important factors causing a patient to reject or accept a student were felt to be bedside manner and previous experience with a student, with least important being attractiveness, gender, and the nurse's opinion. Eighty-seven percent of nurses declared that one of their roles is to help students gain experience, but 71% said they would protect women from students with whom they were not comfortable. CONCLUSION: Labor and delivery nurses generally have a more positive attitude toward students and their learning than review of evaluations by the students would suggest. However, nurses have reservations about students performing technical procedures in the labor and delivery room. Creation of guidelines (objectives) with nursing input and better briefing of students with regard to nursing expectations may improve the student's experience.

Alberta↗
PubMed2001

Effect of clinical teaching on student performance during a medicine clerkship.

PURPOSE: To measure what proportion of student clerkship performance can be attributed to teachers' educational skills as reported by students. SUBJECTS AND METHODS: From August 1992 to June 1994, we collected critiques of teacher skills from 314 third-year students at the end of a 12-week medicine clerkship. Interns, residents, attending physicians, and student preceptors were rated (on a 1 to 5 scale) on teaching behaviors from the 7 categories of the Stanford Faculty Development Program framework. A linear regression model was used to determine the relative contributions of the rated teaching behaviors in predicting final student performance and improvement across the clerkship ("student growth"), measured using end-of-clerkship variables (clinical grades, National Board of Medical Examiners medicine shelf examination, practical laboratory examination, and an analytical essay examination) and preclerkship variables (pre-third-year grade point average [GPA], United States Medical Licensing Examination, Step I, and clerkship pretest). RESULTS: Data were available for 293 (93%) of 314 students, who completed a total of 2,817 critiques. The students' preclerkship GPA accounted for the greatest percentage of variance in student performance (28%, P < 0.0001). Clinical teaching behaviors accounted for an additional 6% (P < 0.0001) of the variance. For student growth across the clerkship, teaching accounted for 10% of the variance (P < 0.0001). Among the 7 Stanford educational categories, teaching behaviors promoting control of session (r2 = 5%, P = 0.0002) and fostering understanding and retention (r2 = 4%, P = 0.001) had the greatest effect. The resident had the most effect on student growth (r2 = 6%, P = 0.0001) when compared with other teaching levels. Teaching had a greater effect on growth for students with preclerkship GPA above the mean (16% versus 6%), for older students (24% versus 7%), and for students with a nonscience undergraduate degree (33% versus 9%). CONCLUSION: The preclerkship GPA, reflecting 2 years of work, was the most important predictor of student performance. Teaching behavior, as measured by student assessments, also affected student performance.

Adult↗