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PubMed2006

Performance of academically at-risk medical students in a problem-based learning programme: a preliminary report.

INTRODUCTION: Racially segregated schooling, a legacy of Apartheid policies, continues to hamper education in South Africa. Students entering university from suboptimal circumstances are at significant risk of demonstrating poor academic performance and dropping out of their programmes. Attempts to address the educational needs of these students have included the introduction of extended medical programmes at several universities. Such a programme, the Academic Development Programme (ADP), was implemented at the University of Cape Town in 1991. Over the past decade the programme has graduated more than 100 students. Upon implementation of a new problem-based learning (PBL) programme in 2002, the ADP was discontinued and all students were entered directly into the new PBL programme. Students who demonstrate a need for additional academic support by the end of the first semester enter the Intervention Programme for 1 year before proceeding to the second semester of the PBL programme. An interim analysis was performed to compare the retention rates and academic performance of academically at-risk students in the new PBL programme and the ADP. METHODS: The records of all academically at-risk students entering the ADP (1991-2000) and the new PBL programme (2002) were reviewed. Retention rates for all years of study, and academic performance in the fourth year clerkship courses of the respective programmes were compared. RESULTS: A total of 239 academically at-risk students in the ADP and 43 at-risk students in the new PBL programme were studied. The median retention rates, per year of study, for at-risk students in the PBL programme was significantly better than for at-risk students in the ADP (p<0.02). Academic performance of the at-risk students in all the fourth year clinical clerkship courses of the PBL programme was significantly better than the mean performance over 10 years for at-risk students in the same fourth year courses in the ADP. CONCLUSION: The introduction of PBL at the University of Cape Town has not had a deleterious effect on the performance of academically at-risk medical students. Interim analysis suggests that retention rates and academic performance in the PBL programme are better than those achieved in the extended traditional programme.

Black People↗
PubMed2006

Spirituality and clinical care: exploring developmental changes in nursing and medical students.

OBJECTIVE: This study identifies and assesses changes in spiritual experiences and the perceived importance of spiritual issues in nursing and medical students participating in a Spirituality and Clinical Care course. Students participated in the study by completing two survey instruments: the Spiritual Experience Index-Revised (SEI-R) and the Spiritual Importance (SI) scales. Differences from pretest to posttest by sex and by discipline (medicine vs nursing) and changes in spiritual maturity are assessed and analyzed. RESULTS: Data analyses explored discipline differences, sex differences, and changes in levels of spiritual maturity one year after the two-week course. Students (N = 416) participating in the course reflected a significant increase in perceived importance of spirituality in practice, with females of both disciplines showing greater increases than males, and students in nursing showing greater increases than students in medicine. Female students were more trusting than male students in spiritual measures for support. An interesting finding revealed that both male and female students evidenced reduced dogmatic perceptions over time, with medical students declining more sharply than nursing students. Finally, changes in the levels of spiritual maturity of the students were measured. Students in contrasting developmental groups (n = 127) regressed over time to more dogmatic and underdeveloped levels of spiritual maturity. CONCLUSIONS: Maintenance or advancement of spiritual development was the expected outcome as students began to develop the art of their practice. It was unexpected that students would regress to a more dogmatic or underdeveloped spiritual level. Several explanations for these findings are explored.

Adult↗
PubMed2002

A comparative investigation of dental and medical student's motivation towards career choice.

OBJECTIVE: A number of recent studies have investigated the motivations underlying the career choice of dental and medical students, suggesting that they may be very different. However, as yet, no studies have been conducted which provide a direct comparison of dental and medical students studying in the same place. Accordingly, the aim of this investigation was to conduct a survey which directly compared the motivation of a selection of dental and medical students at Manchester University. STUDY DESIGN: A questionnaire was developed for this study on the basis of previous surveys investigating the motivations of dental and medical students towards career choice. Six dimensions were covered in the questionnaire including: status and security; the nature of the occupation; career opportunities; patient care and working with people; use of personal skills; and interest in science. In addition, students were asked about the role of work experience in either dentistry or medicine. The questionnaire was distributed to 80 medical students and 80 dental students chosen from a random selection of lecture slots. RESULTS: The results were analysed using the Mann-Whitney U test. Statistically significant differences were revealed in all six areas of career choice motivation. For instance, dental students were significantly more likely to be motivated by factors relating to status and security and the nature of their occupation (eg regular working hours, self employment and independence). By contrast, medical students were significantly more likely to be motivated by factors relating to career opportunities, patient care and working with people, use of personal skills, and interest in science. Work experience was a strong motivating factor in the case of both dental and medical students (though especially for dental students). CONCLUSIONS: In comparison with dental students, medical students manifested a more professional attitude in which altruism and intellectual challenge constituted central motivating factors. By contrast, dental students demonstrated more of a commitment to personal and financial gain. The paper queries how useful such attitudes are to a re-oriented dental profession whose aspiration is to provide more accountable and community oriented services.

Attitude of Health Personnel↗
PubMed2006

Medical and nursing students crying in hospital settings.

Crying may be described as a loss of control, the result of feelings of helplessness and inadequacy, or a sign of suffering. It may occur in a variety of situations, such as unhappiness, sadness, illness, death, anxiety, pain, or failure, but it can also arise from joy and fulfillment. Crying is frequently observed in hospitals. The aim of this study was to determine the crying patterns of undergraduate medical and nursing students. The study design included non-experimental, descriptive research using a self-report questionnaire. Of the 130 students who completed the questionnaire, 90 were medical students and 40 were nursing students. Seventy-nine of the students were women, and 51 were men. All of the students were in their last semester of study. Many of the medical and nursing students reported having cried in a hospital. Of students who had cried, 90% were women, and 10% were men. Medical students usually cried outside the hospital setting, whereas nursing students usually cried in the nurses' room. Personal problems faced by students during their education were the primary reason for crying. Although more than half of the students felt relaxed after crying, only the nursing students sought comfort from the people around them. These findings should be useful in the development and continuous improvement of the curricula of medical and nursing students.

Adaptation, Psychological↗
PubMed2003

Attitudes towards science and alternative medicine of medical, economics and business, and electrical engineering students in Split, Croatia.

AIM: To assess attitudes of students at the Split University Schools of Medicine, Economics and Business, and Electrical Engineering towards science and alternative medicine. METHODS: There were 275 respondents surveyed for their opinion on science and different aspects of alternative medicine. The respondents were grouped into three major groups: medical students (83 or 30%), economics and business students (95 or 35%), and electrical engineering students (97 or 35%). Each group was composed of two subgroups: first and final year students. We used a specially designed questionnaire composed of four parts to collect students' demographic data and investigate their scientific experience and attitudes towards science and alternative medicine. ANOVA was used to test the differences among the three major groups of students and between first and final year students within each group. RESULTS: There was no significant difference among the first year students at three different schools in their scores on attitude towards science (ANOVA; F=0.001, p=0.99) and the attitude towards alternative medicine (F=2.61, p=0.08). However, there was a significant difference among the final year students at the three schools, with medical students being the most positive in their score on the attitude towards science (F=7.30, p=0.001) and least positive in their score on the attitude towards alternative medicine (F=30.7, p<0.001). There was a negative correlation between attitudes towards science and alternative medicine (r=-0.37, p<0.001) for all schools. CONCLUSION: Medical students showed the most positive attitude towards science and least positive attitude towards alternative medicine, compared with the students of economics and business or electrical engineering. The curriculum of the Medical School, unlike the curricula of other two schools, could have an impact on students' attitudes towards science.

Attitude↗
PubMed2005

Stress in health professions students: myth or reality? A review of the existing literature.

The purpose of this literature review was to determine the extent to which health profession students experience counterproductive stress and to examine the existing gaps in the literature concerning all health profession students and stress. The literature search process included using Eric, Education Abstracts, Psyc INFO, ABIN, WebSpirs Databases, FactSearch, Biological Sciences, International Pharmaceutical Abstracts, MEDLINE, Lexis-Nexis, CINAHL and Registry of Nursing Research. Key articles were identified that documented stress, the causes of stress or "stressors," and psychiatric symptoms as a result of counterproductive stress in the disciplines of medicine, dentistry, nursing, and allied health. Findings from this analysis of the literature indicated that the highest incidence of stress occurred in medical students followed by dental and then nursing students. There was, however, a dearth of studies related to stress in pharmacy students alone, despite the fact that pharmacology requires a rigorous educational process that is similar to that of the other health professions. While it may be argued that pharmacy students may not be experiencing the detrimental levels of stress that affect other medical students, a study by Henning Ey, & Shaw (1998) found a disproportionately high level of distress in pharmacy students. The Henning study also compared the stress levels of medical, dental, nursing, and pharmacy students. This literature review documents that health profession students suffer from high levels of stress during their training. A comprehensive list of "stressors" is delineated for the health education profession students. However, there appears to be a lack of emperical evidence with regards to stress and stressors in pharmacy students. Although it can be extrapolated that pharmacy students may be suffering from similar levels of stress, there is a definite need for research in pharmacy students specifically.

Burnout, Professional↗
PubMed2002

Contemporary trends in student selection of medical specialties: the potential impact on general surgery.

HYPOTHESIS: Lifestyle is a priority among senior medical students when selecting a career specialty. The trend toward controllable lifestyle vs noncontrollable lifestyle specialties is affecting the number of students desiring a career in general surgery. DESIGN: The Medical Student Graduation Questionnaire is published and distributed by the Association of American Medical Colleges to all US medical schools for senior medical students to complete before graduation. The results from the survey are published each year in the All Schools Report. We evaluated these reports to track the percentage of students pursuing a career in general surgery during the past decade. The National Resident Matching Program also publishes a report each year outlining the match results. We reviewed these results from 1978 through 2001 and used them to determine the percentage of students choosing to enter general surgery. MAIN OUTCOME MEASURES: First choice of specialty among graduating senior students from US medical schools; positions matched by US and foreign medical students and students from osteopathic medical schools; factors that influenced the decision-making process in choice of specialty; and factors that influenced students to change their mind from one career to another. RESULTS: An established trend of decreasing interest in general surgery exists and has the potential to affect the number of positions that are filled each year in the match. Linear projections confirm that, should the current trend continue (negative slope; P =.01), by 2005 only 4.8% of US graduating senior medical students will be interested in general surgery. This established trend of decreasing interest in general surgery, which began in the early 1980s, did not affect the match until 2001, when the number of positions offered exceeded the number of students interested in general surgery. At present, the specialty of general surgery is at risk for significant numbers of positions remaining unfilled. Our match projections estimate that for 2005, only 76.6% of positions will be filled by US senior students (negative slope; P =.001). CONCLUSIONS: If the trend continues, the students matching in general surgery will not be as competitive as in years past, and there will be a potential shortage of these specialists in the United States.

Career Choice↗
PubMed2005

Medical students' exposure to and attitudes about drug company interactions: a national survey.

CONTEXT: While exposure to and attitudes about drug company interactions among residents have been studied extensively, relatively little is known about relationships between drug companies and medical students. OBJECTIVE: To measure third-year medical students' exposure to and attitudes about drug company interactions. DESIGN, SETTING, AND PARTICIPANTS: In 2003, we distributed a 64-item anonymous survey to 1143 third-year students at 8 US medical schools, exploring their exposure and response to drug company interactions. The schools' characteristics included a wide spectrum of ownership types, National Institutes of Health funding, and geographic locations. In 2005, we conducted a national survey of student affairs deans to measure the prevalence of school-wide policies on drug company-medical student interactions. MAIN OUTCOME MEASURES: Monthly frequency of students' exposure to various activities and gifts during clerkships, and attitudes about receiving gifts. RESULTS: Overall response rate was 826/1143 (72.3%), with range among schools of 30.9%-90.7%. Mean exposure for each student was 1 gift or sponsored activity per week. Of respondents, 762/818 (93.2%) were asked or required by a physician to attend at least 1 sponsored lunch. Regarding attitudes, 556/808 (68.8%) believed gifts would not influence their practices and 464/804 (57.7%) believed gifts would not affect colleagues' practices. Of the students, 553/604 (80.3%) believed that they were entitled to gifts. Of 183 students who thought a gift valued at less than $50 was inappropriate, 158 (86.3%) had accepted one. The number of students who simultaneously believed that sponsored grand rounds are educationally helpful and are likely to be biased was 452/758 (59.6%). Students at 1 school who had attended a seminar about drug company-physician relationships were no more likely than the nonattending classmates to show skepticism. Of the respondents, 704/822 (85.6%) did not know if their school had a policy on these relationships. In a national survey of student affairs deans, among the 99 who knew their policy status, only 10 (10.1%) reported having school-wide policies about these interactions. CONCLUSIONS: Student experiences and attitudes suggest that as a group they are at risk for unrecognized influence by marketing efforts. Research should focus on evaluating methods to limit these experiences and affect the development of students' attitudes to ensure that physicians' decisions are based solely on helping each patient achieve the greatest possible benefit.

Adult↗
PubMed2004

Attitudes and beliefs of Brazilian and Australian physiotherapy students towards chronic back pain: a cross-cultural comparison.

BACKGROUND AND PURPOSE: The attitudes and beliefs of physiotherapists and students can potentially influence the outcome of treatment of low back pain. These attitudes and beliefs may be influenced by external factors, such as ethnicity. No study that compared the attitudes and beliefs of physiotherapy students from different cultural backgrounds, such as from Brazil or Australia, towards chronic low back pain was found. The purpose of the present study was therefore to compare the attitudes and beliefs of Brazilian physiotherapy students with those of Australian physiotherapy students and to published data from North American healthcare providers, and to investigate whether a history of chronic low back pain affects students' attitudes and beliefs. METHOD: A survey study design was used. Data were collected from 153 Brazilian physiotherapy students and compared with existing data from Australian physiotherapy students who had never been exposed to a chronic low back pain teaching module. Students' attitudes and beliefs were assessed by use of the HC-PAIRS questionnaire. These data were also compared with published data from North American healthcare providers. RESULTS: The Brazilian physiotherapy students had significantly higher scores on the HC-PAIRS questionnaire than the Australian students and the North American healthcare providers. A previous history of chronic low back pain did not affect students' attitudes and beliefs. CONCLUSIONS: As demonstrated by higher HC-PAIR scores, the Brazilian physiotherapy students agree more strongly with the notion that low back pain justifies disability and activity limitation than do Australian physiotherapy students and North American healthcare providers. A history of chronic low back pain does not affect students' attitudes and beliefs.

Adult↗
PubMed1994

Medical students' motivation for internal medicine.

OBJECTIVE: To verify that motivational concepts tested in other educational settings are relevant to understanding medical students' choice of a career in internal medicine. More specifically, to compare the effects of "facilitating students' interest" versus "controlling students' learning" as educational models during the internal medicine clerkship. DESIGN: An observational retrospective study of 89 fourth-year medical students. Structural equation modeling compared the two models statistically. MAIN OUTCOME MEASURE: Student choice of internal medicine residency. RESULTS: Instructors who supported students' autonomy engendered in students greater feelings of competence and interest in internal medicine than did controlling instructors. Perceived competence further enhanced students' interest in internal medicine. In turn, interest predicted students' choosing an internal medicine residency. Overall, the facilitating students' interest model better explained students' choice of internal medicine than did the controlling students' learning model. CONCLUSIONS: The results verify that the nature of the learning climate during the internal medicine clerkship is an important predictor of students' subsequent pursuit of internal medicine training. Instructors who teach in an autonomy-supportive manner enhance students' perceived competence and interest in internal medicine, which increases the likelihood they will select an internal medicine residency.

Career Choice↗
PubMed2002

1.1 Student selection and the influence of their clinical and academic environment on learning.

Student selection and recruitment play a vital role in the successful outcome of dental education. To identify key issues and practices in selection and recruitment, the group assessed current processes, philosophies and practices from a range of different educational systems, although it was not possible to gather data from all countries or continents within the timeframe provided. Furthermore, the group explored the effect of the educational learning environment on the successful outcome of teaching dental students. It is clear that a wide variety of practices and philosophies exist and are used in different parts of the world. Measuring the success of any given process used for student selection remains a challenge. In some parts of the world, certain practices have become an integral part of the tertiary educational system, and have been applied in a similar way by many or all of the dental schools in that country. In other countries, methods vary from one dental school to another, often reflecting differences in the structure and philosophy of the educational system. There was great variation in the combinations of selection criteria used and in student recruitment strategies. However, it was clear that there was much to be gained by learning from the experiences of other dental schools in student selection. Lessons learned, best practices and philosophies used and supporting value systems proved to be very helpful for benchmarking the processes used. In the discussion of student selection, a number of important questions were raised which deserve further thought and reflection both in the ongoing debate and as part of the ever-changing world of dental education. Important new matters that require more debate and research include: a) ethical issues, including the nature of funding from the student perspective, and the concern that in some regions dentistry may become a profession only for the elite or wealthy students. b) Health standards of students entering dental school. c) How realistic is the applicant's sense of dentistry as a profession? d) How accurate is the students' sense of their career opportunities and the employment market upon graduation? Finally, the over-arching question remains, how valid, reliable and predictable are existing selection practices? Will it be practical and meaningful to standardize methods used, or will exchanging ideas as part of this global debate assist the thought process of dental leaders to improve selection practices by learning from the experiences of other schools in different parts of the world? The processes of open debate, sharing ideas and opinions and identifying sound practices across the globe is a powerful catalyst for developing innovative answers to the complex problems posed by student selection and recruitment. A 'virtual' global process with wide input from as many dental schools as possible should improve the efficacy of student selection, and allow dental educators to identify the 'potential' of prospective students and predict more accurately dental student outcomes. The debate that we have started will certainly contribute to providing a knowledge base which dental educators will be able to draw on when reviewing selection processes in their own schools.

Aptitude Tests↗
PubMed2002

Communication skills assessment: the perceptions of medical students at the University of Nottingham.

INTRODUCTION: Despite the wealth of literature surrounding communication curricula within medical education, there is a lack of in-depth research into medical students' perceptions of communication skills assessment. This study aims to address this gap in the research literature. METHODS: Five focus group discussions were conducted with 32 students, with representatives from each of the 5 years of the medical degree course at Nottingham University. Audiotapes of the discussions were transcribed in full and the transcripts were theme analysed independently by 2 analysts. RESULTS: Two assessment-related themes emerged from the analysis: namely, students' perceptions of formative assessment and students' perceptions of summative assessment. While students seemed to value formative methods of assessing their communication skills, they did not appear to value summative methods like objective structured clinical examinations (OSCEs). Students had mixed views about who should assess their oral communication skills. Some students preferred self-assessment while others preferred peer assessment. Although students appeared to value medical educators assessing their communication skills, other students preferred feedback from patients. Although summative methods like OSCEs were criticized widely, students suggested that examinations were essential to motivate students' learning of communication skills. DISCUSSION: This study begins to illustrate medical students' perceptions of communication skills assessment. However, further research using large-scale surveys is required to validate these findings. Medical educators should provide students with feedback on their communication skills wherever possible. This feedback should ideally come from a combination of different assessors. Over-assessment in other subject areas should be minimized to prevent students being discouraged from learning communication skills.

Adult↗
PubMed2003

Medical students proposing questions for their own written final examination: evaluation of an educational project.

BACKGROUND: In order to emphasise learning more than control, from autumn 2000 we have invited medical students to propose questions for their own written examination in family medicine. One out of three student's proposals was guaranteed to be a part of their coming written examination, possibly somewhat modified. AIM: To evaluate how sixth year medical students experienced the project, and to what extent their performance in the examination was influenced. PARTICIPANTS: Sixth year medical students. MAIN OUTCOME MEASURES: The project was evaluated using (i) marks in examination; (ii) scores on self-administered questionnaires; and (iii) students' free text evaluation. RESULTS: Fifty-seven of 64 (89%) students taking their examination in autumn 2000, and 56 of 59 (95%) students taking the exam in spring 2001, responded. In autumn 2000, 34 (60%) students reported that the project had changed their learning strategies. During spring 2001, 46 of 56 students participated in producing questions, using a mean of 2.6 hours on the work. Students got 5-7% higher marks on their own questions on a scale ranging from 1 to 12. The students' free text evaluation showed that they had prepared especially thoroughly for the topics proposed by the students. They found it comforting to know at least one of the questions in the examination, and the students' questions were found relevant for general practice. CONCLUSION: Encouraging students to write questions for their own examination makes them feel more confident during the examination period, and may increase their reflective learning, without seriously limiting topics studied or violating the control function of the examination.

Clinical Competence↗
PubMed1977

Diarrhea of travelers to Mexico. Relative susceptibility of United States and Latin American students attending a Mexican University.

A clinic was established at Universidad de las Americas, Cholula, Puebla, Mexico for the study of acute diarrhea rates in newly-arrived students and full-time students. Diarrhea occurred in 22 of 55 newlly-arrived U.S. summer students (40%), compared to 28 of 142 U.S. full-time students (20%), 4 of 29 Venezuelan summer and full-time students (14%) and 7 of 66 Mexican full-time students (11%) (the differences were significant, p less than 0.005). Recurrent episodes of diarrhea during the month of study occurred in 15% of U.S. summer students, 4% of U.S. full-time students, and were non-existent in students from Latin America. As well as the 61 students with diarrhea enrolled in the incidence study, all students who developed diarrhea at the univeristy were encouraged to visit the clinic. This gave a total population of 130 cases of diarrhea. The illness that developed in students form the U.S. varied widely, but it typically consisted of seven to 13 unformed stools during the first 48 hours of illness, with illness persiting three to five days. Illness tended to be more severe in the U.S. students. Fifty per cent of the U.S. students with diarrhea had "severe" illness (greater than or equal to 10 unformed stools in first 48 hours) compared to 23% of the Latin Americans. This study indicates that the agents responsible for diarrhea in Latin America are widespread and that resistance to infection develops after prolonged or repeated exposure.

Diarrhea↗
PubMed1994

Influence of a highly focused case on the effect of small-group facilitators' content expertise on students' learning and satisfaction.

BACKGROUND: There has been considerable debate over the need for content expertise to lead a successful small-group discussion for medical students. Some authors feel process expertise related to the conduct of a small group is of more value than content expertise related to the case. At least one study has presented data that suggest content expertise can lead to teacher domination of the learning environment. In an earlier study, the present authors found that students learned more and were more satisfied with small-group instruction when the instruction was facilitated by a faculty member who was an expert in the content of the case. That study also identified no tendency for content experts to dominate the sessions (e.g., through lecturing or otherwise controlling the learning environment). The purpose of the present study was to explore the efficacy of a carefully designed and highly focused case problem to remove the influence of group facilitators' content expertise on students' learning outcomes. METHOD: The 211 students in the University of Michigan Medical School class of 1994 were randomly assigned to 28 groups in a microbiology and immunology course in the fall of 1991; each small group was led by a faculty facilitator. Complete data were available from 27 groups: 13 groups led by experts and 14 groups led by non-experts. Data collection included observers' codings of interactions between the students and the facilitators (interactional analysis), test scores, and students' ratings of the experience. RESULTS: Unlike in the previous study, group leaders who were content experts devoted significantly more time to teacher-directed activities than did non-content-expert leaders. However, overall, 62% of the time was devoted to student-initiated activity. The results of the multiple-choice tests that were related specifically to the goals of the case indicated there was no significant difference between the students' performances in the groups led by experts and those led by non-experts. With respect to students' satisfaction, all students gave consistently high ratings to the experience and there was no difference between groups led by expert and non-expert facilitators. CONCLUSION: The data from this study suggest that a facilitator's content expertise alone does not determine the amount of teacher-directed behavior in a group, the amount of students' learning, or students' satisfaction. The focus built into the case and the amount of facilitator's training directly related to the content of the case are also significant variables related to students' learning, teacher's behavior, and students' satisfaction.

Curriculum↗
PubMed1995

Effect of student and preceptor gender on clinical grades in an ambulatory care clerkship.

BACKGROUND: Although several studies have addressed the effect of student gender on clinical performance evaluation, none has looked at the effect of preceptor gender or the interaction of preceptor gender and student gender. We investigated the possibility of gender effects in an ambulatory care clerkship where the preceptor-student ratio is usually one to one. METHOD: Clinical grades given by preceptors to third-year students after a required one-month ambulatory care medicine clerkship were analyzed by student gender, preceptor gender, and preceptor-student gender pairs. The study was conducted from August 1990 to October 1992 at the Medical College of Wisconsin. A total of 121 preceptors (97 men and 24 women) and 375 students (233 men and 142 women) participated. Analyses of variance were used to detect significant differences. RESULTS: On a scale of 0 to 4, the female students received a higher mean clinical grade than the male students (3.1 versus 3.0, p < .04). Preceptor gender had no effect on clinical grades until student gender was considered. The highest mean grade of 3.3 was given by male preceptors to female students, and the lowest mean grade of 2.9 was given by female preceptors to male students (p < .01). CONCLUSION: The female students received higher clinical grades in the ambulatory care clerkship, especially when the preceptor was male. Perhaps gender interaction should be considered when assigning students to preceptors and evaluating grading practices.

Ambulatory Care↗
PubMed1996

Medical students as patients: a pilot study of their health care needs, practices, and concerns.

BACKGROUND: The personal health experiences of medical students may contribute in important but previously unacknowledged ways to their well-being and education. This pilot study surveyed medical students about their health care needs, practices, insurance status, and concerns about seeking care. METHOD: A questionnaire was developed and distributed to 151 students at the University of New Mexico School of Medicine in 1993-94. Participant privacy was protected. Responses were compiled and analyzed using logistic regression models and odds ratios. RESULTS: A total of 112 students responded. Most reported health care needs and half routinely received care at their training institution. One-third had informally requested prescriptions or diagnostic tests from medical school faculty and housestaff; one-fourth used such informal consultation as their "usual" method of obtaining care. Eighteen students were uninsured. The students reported that they had not sought care for several reasons, and many had experienced difficulty in obtaining care. The students indicated concern about confidentiality and about the dual role as both student and patient at the training institution. They believed that their academic standing would be jeopardized if they developed certain health problems. When asked about hypothetical scenarios, a majority preferred to avoid the dual role of medical-student-patient. When asked about scenarios in which medical student peers exhibited suicidal depression or severe drug abuse, the students overwhelmingly preferred not to notify the medical school administration. Significant differences in responses were found with respect to gender and training level. CONCLUSION: This pilot study examined the health care needs, practices (including the use of informal consultation), insurance status, and concerns of students at one medical school. The findings highlight the students' perceptions of illness and vulnerability during medical school training. Constructive implications for academic medicine are discussed regarding initiatives in the areas of policy, research, and the resources and structure of student health care services.

Adult↗
PubMed1997

A predictive model of student satisfaction with the medical school learning environment.

PURPOSE: To examine differences in attitudes toward the medical school learning environment among student subgroups based on gender and race-ethnicity, to identify the most influential predictors of student satisfaction with the learning environment, and to create a model of student satisfaction with the learning environment. METHOD: Three years of survey data (1992-93 to 1994-95) from first-year students at the University of Michigan Medical School were combined. The total sample consisted of 430 respondents, broken into two sets of subgroups: women (n = 171) and men (n = 259), and whites (n = 239) and underrepresented minorities (n = 74). Asian students were removed from analyses when comparisons were made by race-ethnicity, but were included in the analyses for all students and those comparing men and women. Student's t-tests were used to identify differences between gender and racial-ethnic groups in mean responses to seven survey items, and effect sizes were used to characterize the magnitudes and practical significances of the differences. Forward stepwise regression was conducted to determine the best predictive models for each student subgroup and for the total sample; the subgroup models were compared with each other as well as with the total-sample model. RESULTS: Cross-validation of the gender and race-ethnicity models showed that the men's satisfaction and the women's satisfaction were predicted equally well using either subgroup's model, and that the white students' satisfaction and the underrepresented-minority students' satisfaction were predicted equally well using either subgroup's model. Furthermore, the total-sample model, employing a subset of five predictors, was similar in its predictive power to the subgroup models. CONCLUSION: The study's findings suggest that curriculum structure (timely feedback and the promotion of critical thinking) and students' perceptions of the priority faculty place on students' education are prominent predictors of student satisfaction (across all subgroups) with the learning environment. In contrast, students' perceptions of the learning environment as a comfortable place for all gender and racial-ethnic groups, although less prominent predictors of satisfaction, will discriminate among the subgroups.

Consumer Behavior↗