Medical Education

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Online ISSN: 1365-2923
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Article
The long case has been gradually replaced by the objective structured clinical examination (OSCE) as a summative assessment of clinical skills. Its demise occurred against a paucity of psychometric research. This article reviews the current status of the long case, appraising its strengths and weaknesses as an assessment tool. There is a conflict between validity and reliability. The long case assesses an integrated clinical reaction between doctor and real patients and has high face validity. Intercase reliability is the prime problem. As most examinations traditionally used a single case only, problems of content specificity and standardisation were not addressed. Recent research suggests that testing across more cases does improve reliability. Better structuring of tests and direct observation increases validity. Substituting standardised cases for real patients may be of little benefit compared to increasing the sample of cases. Observed long cases can be useful for assessment depending on the sample size of cases and examiners. More research is needed into the exact nature of intercase and interexaminer variance and consequential validity. Feasibility remains a key problem. More exploration of combined assessments using real patients with OSCEs is suggested.
 
Article
This article discusses a very early clinical trial from the Old Testament. One of Daniel's and his companions' tribulations in Babylonia is explicated within the framework of the modern clinical trial. Even if many, or maybe even most, guidelines for good clinical trial practice are violated (it can even be argued that this is not really a clinical trial), a discussion of this biblico-historical episode in, for example, a problem-based course in (clinical) epidemiology or a course in the critical appraisal of the literature, can be a useful (and possibly entertaining) exercise.
 
Article
Problem based learning (PBL) has become an integral component of medical curricula around the world. In Ontario, Canada, PBL has been implemented in all five Ontario medical schools for several years. Although proper and timely feedback is an essential component of medical education, the types of feedback that students receive in PBL have not been systematically investigated. In the first multischool study of PBL in Canada, we sought to determine the types of feedback (grades, written comments, group feedback from tutor, individual feedback from tutor, peer feedback, self-assessment, no feedback) that students receive as well as their satisfaction with these different feedback modalities. We surveyed a sample of 103 final year medical students at the five Ontario schools (University of Toronto, McMaster University, Queens University, University of Ottawa and University of Western Ontario). Subjects were recruited via E-mail and were asked to fill out a questionnaire. Many students felt that the most helpful type of feedback in PBL was individual feedback from the tutor, and indeed, individual feedback was one of the more common types of feedback provided. However, although students also indicated a strong preference for peer and group feedback, these forms of feedback were not widely reported. There were significant differences between schools in the use of grades, written comments, self-assessment and peer feedback, as well as the immediacy of the feedback given. Across Ontario, students do receive frequent feedback in PBL. However, significant differences exist in the types of feedback students receive, as well as the timing. Although rated highly by students at all schools, the use of peer feedback and self-assessment is limited at most, but not all, medical schools.
 
Article
To document learners' feedback on an educational intervention to provide interns with a hands-on learning experience in population-based research. Cross-sectional inquiry using a structured tool. A medical school in India. 306 interns from 13 consecutive groups in a 3-month posting. Interns' participatory involvement in each of the nine units of learning. In six out of the total of nine units of learning, nearly 70% of the students rated their participatory involvement at 3 points or above (on a 5-point rating scale). This rating was 4 or 5 (good or maximal) for 50% or more students with regard to identification of research questions, review of literature, data analysis and interpretation, and for 65.4% students in data collection. However, in the last two units, on writing the research report and its presentation, a large proportion of students rated their participatory involvement as minimal or unsatisfactory (38.9% and 46.4%, respectively). For 91.2% of students, this was the first hands-on experience of any type of population-based research. When the students were asked to identify the most important factor which hampered learning during the present exposure, 54.2% of them reported that it was the unsuitable timing of the exposure, since their priority during internship was the entrance examination for postgraduate courses. This study empirically demonstrates that with some extra effort from teachers, interns can be exposed to a hands-on learning experience in population-based research, on a systematic basis, without additional resources.
 
Article
The history of medical education in Scotland is quite well known. It is largely told as a story of universities, of high standards and of an education mainly available to men from ordinary backgrounds who became general practitioners and servants of the British Empire. This paper asks whether there was anything peculiarly Scottish about the medical education to be had north of the border. The answer to this is yes. The paper shows there was a commitment among Scottish teachers to present medicine as a practical art based on general principles that brought the subject together in all its aspects, notably uniting internal medicine and surgery. Modern academic medicine has ironed out these differences and medical education in Scotland today is much the same as western medical education in excellent universities anywhere in the world.
 
Article
Medical Education 2010:44:603–612 Objectives Many factors influence the career specialty decisions made by medical students. The aim of this study was to broaden consideration of the determinants of specialty choice in a large population of medical students in their sixth year of study. Methods A total of 2588 students distributed across all of the 39 medical schools in France participated in a National Practice Examination in December 2008, after which an electronic questionnaire was administered. Study criteria were: population characteristics; demographics, and motivation for and drawbacks to medical specialty choice. Results A total of 1780 students (1111 women, 62%) responded to the questionnaire (69% response rate). The mean age of respondents was 23.8 years (22–35 years). Of these, 1555 students (87%) stated their preferred medical specialty. Surgical and medical specialties were the two specialties selected most frequently by students (n = 729, 47%). General practice was chosen by 20%. Gender influenced the choice of specialty: 88% of future paediatricians, 82% of gynaecologists and 77% of general practitioners (GPs) were women (p < 0.05). Main motivating factors included interesting diseases, opportunities for private practice and patient contact. Main drawbacks limiting the choice of other specialties were poor quality of life, an exclusively hospital-based career and loss of patient contact. Gender was the criterion most associated with significant differences in factors of motivation for or discouragement from a career. Patient contact and opportunities for private practice were significantly highlighted by future GPs compared with students opting for the medical or surgical specialties (p < 0.0001). Conclusions Students’ career choices regarding specialties or general practice result from the interplay among several factors. Career interest in general practice is particularly low. Initiatives to address the factors affecting student career choices regarding less favoured specialties and to deal with the growing feminisation of the profession, which will lead to irreversible changes in clinical practice, are required.
 
Article
Two educational implications of the prototype view of categorization of medical disorders in the long-term memory of medical students are tested: first, that categories are better learned when the initial exposure is through representative exemplars, the prototypes as opposed to the whole range of instances; second, that concepts are initially learned at an intermediate level of abstraction (e.g. angina pectoris), corresponding to the prototypes, as opposed to more general levels (e.g. coronary disorders). In a group of third-year medical students (n = 42) taken from a previous study, the recall frequencies of undergraduate course materials in eight system courses are inversely related to the number of disorders presented, r(6) = -0.58, P = 0.06. The recall frequencies are highest for courses with the highest proportion of intermediate-level materials, r(6) = 0.73, P = 0.02. The implications of these results for curriculum design are discussed.
 
Article
Medical ethics as taught by members of the Department of Forensic Medicine in three of five medical colleges in Sri Lanka is a ‘rule ethic’ (‘normative ethic’) based on ‘traditional’ or ‘classical’ ethics. Instruction includes the teaching of moral principles, illustrated with examples. Also included are aspects concerning the functions of the Sri Lanka Medical Council. The topic is evaluated in the essay, multiple choice question and oral components of the third MBBS (Part II) examination (end of fourth year). As presently taught the syllabus is thoroughly inadequate for dealing with modern (medical) ethical issues. The shortcomings and limitations in the present programme are pointed out and requisite improvements suggested. A case is made for an eclectic view of ethics, in which a ‘situation ethic’ would play a part. Finally, the training of a highly moral responsible medical professional is emphasized.
 
Article
The teaching of anatomy remains controversial to the present day. This paper explores the arguments over its merits in medical and scientific education at one of the ancient universities. Medical professors at Cambridge University relied upon the science departments to provide basic scientific instruction, whilst science professors relied upon medical students to make up numbers for their courses. Human anatomy became a source of contention: did it really educate the mind, or was it simply a dry subject that medical students had to learn by rote? Could the university even cater for professional education?
 
Article
This article investigates the development of clinical academic units and the concept of a university model of medical education. It argues that clinical academic units emerged from debates about the nature of the medical education and the role of science and the laboratory in the construction of medical knowledge and in the curriculum. Although the integration of clinical academic units into medical schools was seldom harmonious, from the 1920s onwards the appointment of full-time professors to head them imposed a new intellectual order on bedside teaching and research. They provided a means through which laboratory medicine was included in the curriculum and brought the ward and the laboratory closer together. The ideal of a university medical education and the creation of university medical schools took longer to establish and it was only in the 1970s after a number of royal commissions that opposition was finally eroded.
 
Article
The St Andrews MD, 1935--1972, has been investigated. The number of awards has declined and the porportion of doctors proceeding to MD has also declined. The average time between the award of the MD ChB degree and the MD degree was 11 years. About one third of the awards were at the Honours or Commendation grade. Only two doctors gained Honours in both the MB ChB and the MD. A smaller proportion of women gianed an MD degree, but of those that did a similar proportion received Honours or Commendation as in the male group. Laboratory-based studies are more likely to attract the higher grades of award compared with clinically based studies. Subsequent achievement areas show almost half the graduates to be in clinical or laboratory hospital work, 15% in administrative posts, 27% in academic posts but only 5% in general practice. Even less are in industry or the services.
 
Article
Introduction This article is concerned with medical education in London during 1939–41. It is set against the London Blitz, an event that was then unique in its subjecting of civilians to an intense and prolonged aerial bombardment. Its very uniqueness ensured that medical students, like others in the capital, had no set rules of conduct with which to govern their response to death and destruction on such an unprecedented scale in an urban area. Evacuation For students at London's world-famous medical schools, the outbreak of war in 1939 resulted in the execution of evacuation plans formulated during the 1930s; these are outlined in the text. The London teaching hospitals and their attached medical schools were removed to sector hospitals and, in the case of the medical schools, to universities and colleges in areas deemed to be safe. Medical teaching during the war Just as the schooling of children evacuated from Britain's big cities was subject to considerable disruption during this period, so was medical education. This article attempts to both chart the effects of these difficulties and study the manner in which the medical schools and, more particularly, London medical students, overcame them. Emphasis is placed on the dramatic months of the Blitz, not least because of the moulding effect such a sudden experience of warfare must have had on the very young, mainly male, students who lived through it. Finally, mention is made of some of the medical innovations the improvisations of the Blitz brought about.
 
Article
1. The migration of doctors from Medical College, Baroda, is studied in detail. 2. From 1949 to 1972, 584 doctors migrated to other countries and only twenty-nine doctors have returned so far. The incidence of migration is to the extent of 39-75%. 3. Among those who migrated 77-7% have gone to U.S.A. and 11-7% have gone to the U.K. 4. Ninety-four women graduates out of 241 passed prior to 1971 are abroad.. 5. The majority migrate for better and more comfortable living conditions. A small number migrate for better research facilities and encouragement. Those who are denied the opportunity of a post-graduate training also migrate. 6. Migration of doctors, though universal, is disturbingly high in India and a major cause of concern to the government and the educationist.
 
Article
About 80% of MBs who proceed to MD or ChM do so within 15 years of obtaining their primary medical qualification. Using this measurement as a yardstick, an attempt is made to draw a valid reflection of the award of thses postgraduate degrees in the twenty university medical schools during the period 1953-70. London produced half as many MDs and ChMs as expected, Oxbridge considerably more and Scotland about half the expected ChMs.
 
Article
It appears from this survey that the employment prospects of women in medicine are not as gloomy as might be imagined. However, they may be employed in posts underusing their talents and should be encouraged at medical school to consider medicine as a meaningful career. Women science graduates appear to fare badly in the employment field compared to women doctors and are employed, very often, in jobs unconnected with their qualifications. An advisory service for women science students is recommended.
 
Article
A survey of the career experience and postgraduate training of the 1965 and 1970 graduates of the Scottish university medical schools was carried out in 1975. The duration of training for the specialties of medicine and surgery and for obstetrics and gynaecology was in general longer than for anaesthetics, psychiatry and radiology; the implications of varying periods of training for postgraduate education are discussed. Attention is drawn to a number of factors which influenced career choice. The 1970 graduates who became principals spent longer in training for general practice than those of 1965. Some married women with children had difficulty in finding suitable part-time work; this may be a serious problem for those seeking accreditation of higher specialist training and for training for general practice. It was estimated that, of the British nationals, about 11% of the 1965 and 8% of the 1970 graduates had emigrated. General practice was the discipline most commonly chosen by doctors working overseas.
 
Article
Undergraduate medical education in Britain has been in a state of change since before the introduction of the National Health Service. Since then the changes in the General Medical Councils's recommendations concerning the medical curriculum (1947, 1957, 1967) have accompanied attention to curricular content, and the manpower requirements of the Health Service have drawn attention to the career preferences of students. Martin & Boddy (1962) reported a survey of medical students throughout the United Kingdom which was carried out under the auspices of the Association for the Study of Medical Education (ASME). A questionnaire was used which covered such areas as reactions to the medical school and curriculum, professional expectations and attitudes, and career preferences. Then in 1966 a similar survey was carried out by ASME and the National Foundation for Educational Research, providing data for the Royal Commission on Medical Education and published as Appendix 19 of the Todd Report (1968). The survey in 1966 used a questionnaire which investigated the background of the students, the course and students' reaction to it, and career aims, considering first preclinical and final year students only.
 
Article
In a postal follow-up study of five annual cohorts of Aberdeen medical graduates, respondents (88% of those approached) were asked how satisfied they were with their jobs 4--5 years after qualifying. Eight out of ten males and seven out of ten females appeared to be content with their jobs, the proportion being rather higher among those in or training for general practice. Reasons for good job satisfaction tended to be different among those in training for hospital medical careers compared to general practice.
 
Article
The M.Sc. course in Occupational Medicine started in September 1969 at the London School of Hygiene and Tropical Medicine. Between 1969--74, ninety-eight doctors attended this 9 month full-time course. Thirty-four were British and sixty-four from overseas. A questionnaire was mailed to all of them. Eighty-four replied, i.e. a response rate of 86%. Thirty-one of the U.K. doctors and fifty-three of the overseas replied. The difference between the UK and overseas doctors working full-time in occupational medicine was very marked before and after the course. 100% of the U.K. doctors and 89% of the overseas thought their objectives of attending the course were fulfilled. 97% of the U.K. doctors said the course covered the problems of their country as compared with 77% of the overseas. 100% of the U.K. doctors found the knowledge gained of practical value to their work. Suggestions were also made on topics taught and on the practical instruction of the course. It appears that the M.Sc. course is successful and that the objectives outlined when starting the M.Sc. were to a great extent fulfilled. The new changes introduced this year 1976 in the organization and the content of the course are also discussed, and their advantages emphasized.
 
Article
To identify academic and non-academic predictors of success of entrants to the Nottingham medical course over the first 25 completed years of the course's existence. SETTING, DESIGN AND MAIN OUTCOME MEASURES: Retrospective study of academic and non-academic characteristics of 2270 entrants between 1970 and 1990, and their subsequent success. Analyses were undertaken of two cohorts (entrants between 1970 and 1985 and entrants between 1986 and 1990). Overall, 148 of 2270 (6.5%) entrants left the course, with the highest proportion being from the first 6 years (10.7%). Of the 148 leavers, 58 (39.2%) did so after obtaining their BMedSci degree. Concerning non-academic factors, in the 1970-85 cohort, applicants from the later years and those not taking a year out were more successful. However, these two factors had no influence on outcome in 1986-90. In contrast, ethnicity and gender were highly significant predictors of success in obtaining honours at BMBS in 1986-90 but at no other exam nor in the earlier years. Older, mature or graduate entrants were more successful at obtaining a first-class degree at BMedSci for the whole 21 years. However, they were less likely to be successful at passing the BMBS. With regard to academic factors, overall, A grades at Ordinary level/General Certificate of Secondary Education (O-Level/GCSE) were inconsistent independent predictors of success. However, for 1986-90, high grades at O-Level/GCSE chemistry and biology were strong independent predictors of success at BMedSci and BMBS. Very few Advanced level (A-Level) criteria were independent predictors of success for 1970-85. In contrast, for 1986-90 entrants, achieving a high grade at A-Level chemistry predicted success at obtaining a first-class degree at BMedSci, and a high grade at A-Level biology predicted success at BMBS. Over the 21 years, the majority of entrants achieved significantly lower grades at A-Level than predicted. General Studies A-Level was a poor predictor of achievement. On balance our current GCSE A-grade requirements should remain. Biology should be added to Chemistry as a compulsory A-Level subject. If predicted A-Level grades are borderline then the lower estimate should be used. General Studies should continue not to be used in selection. Performance of more recent mature entrants at BMBS needs further study. The recent gender and ethnic biases in obtaining honours at BMBS is currently being examined. The motivation of applicants planning to take deferred entry should be carefully explored at interview.
 
Article
The problems of student selection are constantly in the mind of medical school administrators and medical teachers. When reviewing current policies there is clearly a need to study the recent journal literature, but the term 'student selection' is not a subject heading in Index Medicus; consequently no convenient listing of journal articles on this important topic is readily available. To assist administrators and medical teachers a bibliography has now been prepared. The references are taken from Index Medicus 1970-75 and presented here in a quick-reference alphabetical format. To the list has been added World Health Organization publication EURO 6203 which is considered an important document on the subject. The bibliogrraphy therefore provides a concise reference to the recent literature on student selection for medical education.
 
Article
A short undergraduate course in human sexuality has been developed over a period of 7 years. The objectives, initially concerned with cognitive learning, shifted to affective aspects of the topic, introduced through a format of sexually explicit films and small-group discussions. Continuing evaluation of successive courses by students has been particularly valuable in identifying helpful and unhelpful behaviour in group leaders, and has been used in their training. The evaluations also demonstrated that students saw a need to develop their interviewing skills. The course, therefore, now seeks to combine affective learning with other topics of direct relevance to clinical practice.
 
Article
Efforts at the local training of postgraduate doctors in Nigeria started formally in 1970, following the establishment of the Nigerian Fellowship Programme, now called the National Postgraduate Medical College of Nigeria. The programme consists of three sets of examinations termed Primary, Part I and Part II examinations. This report is an analysis of the performance at examinations conducted by the National Postgraduate Medical College of Nigeria. Since its inception in 1970, a total of 4388 attempts at the various examinations of the College had been made by November 1984. The mean pass rate was 38–8%. Pass rates in the Primary and Part I examinations were similar to each other and to pass rates in similar examinations in other countries. Pass rates were much higher in the Part II or final examinations. The College has produced a total of 145 Fellows during the period under review. Of these 36, 34, 27 and 13 respectively were in internal medicine, obstetrics and gynaecology, general surgery and paediatrics. All other faculties accounted for 35 of the 145 Fellows. Applications for these examinations have increased tremendously in recent years and this trend is likely to continue in the future. The pace at which candidates complete the programme appears slow. The possible causes of the apparent poor performance of the College and ways of improving it are discussed.
 
Article
Pre-registration house officers who answered enquiries in 1973 and 1974 about career preferences were written to again in 1976. This yielded 205 comparisons, in which 134 (65.5%) doctors retained their original first choice of career, thirty-five (17%) opted for their previous second or third choice and thirty-six (17.5%) gave a completely new choice. The most common reasons for a change in career choice were reappraisal of aptitudes and abilities, altered domestic circumstances, additional knowledge of promotion and career prospects and additional experience of the new choice of career.
 
Article
For 96.7% of identified qualifiers from British medical schools in 1974, career information was available concerning experience outside the United Kingdom. A total of 34.2% of respondents had been abroad at some time by 1987, the peak period being 6 years after qualifying when over 15% were abroad. Twelve per cent were still abroad 13 years after qualifying. Compared to English and Welsh medical schools, Scotish medical schools produced higher percentages of qualifiers who were abroad and who intended not to practise in the United Kingdom. The commonest reasons for going abroad were adventure, travel, vacation, better lifestyle and living conditions, and better career prospects. Further aspects of motivation for travel abroad and return to the United Kingdom are discussed.
 
Article
We report on some demographic characteristics of junior doctors in the United Kingdom, studied in six national cohorts of qualifiers between 1974 and 1993. Over the 20 years covered by the data, the percentage of qualifiers who were women increased substantially (from 27% in 1974 to 47% in 1993). Between 1983 and 1993, the number of women qualifiers rose by 242 (a 17% rise) and the number of men fell by 430 (a fall of 18%). Of all doctors, 52% were aged 23 years or less when they qualified and there was no increase over time in mature qualifiers. We report on increases in the percentage of doctors who qualified in the UK but who were born outside it (from 11% to 16%). The percentage of respondents who were married at the end of the first year after qualification declined from 45% in 1974 to 15% in 1993. At 25 years of age, 2% of the women doctors who qualified in 1983 had children compared with 45% of women aged 25 in the general population. Two-thirds of the women doctors had children by their mid-30s.
 
Article
A postal questionnaire was carried out in 1984 to determine the career pattern of United Kingdom women medical graduates of 1974. The response rate was 57%. The median age was 33 and 82% were married. Eighty‐nine per cent were employed in a vast range of specialties; most of those not working at the time of the survey planned to return to work within 6 months. Many expressed a need for more career advice at all stages, and for more training in the community‐based specialties. 1987 Blackwell Publishing
 
Article
The career aspirations of doctors who qualified from a UK medical school were examined in relation to firmness of career choice and marital and family circumstances 1 year and 7 years after qualification. Although there was greater certainty of career choice amongst all doctors, the women were consistently less likely to be certain than the men. The men were more likely than the women to be married (and more likely to have children). The main differences in patterns of career choice were the greater popularity of medicine and surgery among the men and of general practice and community medicine among the women. The most plausible explanation for these differences is the different marital and family pressures experienced by men and women.
 
Article
The structure, character and results of the final M.B. examinations held in United Kingdom medical schools in 1974 were investigated by postal questionnaire. The mean failure rate (10-5%, range 0-24-6%) was significantly higher in the student sample from the London medical schools compared with those in the periphery. No significant sex difference in total failure rate was noted. Wide variations were observed in the length and character of the examinations.
 
Article
Although our projections are not completely accurate, due to inadequate data and crude methods of approximation, three conclusions are inescapable: 1. The nation should give priority to planning new schools for health administrators and rural health workers, and to generally expanding present schools for paramedicals. 2. Plans should proceed rapidly for the two new medical schools. 3. A Health Manpower plan based on census information and special studies should be developed over the next 2 years. This plan should have input from all concerned ministries. (The Ministry of Health has regarded a proposal from University Associate "a group of Harvard, Johns Hopkins and A.U.B. professors" for technical cooperation in health services planning.)
 
Article
Since 1966 all recently appointed consultants in general psychiatry in the United Kingdom have been asked to rate their training experiences. Four postal surveys have been made at three yearly intervals, of 574 consultants appointed in the period 1 October 1965—30 September 1978. This paper reports the findings from the responses of 162 consultants appointed 1975–1978. Fifty per cent, or fewer, reported satisfactory training in special forms of psychotherapy, addiction, work in the community, mental handicap, forensic psychiatry, administration, research, psychogeriatrics, work with longstay patients, rehabilitation, medico-legal work, group psychotherapy, work in a therapeutic community, child psychiatry, epidemiology and postgraduate teaching. Those who had been at the Maudsley Hospital considered that they had experienced the best training, while those who had been at peripheral hospitals the worst. Progress has been made in the past 3 years, notably in the fields of individual psychotherapy, community work and forensic psychiatry.
 
Article
A descriptive account is given of changes in the composition of the postgraduate medical student population at the Institute of Psychiatry from 1977 to 1987, focusing on total numbers, country or region of origin, previous experience, source of sponsorship and training requirements. It is concluded that economic influences in the UK and abroad exert profound effects on the pattern of training demand, the overall recent trend being away from government-sponsored developing-world trainees towards self-sponsored students from developed countries. The combined effect of developing-world poverty and financial pressure on UK academic institutions could be a failure to cater for the mental health needs of developing countries.
 
Article
At the conclusion of undergraduate medical education in the United Kingdom most students pass a university qualifying examination and obtain a degree in medicine and surgery. Some students pass an external non-university qualifying examination in medicine as an alternative to obtaining a degree, and some do both. The degree may be obtained in the same year as the non-university qualifying examination, or in a different year. Some students from a medical school intake qualify in a later year than expected, for various reasons. Data from university, Health Department and other sources may relate to the academic year, the calendar year, or a fixed date such as 30 September. It is not a simple exercise, therefore, to define the exact number of people who qualify to practise medicine, for the first time, in any given 'year'. In counting qualifiers from individual medical schools, the problems are further compounded by the movement of students between the preclinical and clinical stages of the course, particularly from Oxford and Cambridge to London teaching hospitals. This paper analyses the situation for the calendar years 1977 and 1983, showing a decline in the number of students obtaining double (i.e. both university and non-university) qualifications. The number of UK graduates not registering with the General Medical Council to practise, at least for a time, in the UK was small, and the population base compiled for Medical Career Research Group studies was reasonably accurate in each of the 2 years examined.
 
Article
In the context of the 1997 Report of the Medical Workforce Standing Advisory Committee, it is important that we develop an understanding of the factors influencing medical school retention rates. To analyse the determinants of the probability that an individual medical student will drop out of medical school during their first year of study. Binomial and multinomial logistic regression analysis of individual-level administrative data on 51 810 students in 21 medical schools in the UK for the intake cohorts of 1980-92 was performed. The overall average first year dropout rate over the period 1980-92 was calculated to be 3.8%. We found that the probability that a student would drop out of medical school during their first year of study was influenced significantly by both the subjects studied at A-level and by the scores achieved. For example, achieving 1 grade higher in biology, chemistry or physics reduced the dropout probability by 0.38% points, equivalent to a fall of 10%. We also found that males were about 8% more likely to drop out than females. The medical school attended also had a significant effect on the estimated dropout probability. Indicators of both the social class and the previous school background of the student were largely insignificant. Policies aimed at increasing the size of the medical student intake in the UK and of widening access to students from non-traditional backgrounds should be informed by evidence that student dropout probabilities are sensitive to measures of A-level attainment, such as subject studied and scores achieved. If traditional entry requirements or standards are relaxed, then this is likely to have detrimental effects on medical schools' retention rates unless accompanied by appropriate measures such as focussed student support.
 
Article
A new computerized system for the allocation of pre-registration house-officer appointments to medical graduates at the Welsh National School of Medicine is described. The need to withdraw an earlier system, used through much of the 1970s, is explained, and the advantages possessed by the new system are discussed.
 
Article
A follow-up survey of undergraduate teaching of geriatric medicine was carried out in 1986. All 27 clinical medical schools responded. Geriatric medicine is taught to all medical students in 25 and to only a proportion of students in two. Fifty-nine per cent of schools have academic departments teaching for a mean of 89 hours compared with 33 hours in non-academic departments--an overall mean of 68 hours. The subject is taught by various methods with 70% of teaching time spent on bedside clinical instruction. Other aspects of institutional and community care are often covered. The subject is examined in 18 schools. New academic departments are planned at four schools, and an increase in teaching time planned in five. To meet the needs of the population of the next century, reconsideration of curricula in some of the medical schools is recommended.
 
Article
Between 1983 and 1994 the amount and variety of teaching about death, dying and bereavement in UK medical schools has grown considerably. Twenty-seven of the 28 UK medical schools now have some formal teaching in this area, and a number of schools have substantial programmes of teaching. A wider range of topics is now taught, with most schools providing formal teaching about physical therapy, teamwork and ethical issues in terminal/palliative care. A greater range of teachers are involved, presumably providing a wider range of perspectives and expertise. The influence of the hospice movement is particularly noticeable, with the majority of schools using their local hospice as a teaching resource. It seems that the General Medical Council's proposed 'new curriculum' for undergraduate medical education will result in a further expansion of teaching about palliative care in many schools. However, rigorous evaluation of the effectiveness of such teaching is largely absent.
 
Article
The pre-registration year, a mandatory period of general clinical training in the United Kingdom, has been the subject of recent comment and criticism. The literature on the year is analysed, taking as a starting point and framework the 1983 review by the Association for the Study of Medical Education (ASME), and focusing on the 1987 Recommendations of the General Medical Council. It is concluded that the pre-registration programme has been improved, but that attention needs to be given to house officers' hours of duty, to career counselling for them and to training for teachers and supervisors.
 
Article
A total of 196 graduates from the four medical schools in Sri Lanka responded to a postal questionnaire on their career preferences and factors influencing the choice of specialty. Medicine (38%), surgery (21%), paediatrics (15%) and obstetrics (12%) were the most popular choices. ‘Service’ specialties such as anaesthesia (1.5%), pathology (1.5%) and radiology (i%) were strikingly less attractive. Community medicine (2%) and general practice (2%) were similarly unattractive; medical administration (0.5%) was the least popular choice. In the choice of a career, opportunity for direct contact with patients (59%) was the most important determinant when compared to financial reward (12%), social prestige (10%) and fixed hours of work (12%). Research prospects (6%) and teaching opportunity (5%) were relatively unimportant considerations. The graduates preferred employment in the state health service (65%) to teaching in the clinical departments of medical schools (26%) and full-time private practice (7%). Pre- and paraclinical departments of medical schools attracted only 2% of the graduates. A total of 80% of the graduates wished to practise in the capital city or a major provincial city, while 10% chose to seek employment overseas. These results will be useful in planning undergraduate and postgraduate education, and in designing policies to attract manpower to the scarcity and high priority disciplines, so that the imbalances encountered would be minimal in the future.
 
Article
A total of 196 intern medical officers who had graduated from the four medical schools in Sri Lanka in 1984 indicated their attitudes towards anaesthesia as a medical specialty in response to a postal questionnaire. Eighty per cent of the graduates considered anaesthesia to be an established specialty in Sri Lanka, while 17% felt that the specialty had limited clinical application. A total of 62% of the graduates were not aware, prior to their entry to medical school, that anaesthesia was related to medical practice. All the graduates indicated that the intra-operative role of the anaesthetist was on a par with that of the surgeon, but 40% felt that the pre- and postoperative roles were of a secondary nature. Overall, 42% considered that an anaesthetist acts as an assistant to the surgeon. The graduates were of the opinion that only 35% of the patients undergoing surgery were appreciative of the services rendered by an anaesthetist. Fifty per cent of the graduates considered exposure to the specialty in the undergraduate curriculum as inadequate. Anaesthesia was chosen as the first career preference by 1.5%. The dominant reasons for not selecting anaesthesia as a career specialty were: minimal patient contact and patient recognition (62%), and lack of recognition of the specialty by society (54%). Anaesthetists in Sri Lanka are challenged to alter the perceptions associated with the specialty, which are probably a result of chronic staff shortages restricting practice to the confines of operating theatres.
 
Article
To assess the reliability of the MRCP(UK) Part I Examination over the period 1984-2001, and to assess how the reliability is related to the difficulty of the examination (mean mark) and to the spread of the candidates' marks (standard deviation). Retrospective analysis of the reliability (KR20) of the MRCP(UK) examination recorded in examination records for the 54 diets between 1984 and 2001. The reliability of the examination showed a mean value of 0.865 (SD 0.018, range 0.83-0.89). There were fluctuations in the reliability over time, and multiple regression showed that reliability was higher when the mean mark was relatively high, and when the standard deviation of the marks was high. The reliability of the MRCP(UK) Examination was maintained over the period 1984-2001. As theory predicted, the reliability was related to the average mark and to the spread of marks.
 
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Many factors have led to a movement from the emphasis of the 1960s and 1970s on departmental expansion towards an emphasis on cost-effective undergraduate medical education emphasizing the 'art' as well as the 'science' of medicine. In January 1985 a questionnaire was sent under the auspices of the Undergraduate Education Committee of the Association of Professors of Obstetrics and Gynecology to all chairmen of departments of obstetrics and gynecology in the USA and Canada seeking their opinions about these trends and information about the educational programmes in their departments. The information from this study indicates that the chairmen are aware of and responding to this new direction in medical education. A stabilization of teaching staff and clerkship sizes and the emphasis on clinical as well as cognitive evaluation, despite recognition of the cost of the former, shows active interventions towards these ends. An emphasis on education in 'basic' as compared to 'subspecialty' areas which is independent of the subspecialty of the academic chairman also supports this trend.
 
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Accurate, comprehensive follow up of individual medical students is not currently available. The best aggregate data source is probably the Higher Education Funding Council for England (HEFCE). According to their Medical Return tables, 43 131 students began undergraduate medical studies in the United Kingdom (UK) in the decade 1985-94, and 38 376 doctors qualified from UK medical schools in the decade 1990-99, being 89% of the intake numbers 5 years previously. Continuous monitoring is required to enable medical school intake to be adjusted according to the demand for more doctors.
 
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Appointments to accredited specialist training positions in the State of Queensland, Australia in 1988 were analysed to show the success rates of applicants. Women were less likely to apply for training, but gained proportionately more appointments than men. Other factors in success were application from a major teaching hospital, graduation from the State medical school and, for new applicants, an honours degree. The success rates in various specialties differed significantly as did their appeal to women and to honours graduates. It is concluded that new graduates need better information and advice on career choice and that individual disciplines need to look carefully at the image and organization of their training programmes.
 
Top-cited authors
Cees Van der Vleuten
  • Maastricht University
William C Mcgaghie
  • Northwestern University
Barry Issenberg
  • University of Miami Miller School of Medicine
Geoffrey Norman
  • McMaster University
Lynn Monrouxe
  • The University of Sydney