Dataset Information

Effects of raising the bar on medical student study progress: An intersectional approach.

ABSTRACT:

Context

Medical schools seek for measures to improve their students' study progress and are responsible for a diverse student population.

Objectives

The effect of a stricter academic dismissal (AD) policy in medical school on short-term and long-term study progress was investigated in a longitudinal cohort study. In addition, differential effects for subgroups were assessed by intersecting gender, ethnicity and prior education (intersectional framework).

Methods

Participants were first-year Bachelor students enrolled in 2011 to 2016 in a Dutch medical school. For cohorts 2011-2013, the AD policy consisted of a minimum of 67% of Year-1 credits required to remain enrolled (67%-policy, n = 1189), and for cohorts 2014-2016, this bar was raised to 100% of Year-1 credits (100%-policy, n = 1233). Outcome measures on study progress were Year-1 completion and dropout (short term) and Bachelor completion in three and four years (long term).

Results

Overall, Year-1 completion rates increased under the 100%-policy compared to the 67%-policy (OR = 2.50, 95%-CI:2.06-3.03, P < .001). Yet, this increase was not present for students with non-standard prior education - except for males with a migration background (OR = 7.19, 95%-CI:2.33-25.73, P < .01). The dropout rate doubled under the 100%-policy (OR = 2.41, 95%-CI:1.68-3.53, P < .001). Mainly students with standard prior education dropped out more often (OR = 3.68, 95%-CI:2.37-5.89, P < .001), except for males with a migration background. Bachelor completion rates after three and four years were not positively affected by the 100%-policy. Notably, females without a migration background and with non-standard prior education suffered from the 100%-policy regarding Bachelor completion after three years (OR = 0.29, 95%-CI:0.11-0.76, P < .05).

Conclusions

Despite increased dropout rates, the stricter AD policy improved Year-1 completion rates - especially for under-represented subgroups, thereby improving study progress without harming student diversity on the short term. However, these positive effects did not hold regarding Bachelor completion rates indicating that long-term effects require higher performance standards throughout the Bachelor, which in turn may harm other subgroups and thereby student diversity.

SUBMITTER: Broks VMA

PROVIDER: S-EPMC8361716 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundThere are growing numbers of refugees throughout the world. Refugee health is a relatively unstudied and rarely taught component of medical education. In response to this need, a Refugee Health Elective was begun. Medical student perceptions toward cultural aspects of medicine and refugee health before and after participation in the elective were measured.MethodsPreliminary questionnaires were given to all preclinical students at the academic year commencement with follow-up questionnaires at the refugee elective's conclusion. Both questionnaires examined students' comfort in interacting with patients and familiarity with refugee medical issues, alternative medical practices, and social hindrances to medical care. The preliminary answers served as a control and follow-up questionnaire data were separated into participant/non-participant categories. All preclinical medical students at two Midwestern medical schools were provided the opportunity to participate in the Refugee Health Elective and surveys. The 3 data groups were compared using unadjusted and adjusted analysis techniques with the Kruskall-Wallis, Bonferroni and ANCOVA adjustment. P-values < 0.05 were considered significant.Results408 and 403 students filled out the preliminary and follow-up questionnaires, respectfully, 42 of whom participated in the elective. Students considering themselves minorities or multilingual were more likely to participate. Elective participants were more likely to be able to recognize the medical/mental health issues common to refugees, to feel comfortable interacting with foreign-born patients, and to identify cultural differences in understanding medical/mental health conditions, after adjusting for minority or multilingual status.ConclusionAs medical schools integrate a more multicultural curriculum, a Refugee Health Elective for preclinical students can enhance awareness and promote change in attitude toward medical/mental health issues common to refugees. This elective format offers tangible and effective avenues for these topics to be addressed.

Project description:Vodcasts (video podcasts) are becoming increasingly popular in medical education. At A.T. Still University School of Osteopathic Medicine in Arizona (ATSU SOMA), vodcasts are an essential component of our blended learning environment, where year 2-4 students train in a contextual setting at community health centers across the U.S. Vodcasts are used far less frequently in our year 1 residential learning environment at the main campus in Arizona, but we are considering moving to significantly more interactive educational experiences with on-demand videos followed by in-class activities. The aim of this study was to determine stakeholder (i.e. medical student) preferences for vodcast design, format, and pedagogical strategies. The overall goal was to increase opportunities for students to learn with this modality.An interactive Qualtrics™ survey was administered to three cohorts of medical students. The survey generated quantitative and open-ended response data that addressed principles of vodcast instructional design and learning. Responses to survey items were analyzed for statistical significance using the independent samples t-test for interval data, the chi-square test for categorical data, and the Kruskal-Wallis test for ordinal data, using the post-hoc Bonferroni procedure to determine the appropriate ? level. Responses to open-ended prompts were categorized using open- and axial-coding.The most highly valued vodcast attributes, considered essential by all three cohorts, were clear explanations, organization, conciseness, high-yield for medical board exams, and the ability to speed vodcasts up. The least helpful vodcast attributes for all three cohorts were music and objects moving on screen. The average preferred vodcast length for each cohort was 27-28 min. There were significant differences between the less experienced learners in the residential setting and the more mature learners in the blended learning environment regarding certain vodcast attribute preferences, format of included practice questions, explanations for preferred vodcast lengths, and reasons for not viewing vodcasts.Overall, learner preferences were in line with non-interactive, screen-capture type vodcasts, which have lower demands on institutional cost and faculty production time than Flash™-type interactive vodcasts. Students in the blended learning environment were much more focused on vodcast features that decreased their time commitment, including a preference for noninteractive vodcasts. Given the increase in distance learning in medical education, our results should be of value to other medical programs.

Project description:BackgroundSubstance misuse teaching within the undergraduate medical curriculum has been underrepresented compared to more traditional medical topics. In response several national curriculum reviews such as the most recent UK department of health initiative (DOH) have identified deficiencies in substance misuse education and have suggested curriculum interventions for local faculties to implement. The student perspective however has largely been muted during this process and this study aims to explore this using a constructivist grounded theory approach.MethodsEleven final year and intercalating medical students across three separate focus groups participated in this study over a three-month period commencing from March 2018. Time between the audio recorded focus groups allowed for a parallel process of data collection and analysis into more focussed codes and categories to occur, consistent with the grounded theory approach. The qualitative study took place in a single medical school in the UK.ResultsMedical students had a common consensus that substance misuse education was an underperforming subject in their curriculum, from limited teaching hours to curriculum design and organisational problems. Students identified an alternative curriculum is required to not only prepare students for their future clinical duties but also their own personal lives. Students highlighted this proximity to a 'dangerous world' where exposure to substance misuse risks were faced daily. This exposure also provided a source of informal learning experiences which students deemed as being potentially unbalanced and even dangerous. Students also identified unique barriers to curriculum change with reference to a lack of openness due to the impacts of disclosure in substance misuse.ConclusionLarge scale curriculum initiatives appear to correspond to the student voice obtained in this study, providing backing for the implementation of a co-ordinated substance misuse curriculum within medical schools. The student voice however provides an alternative lens by outlining how substance misuse pervades into students' lives and how informal learning is a largely underestimated hidden source of learning with more dangers than benefits. This together with the identification of further barriers to curriculum change, provide space for medical faculties to incorporate and work with students to facilitate local level curriculum changes relating to substance misuse education.

Project description:Peer-assisted learning (PAL) is the development of new knowledge and skills through active learning support from peers. Benefits of PAL include introduction of teaching skills for students, creation of a safe learning environment, and efficient use of faculty time. We present a novel approach to PAL in an emergency medicine (EM) clerkship curriculum using an inexpensive, tablet-based app for students to cooperatively present and perform low-fidelity, case-based simulations that promotes accountability for student learning, fosters teaching skills, and economizes faculty presence.We developed five clinical cases in the style of EM oral boards. Fourth-year medical students were each assigned a unique case one week in advance. Students also received an instructional document and a video example detailing how to lead a case. During the 90-minute session, students were placed in small groups of 3-5 students and rotated between facilitating their assigned cases and participating as a team for the cases presented by their fellow students. Cases were supplemented with a half-mannequin that can be intubated, airway supplies, and a tablet-based app (SimMon, $22.99) to remotely display and update vital signs. One faculty member rotated among groups to provide additional assistance and clarification. Three EM faculty members iteratively developed a survey, based on the literature and pilot tested it with fourth-year medical students, to evaluate the course.135 medical students completed the course and course evaluation survey. Learner satisfaction was high with an overall score of 4.6 on a 5-point Likert scale. In written comments, students reported that small groups with minimal faculty involvement provided a safe learning environment and a unique opportunity to lead a group of peers. They felt that PAL was more effective than traditional simulations for learning. Faculty reported that students remained engaged and required minimal oversight.Unlike other simulations, our combination of brief, student-assisted cases using low-fidelity simulation provides a cost-, resource- and time-effective way to implement a medical student clerkship educational experience.