Abstract
BackgroundRecent meta-analyses have found small-moderate positive associations between general performance in medical school and postgraduate medical education. In addition, a couple of studies have found an association between poor performance in medical school and disciplinary action against practicing doctors. The aim of this study was to examine if a sample of Danish residents in difficulty tended to struggle already in medical school, and to determine whether administratively observable performance indicators in medical school could predict difficulties in residency.MethodsThe study design was a cumulative incidence matched case–control study. The source population was all active specialist trainees, who were medical school graduates from Aarhus University, in 2010 to June 2013 in two Danish regions. Cases were doctors who decelerated, transferred, or dropped out of residency. Cases and controls were matched for graduation year. Medical school exam failures, grades, completion time, and academic dispensations as predictors of case status were examined with conditional logistic regression.ResultsIn total 89 cases and 343 controls were identified. The total number of medical school re-examinations and the time it took to complete medical school were significant individual predictors of subsequent difficulties (deceleration, transferral or dropout) in residency whereas average medical school grades were not.ConclusionsResidents in difficulty eventually reached similar competence levels as controls during medical school; however, they needed more exam attempts and longer time to complete their studies, and so seemed to be slower learners. A change from “fixed-length variable-outcome programmes” to “fixed-outcome variable-length programmes” has been proposed as a way of dealing with the fact that not all learners reach the same level of competence for all activities at exactly the same time. This study seems to support the logic of such an approach to these residents in difficulty.
Highlights
Recent meta-analyses have found small-moderate positive associations between general performance in medical school and postgraduate medical education
Much of the existing research on residents in difficulty appears to be originating from English-speaking countries, in particular the US and the UK [8,9,10,11], a situation which may lead to systematic bias
This study reports the results of a case–control study that examined medical school predictors of struggling to complete residency training as planned
Summary
Recent meta-analyses have found small-moderate positive associations between general performance in medical school and postgraduate medical education. A couple of studies have found an association between poor performance in medical school and disciplinary action against practicing doctors. Residents in difficulty may suffer and strain the learning environment and patient care [2] It has been reported in the international literature that around 3–10% of doctors in postgraduate training are. One meta-analysis including international studies reported a small effect size for previous academic performance as predictors of postgraduate performance [8]. A couple of studies have examined factors associated with extremely poor performances of practicing doctors [5,12,13]. No cohort study on the risk factors for being a resident in difficulty in a Danish context has previously been published nationally or internationally
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