Australian Medical Schools Research Articles

Letter to the Editor Regarding “Neuroanatomy Teaching in Australian and New Zealand Medical Schools”

Letter to the Editor Regarding “Neuroanatomy Teaching in Australian and New Zealand Medical Schools”

Factors Determining Medical Students' Experience in an Independent Research Year During the Medical Program.

There is ongoing debate about best practice models to support active learning by encouraging medical students to conduct independent research projects. This study explored student satisfaction, experiences, and learning outcomes of a unique, mandatory research program in an Australian medical school. Students were invited to complete an anonymous survey ranking statements using Likert scales and completing open-ended questions. Factors predicting student satisfaction with the research year were analysed using a generalised linear regression model. A content analysis of open-ended questions was conducted. The survey was completed in October 2019 by 117 of 252 students (46%). The majority (84%) reported satisfaction with the research year. Factors associated with satisfaction were research skills learnt (OR 2.782, 95% CI 1.428-5.421; p < 0.003), supervision and support (OR = 2.587, 95% CI 1.237-5.413; p < 0.012), and meaningfulness and experience (OR = 2.506, 95% CI 1.100-5.708; p < 0.029). Qualitative results confirmed support from the faculty and supervisors, perceiving their research as meaningful, and the opportunity to learn research skills were highly regarded by students. This study has shown that learning outcomes for basic research skills and high satisfaction rates can be achieved in a mandatory undergraduate research programme when students have dedicated time for their research, opportunities to negotiate their own project, and good support from faculty and mentors. The online version contains supplementary material available at 10.1007/s40670-021-01340-9.

Abortion education in Australian medical schools.

This aim of this study was to gain an updated perspective of the teaching and learning experiences of abortion care among Australian medical students. All 2020 Australian final-year medical students were invited to complete a 12-question cross-sectional electronic survey. While it appears that abortion care is taught in most Australian medical schools, in some it is not, and where the topic is presented, structured and standardised teaching is still lacking. Students' confidence around abortion care once they are in practice is low, and the majority of students showed a strong desire to have more direct abortion placement exposure. The current abortion curriculum in Australia needs revision and refinement.

The experiences, attitudes and understanding of research amongst medical students at an Australian medical school

BackgroundResearch engagement plays an integral role in developing clinicians that practice effective, evidence-based medicine. Research participation by clinicians, however, is declining. Given the link between research during medical school and future research output, promotion of medical student research is one avenue by which this shortage can be addressed. Student research attitudes and participation in Australia are not well-documented in the literature. This study therefore aims to investigate research practices, motivators, and barriers amongst Australian medical students in order to determine whether there is a need for further integration of research within Australian medical school curriculums.MethodsA cross-sectional study design was used to explore research experience and attitudes, as well as the enablers and barriers to research amongst students enrolled in all years of the five-year medical course at Monash University. A questionnaire was created by combining questions from several surveys on medical student research and comprised Likert scales, multiple choice options and free-text responses assessing research experience, attitudes, motivators, and barriers.ResultsSeven hundred and four respondents (69.4% female; survey response rate 36.7%) reported variable research experience and interest. Less than half of the cohort (n = 296; 44.9%) had contributed to a research project. Increasing employability for specialty training programs was the primary motivating factor (n = 345; 51.9%) for pursuing research, with only 20.5% (n = 136) citing an interest in academia as a motivator. Time constraints (n = 460; 65.3%) and uncertainty surrounding how to find research opportunities (n = 449; 63.8%) were the most common barriers to research.ConclusionsMedical students at Monash University are interested in but have limited experience with research. Students are, however, primarily motivated by the prospect of increasing employability for specialist training; medical schools should therefore focus on encouraging intrinsic motivation for pursuing research. Greater integration of research education and opportunities within medical school curricula may also be required to provide students with the skills necessary to both pursue research and practice evidence-based medicine.

Moral judgement development during medical student clinical training

BackgroundWhereas experience and cognitive maturity drives moral judgement development in most young adults, medical students show slowing, regression, or segmentation in moral development during their clinical years of training. The aim of this study was to explore the moral development of medical students during clinical training.MethodsA cross-sectional sample of medical students from three clinical years of training were interviewed in groups or individually at an Australian medical school in 2018. Thematic analysis identified three themes which were then mapped against the stages and dimensions of Self-authorship Theory.ResultsThirty five medical students from years 3–5 participated in 11 interviews and 6 focus groups. Students shared the impacts of their clinical experiences as they identified with their seniors and increasingly understood the clinical context. Their accounts revealed themes of early confusion followed by defensiveness characterised by desensitization and justification. As students approached graduation, some were planning how they would make moral choices in their future practice. These themes were mapped to the stages of self-authorship: External Formulas, Crossroads and Self-authorship.ConclusionsMedical students recognise, reconcile and understand moral decisions within clinical settings to successfully reach or approach self-authorship. Curriculum and support during clinical training should match and support this progress.

Neuroanatomy Teaching in Australian and New Zealand Medical Schools

Graduate doctors' knowledge of central and peripheral nervous system anatomy is below an acceptable level. New technologies have been introduced to enhance education in the context of integrated curricula and reduced anatomy teaching hours in medical schools. However, it is unknown how varied this instruction has become between universities. This mixed methods study aimed to describe neuroanatomy teaching in medicine across Australia and New Zealand. An electronic survey was sent to Australian (n= 22) and New Zealand (n= 2) medical schools, endorsed by the Royal Australasian College of Surgeons. Academics were asked to comment on the course, content, instruction, and assessment of neuroanatomy for the 2019 academic year. Ninety-two percent (22/24) of medical schools responded. Neuroanatomy content and instructional methodology was highly variable between institutions. The average time dedicated to teaching neuroanatomy was 46.0 hours (±38.1) with a range of 12-160 hours. Prosections (77%) and models (77%) were used at most universities. Dissection was utilized at 13 of 22 (59%) universities. Incorporation of new technologies was highly variable, the most common being 3-dimensional software (59%) and eBook (55%). Adoption of any virtual reality technologies was low (36%). Seven universities used an established curriculum (29%), whereas most did not (61%). Academics indicated anxiety and motivation were key elements of student engagement. Results demonstrate widespread heterogeneity in the way neuroanatomy is taught to medical students. A standardized curriculum may improve collaboration between universities and facilitate translation of future research in the area into practice.

Leadership curricula and assessment in Australian and New Zealand medical schools

BackgroundThe Australian Medical Council, which accredits Australian medical schools, recommends medical leadership graduate outcomes be taught, assessed and accredited. In Australia and New Zealand (Australasia) there is a significant research gap and no national consensus on how to educate, assess, and evaluate leadership skills in medical professional entry degree/programs. This study aims to investigate the current curricula, assessment and evaluation of medical leadership in Australasian medical degrees, with particular focus on the roles and responsibilities of medical leadership teachers, frameworks used and competencies taught, methods of delivery, and barriers to teaching leadership.MethodsA self-administered cross-sectional survey was distributed to senior academics and/or heads or Deans of Australasian medical schools. Data for closed questions and ordinal data of each Likert scale response were described via frequency analysis. Content analysis was undertaken on free text responses and coded manually.ResultsSixteen of the 22 eligible (73%) medical degrees completed the full survey and 100% of those indicate that leadership is taught in their degree. In most degrees (11, 69%) leadership is taught as a common theme integrated throughout the curricula across several subjects. There is a variety of leadership competencies taught, with strengths being communication (100%), evidence based practice (100%), critical reflective practice (94%), self-management (81%), ethical decision making (81%), critical thinking and decision making (81%). Major gaps in teaching were financial management (20%), strategic planning (31%) and workforce planning (31%). The teaching methods used to deliver medical leadership within the curricula are diverse, with many degrees providing opportunities for leadership teaching for students outside the curricula. Most degrees (10, 59%) assess the leadership education, with one-third (6, 35%) evaluating it.ConclusionsMedical leadership competencies are taught in most degrees, but key leadership competencies are not being taught and there appears to be no continuous quality improvement process for leadership education. There is much more we can do as medical educators, academics and leaders to shape professional development of academics to teach medical leadership, and to agree on required leadership skills set for our students so they can proactively shape the future of the health care system.

A preliminary evaluation of data-informed mentoring at an Australian medical school

Introduction: In 2017, the School of Medicine of the University of Notre Dame Australia implemented a data-informed mentoring program as part of a more substantial shift towards programmatic assessment. Data-informed mentoring, in an educational context, can be challenging with boundaries between mentor, coach and assessor roles sometimes blurred. Mentors may be required to concurrently develop trust relationships, guide learning and development, and assess student performance. The place of data-informed mentoring within an overall assessment design can also be ambiguous. This paper is a preliminary evaluation study of the implementation of data informed mentoring at a medical school, focusing specifically on how students and staff reacted and responded to the initiative. Methods: Action research framed and guided the conduct of the research. Mixed methods, involving qualitative and quantitative tools, were used with data collected from students through questionnaires and mentors through focus groups. Results: Both students and mentors appreciated data-informed mentoring and indications are that it is an effective augmentation to the School’s educational program, serving as a useful step towards the implementation of programmatic assessment. Conclusion: Although data-informed mentoring is valued by students and mentors, more work is required to: better integrate it with assessment policies and practices; stimulate students’ intrinsic motivation; improve task design and feedback processes; develop consistent learner-centred approaches to mentoring; and support data-informed mentoring with appropriate information and communications technologies. The initiative is described using an ecological model that may be useful to organisations considering data-informed mentoring.

The goal of our ambition: the transformation of medical education and research at Australian Universities, 1914–20

Australian medical schools faced dramatic organisational and epistemological challenges during and after World War I. The conflict and consequent ‘Spanish’ influenza pandemic interrupted more than university teaching; it challenged the very basis of clinical practice. In particular, an emergent research culture began to redefine the nature and purpose of medical knowledge. Concurrently, wartime coordination hastened the development of specialisation, reshaping medical politics into the inter-war era. The years 1914 to 1920 thus witnessed fundamental shifts in the education, organisation and aspirations of doctors, both for their own profession and for the health of the Australian polity.

Twelve things we have learned from medical students during the Pandemic.

This article was migrated. The article was marked as recommended. While the COVID-19 pandemic has disrupted every aspect of modern life, including medical education, the response has been remarkable. Ingenuity and innovation have flourished in the face of adversity. An international community of practice has blossomed in response to the challenges posed by COVID-19. Communication and sharing of information have been a hallmark of this community. In Australasia, the Medical Education Collaborative Committee hosted a series of meetings and webinars which enabled educators from all Australian and New Zealand medical schools to share experiences, solutions and resources. This group is auspiced by the Medical Deans Australia and New Zealand, which is the peak body representing professional entry-level medical education, training and research. One of these webinars focused on the student experience, featuring a panel of Australasian medical students drawn from a range of medical schools. The discussion during this session was wide reaching, including topics such as communication, co-designing curriculum changes, the importance of compassion, innovative practice, and meaningful student participation in placements. The ideas drawn from the panel discussion augmented by rich audience participation form the basis of the twelve tips presented in this paper. While derived from the experience in Australia and New Zealand, the authors believe these lessons are likely to be relevant in other jurisdictions.

Australian university and medical school life during the 1919 influenza pandemic

PurposeThis article examines the impact of the 1919 influenza pandemic on the life and culture of Australian universities, and the curious absence of sustained discussion about the crisis in university magazines. It considers two contexts, from the perspective of the general university population, and from the particular focus of medical students.Design/methodology/approachThe primary source for this analysis is based on detailed reading of university magazines across three universities, as well as other primary and secondary literature. The article was written during the 2020 COVID-19 pandemic, which has limited access to some other magazines held in library collections, but the corpus of material is more than sufficient.FindingsThis article shows that the pandemic further deferred the resumption of university life after a hiatus during the First World War. The failure to identify the causal agent limited technical discussion in medical school magazines.Originality/valueThis is one of the first dedicated studies of the effect of the 1919 influenza pandemic on Australian universities. It joins a growing body of work considering the effect of the influenza on different community groups.

Has teaching about intellectual disability healthcare in Australian medical schools improved? A 20-year comparison of curricula audits

BackgroundPeople with intellectual disability (ID) have multiple and complex health needs, more frequent healthcare episodes, and experience poorer health outcomes. Research conducted two decades ago showed that medical professionals were lacking in the knowledge and skills required to address the complex needs of this patient group. The aim of the current study was to determine whether Australian undergraduate medical schools that offer ID health education content had changed the amount and nature of such teaching over this period.MethodsIdentical or equivalent questionnaire items were compared across eight Australian medical schools that participated in curricula audits conducted in 1995 (referred to as T1) and 2013/14 (T2). The audits were of the nature of the ID content, methods used to teach it, and who taught it.ResultsThere was no significant difference in the number of hours of compulsory ID content offered to medical students at T2 (total = 158.3 h; median = 2.8 h per ID unit) compared with T1 (total = 171 h; median = 2.5 h). At T2 compared with T1, units with ID content taught in the area of general practice had increased (2 units; 3.6% to 7 units; 16.3%), while decreases were seen in paediatrics (22 units; 40.0% to 10 units; 23.3%) and psychiatry (10 units; 18.2% to 4 units; 9.3%). The number of schools using problem- and/or enquiry-based learning rose to six at T2 from one at T1. Inclusive teaching practices (people with ID develop or deliver content) in compulsory/elective units had increased at T2 (10 units; 23.3%) compared with T1 (6 units; 10.9%), but direct clinical contact with people with ID had decreased (29 units; 52.7% to 11 units; 25.6%).ConclusionsOverall, little progress has been made to address the gaps in ID education for medical students identified from an audit conducted in 1995. Renewal of ID content in medical curricula is indicated as a key element in efforts to improve workforce capacity in this area and reduce barriers to care, with the aim of reversing the poor health outcomes currently seen for this group.

Examiners' decision-making processes in observation-based clinical examinations.

Objective structured clinical examinations (OSCEs) are commonly used to assess the clinical skills of health professional students. Examiner judgement is one acknowledged source of variation in candidate marks. This paper reports an exploration of examiner decision making to better characterise the cognitive processes and workload associated with making judgements of clinical performance in exit-level OSCEs. Fifty-five examiners for exit-level OSCEs at five Australian medical schools completed a NASA Task Load Index (TLX) measure of cognitive load and participated in focus group interviews immediately after the OSCE session. Discussions focused on how decisions were made for borderline and clear pass candidates. Interviews were transcribed, coded and thematically analysed. NASA TLX results were quantitatively analysed. Examiners self-reported higher cognitive workload levels when assessing a borderline candidate in comparison with a clear pass candidate. Further analysis revealed five major themes considered by examiners when marking candidate performance in an OSCE: (a) use of marking criteria as a source of reassurance; (b) difficulty adhering to the marking sheet under certain conditions; (c) demeanour of candidates; (d) patient safety, and (e) calibration using a mental construct of the 'mythical [prototypical] intern'. Examiners demonstrated particularly higher mental demand when assessing borderline compared to clear pass candidates. Examiners demonstrate that judging candidate performance is a complex, cognitively difficult task, particularly when performance is of borderline or lower standard. At programme exit level, examiners intuitively want to rate candidates against a construct of a prototypical graduate when marking criteria appear not to describe both what and how a passing candidate should demonstrate when completing clinical tasks. This construct should be shared, agreed upon and aligned with marking criteria to best guide examiner training and calibration. Achieving this integration may improve the accuracy and consistency of examiner judgements and reduce cognitive workload.

Medical student perceptions of curricular influences on their wellbeing: a qualitative study

BackgroundMedical student mental health and wellbeing is highly topical and the subject of much research. While theoretically informed definitions of wellbeing abound, how do medical students themselves understand and perceive wellbeing? What aspects of the curriculum do they regard as affecting their wellbeing and mental health? This study explored these questions, and aimed to identify factors associated with student acceptability of wellbeing programs and interventions.MethodsAll students at an Australian undergraduate medical school (n = 619) were invited to complete a qualitative online questionnaire between 2017 and 2018 following the introduction of several wellbeing initiatives, including “Wellbeing Days” (WBD). WBD allow students to take single absence days for self-care. Open-ended questions were asked about perceptions and experience of mental health and wellbeing, and views on interventions to improve wellbeing such as WBD. Thematic analysis was conducted across all responses. Three authors developed preliminary themes, which were then refined and confirmed by all researchers. Thematic saturation was achieved within data from the 68 respondents, which included participants from all cohorts.ResultsParticipants described wellbeing as positively experienced work/life balance, impacted by four factors; contact hours, peer relationships, staff relationships, and trust in how wellbeing initiatives were used. Long contact hours were deemed incompatible with self-care activities, maintaining employment, and seeking professional medical/psychological help. Peers could promote wellbeing by offering social and academic support, but also undermine wellbeing by being competitors. Degree of trust, engagement and communication with staff influenced acceptability of interventions. Participants viewed initiatives such as WBD favourably, but distrust of peers, and of staff, led to perceptions that WBD could be prone to misuse, or used for surveillance rather than support.ConclusionOur findings suggest that wellbeing days which allow self-care, reduction in contact hours, and peer support may promote student wellbeing, but the acceptability of any interventions is influenced by relationships between staff and students, and in particular, trust in these relationships. We suggest strategies to strengthen trust and further research to investigate the relationship between trust and perceptions of wellbeing in self and peers.

Beyond right or wrong: More effective feedback for formative multiple-choice tests.

IntroductionThe role of feedback in test-enhanced learning is an understudied area that has the potential to improve student learning. This study investigates the influence of different forms of post-test feedback on retention and transfer of biomedical knowledge within a test-enhanced learning framework.Methods64 participants from a Canadian and an Australian medical school sat two single-best-answer formative multiple choice tests one week apart. We compared the effects of conceptually focused, response-oriented, and simple right/wrong feedback on a learner’s ability to correctly answer new (transfer) questions. On the first test occasion, participants received parent items with feedback, and then attempted items closely related (near transfer) to and more distant (far transfer) from parent items. In a repeat test at 1 week, participants were given different near and far transfer versions of parent items. Feedback type, and near and far transfer items were randomized within and across participants.ResultsAnalysis demonstrated that response-oriented and conceptually focused feedback were superior to traditional right/wrong feedback for both types of transfer tasks and in both immediate and final retention test performance. However, there was no statistically significant difference between response-orientated and conceptually focused groups on near or far transfer problems, nor any differences in performance between our initial test occasion and the retention test 1 week later. As with most studies of transfer, participants’ far transfer scores were lower than for near transfer.DiscussionRight/wrong feedback appears to have limited potential to augment test-enhanced learning. Our work suggests that item-level feedback and feedback that identifies and elaborates on key conceptual knowledge are two important areas for future research on learning, retention and transfer.

Medical ethics education in Australian and New Zealand (ANZ) medical schools: a mixed methods study to review how medical ethics is taught in ANZ medical programs

The objective of this study was to review the design and delivery of medical ethics (ME) education within medical programs across Australia and New Zealand (ANZ), how current teaching has been informed by the proposed core curriculum published in 2001 by the ATEAM (Braunack-Mayer et al. 2001) and how it could look moving forward. We conducted a mixed methods study using an online questionnaire consisting of 51 items. This included both binary and open-ended questions to categorise and explore similarities and differences in medical ethics curricula in medical programs accredited by the Australian Medical Council (AMC) across ANZ. Participants were asked about curriculum design format, duration, goals, assessments, content areas of their own ME curriculum. Convenors from 18 universities responded (78%). The main commonality was that ME curricula were integrated both longitudinally and laterally with other content. There was also commonality in content areas addressed. The goals, format, educators, and assessments of the ME curricula were highly variable. Most respondents described a curriculum which prioritised knowledge and skill development related to ME. Although the core goals of including knowledge, skills, and attitudinal development in ME curricula are still present, there is no uniformity in terms of format, delivery, or assessment across medical programs in ANZ. This is an area for collaborative development.

Selling medical education to international students: time for review.

Over 600 international medical students commence training in Australian medical schools each year. Government funding policies are driving medical schools to recruit more international students. The need to lobby for intern positions for domestic graduates and for international students has placed Australia's medical schools in conflicted positions. It is time for a thorough re-examination of all aspects of medical education in Australia.

In-course and career outcomes predicted by medical school selection procedures based on personal qualities

This paper reports a 40-year follow-up of 57 graduates from the initial intake to an Australian medical school who were selected on the basis of either academic criteria alone or desirable personal qualities as assessed by non-cognitive tests and an interview (with a third small group satisfying both criteria). Both students and teaching staff have remained blind to the basis for selection until the present day. Analysis of their under- and post-graduate careers indicates that ‘academic’ entrants were more likely to complete an intercalated BMedSci degree and to become specialists, while ‘personal qualities’ entrants were more likely to graduate with honours, become GPs, and win higher degrees after graduation. However, gender more significantly predicted these outcomes, with female results similar to ‘personal qualities’ entrants and males’ similar to ‘academic.’ The results are interpreted with reference to the aims and structure of the Newcastle medicine curriculum.

Dissecting the Student Experience at Australian Medical Schools, 1884–1912

Abstract Historians of medicine have observed that the student experience of medical school is difficult to capture. While students sometimes left behind notebooks containing lecture notes and diagrams, there is often little evidence that illuminates their lived experiences and responses to their education. This article analyses written submissions to the publication of the Melbourne Medical Students’ Society, Speculum, between 1884 and 1912, to argue that students at the Melbourne Medical School in this era actively participated in discussions about the curriculum on offer, were highly aware of the moral and ethical consequences of their actions in the dissecting room and took great interest in the advancements and debates of the medical profession. It reclaims the student experience of medical school, which has often been hidden in favour of history written from the perspective of those in positions of power, to offer fresh insights into the history of medical education.

Journal clubs in Australian medical schools: prevalence, application and educator opinion.

PurposeMedically-focused journal clubs have been used as an educational tool for over 100 years, with research indicating that they improve knowledge, reading behaviour, and critical appraisal skills. However, it is unknown how widespread they are in Australian medical schools, nor the opinions of medical education leaders as to their value.MethodsA nationwide cross-sectional study was performed among academic leaders from every Australian medical school. Individuals were asked to complete a survey detailing their attitudes towards journal clubs using single- or multiple-answer questions, Likert scales, and ranked data. They were asked whether students at their institutions were able to partake in journal clubs, and if so, provided details on their implementation.ResultsAt least 1 response was collected from 18 of 19 Australian medical schools. The response rate was 40.8% (60 of 147), and 36 responses (60.0%) were from heads of clinical schools. Respondents from 15 of 18 institutions (83.3%) stated that their institution had a journal club. Of these, 23 (65.7%) were metropolitan institutions and 12 (34.3%) were rural institutions. Eighteen (51.4%) journal clubs were clinician-led, 13 (37.1%) were run through specific hospital departments, and 23 (65.7%) occurred during clinical years. Most respondents (20 [57.1%]) stated that the primary aim of the journal club was to develop critical appraisal skills.ConclusionJournal clubs are a highly regarded educational tool in the armoury of medical school educators, with significant heterogeneity in their structure, geographic prevalence, and intended purpose. Further studies of their efficacy in teaching evidence-based medicine is warranted.