Final Year Of Medical School Research Articles

The Key Role of a Transition Course in Preparing Medical Students for Internship

Among the core transitions in medical education is the one from medical school to residency. Despite this challenging transition, the final year of medical school is known as lacking structure and clarity. The authors examine the preparation of medical students for the professional and personal challenges of internship in the context of transition courses. They first describe the development of a residency transition course, offered since 2001 at the University of California, San Francisco, School of Medicine (UCSF), exploring aspects of a needs assessment, course goals and content, core competencies, and course implementation. They then critically analyze the course, judging it successful based on high subjective satisfaction scores and increased perceived preparedness data. Next, the authors discuss the national context of transition courses, perspectives of various stakeholders, and lessons learned from the UCSF experience. Finally, they consider future directions, suggesting that internship transition courses be a standard part of the medical school curriculum.

Differences in Final Product of a Bowel Anastomosis of Male and Female Novice Surgeons

There is a disproportionate ratio of male to female surgeons when compared with the ratio at medical school. Although gender differences in surgical technical ability is not known, studies have shown gender differences in visuospatial ability and manual dexterity. We devised a study to assess objectively the quality of final product of small bowel anastomosis in male and female novice surgeons to explore differences in surgical technical ability. Thirty-six novice surgeons in the final year of medical school with minimal surgical experience were taught surgical knot tying and small bowel suturing. The students were asked to complete 7 small bowel anastomosis in 7 separate sessions. The quality of the final product was assessed looking at the "fine details" (number of sutures and accuracy, ie, ratio of sutures piercing the full thickness of the bowel) and the "gross apposition" of the bowel ends at the anastomotic site. A grading system for apposition was devised to assess apposition. The results with fine details and accuracy of suturing revealed that female surgeons were significantly better in the fourth to the sixth sessions with no gender difference in the number of sutures placed. With gross apposition at the anastomotic ends, male surgeons were consistently better between the third to the sixth session. However, these differences were eliminated with training. Known gender differences in visuospatial ability and manual dexterity may explain the initial gender differences in the quality of the final product. However, these differences were not present by the end of the training sessions. Therefore, with training, no difference in surgical technical ability was found between male and female novice surgeons.

Passion for Sports Used to Defeat Mental Illness

Passion for Sports Used to Defeat Mental Illness

A 1-Week Simulated Internship Course Helps Prepare Medical Students for Transition to Residency

The transition from medical student to intern is inherently stressful, with potentially negative consequences for both interns and patients. We describe Internship Boot Camp, an innovative course specifically designed to prepare fourth-year medical students for the transition from medical school to internship. An intensive 1-week course, Internship Boot Camp has simulated, longitudinal patient-care scenarios that use high-fidelity medical simulation, standardized patients, procedural task trainers, and problem-based learning to help students apply their knowledge and develop a framework for response to the challenges they will face as interns. In March 2007, 12 students participated in the course as an elective in their final year of medical school, and the other 28 students in their class did not. After beginning internship and 5 to 7 months after the completion of Internship Boot Camp, all 40 former students were asked to complete a blinded survey about their preparation for internship. The overall response rate for the survey was 80%. Of responders to an open-ended question about the aspects of medical school training that best prepared them for internship, 89% (8 of 9) of course participants listed "Internship Boot Camp." The next highest response ("subinternship") was given by 45% (9 of 20) of nonparticipants and 33% (3 of 9) of course participants. Internship Boot Camp is a unique learning environment that is recalled by participants as the most helpful, of all components of their medical school education, in preparation for internship.

Factors at medical school and work related to exhaustion among physicians in their first postgraduate year

Background: Burnout and stress is frequently reported in young physicians but longitudinal studies are sparse. Exhaustion is a core facet of burnout. Aims: To study individual and environmental medical school predictors and associated working conditions of postgraduate exhaustion, with a reference to gender. Methods: Two cohorts of junior doctors (n=253, 58% women) graduated from Karolinska Institutet were assessed in medical school (2002 and 2005) and in their first postgraduate year (2003 and 2006). Baseline measures were: Performance-based self-esteem (PBSE), study conditions (Higher Education Stress Inventory, HESI) and exhaustion, and at follow-up exhaustion (Oldenburg Burnout Inventory, OLBI) and Learning climate in the clinic. Regression analyses on postgraduate exhaustion (OLBI) were performed in four steps. First PBSE gender and age was entered, second study conditions (HESI), third working conditions (Learning climate in the clinic), and finally we controlled for exhaustion at final year of medical school. Results: Response rate was 73%. Worries about future endurance/capacity (WFEC; HESI) predicted postgraduate exhaustion, but not PBSE, when baseline exhaustion was controlled for. Women's higher exhaustion scores were explained by their higher WFEC. A positive Learning climate was negatively associated with exhaustion. Conclusions: High WFEC was a risk factor of exhaustion to which women were more subjected. Students with high doubts of themselves may benefit from specific programmes in medical school, addressing this risk. A positive Learning climate at follow-up seemed protective, although no conclusions on direction of causality can be made. The effect of PBSE needs further study.

Prevalência da infecção tuberculosa em universitários da Universidade Estadual de Montes Claros, Minas Gerais

O objetivo deste estudo foi conhecer a taxa de infecção pelo bacilo da Tuberculose entre estudantes dos dois primeiros e dois últimos períodos dos cursos de Medicina e Enfermagem da Universidade Estadual de Montes Claros, além de verificar o conhecimento sobre a transmissão e prevenção da tuberculose ocupacional, bem como a utilização destas medidas preventivas. Realizou-se estudo transversal, em que todos os estudantes dos dois períodos iniciais e dois períodos finais do curso de Medicina e de Enfermagem foram submetidos a um questionário padrão e ao teste tuberculínico (PPD), para determinar a prevalência de infecção por tuberculose. Os resultados mostraram diferença de reação ao teste tuberculínico nos estudantes dos períodos iniciais e finais do curso médico, enquanto nos estudantes de Enfermagem não houve diferença entre os períodos. Ficou evidenciado o limitado conhecimento sobre a transmissão e prevenção da aquisição de tuberculose, o que aumenta os riscos de aquisição do bacilo.

MEDICAL STUDENTS' GENDER-SPECIFIC EXAMINATION PERFORMANCE

In this study the experiences of final-year medical students performing gender-specific examinations were assessed. In 2006, all students in the final year of medical school at the University of Erciyes, Turkey, were given a questionnaire containing 17 questions on gender-specific examinations. A total of 200 (94%) students completed the questionnaire. Female students were less confident in performing male genital and prostate examinations. In this study, it was demonstrated that there was suboptimal exposure to gender-specific examinations, resulting particularly in less than confident female students. Student logbooks should be used more accurately and efficiently to increase opportunities to perform gender-specific examinations.

Aspirations et exercice professionnel futur des jeunes orthopédistes français: Étude sociologique

Medical demographics have become a major public health issue in France since the publication of the Berlan report in 2002 which announced an upcoming shortage in the next 20 years. But demographic projections cannot be limited to an accounting of training and retirement figures. Other factors such as demographic distribution, changing societal aspirations (free time), modes and sites of occupational activities, the influence of feminization, and initial training and its effects on professional practice must be taken into consideration. The purpose of this work was to study these parameters in orthopedic and traumatology surgery. This was a sociological study designed to ascertain the aspirations of junior orthopedic surgeons. Forty-seven interns in orthopedic surgery in the Paris area were invited to complete a questionnaire in March 2003. Forty-two responded. The choice of orthopedics was an intellectual choice. The attractiveness of the specialty was particularly important during the final years of medical school. Fewer junior surgeons would rather practice in a university hospital setting, more preferring a mixed setting with a private (fees) and a public (salary) component. The desire for “free time” was particularly important. Fewer juniors wanted to practice in general hospitals. For orthopedic surgeons, private practice and payment by fees are the cornerstones of medical practice.

Clinical training in the Top End: impact of the Northern Territory Clinical School, Australia, on the Territory's health workforce

The Northern Territory Clinical School (NTCS), a teaching site of the Flinders University School of Medicine, was established in Darwin, Northern Territory (NT; 1997) in response to a need for regional clinical training. An enrolment quota of NT resident, Aboriginal and Torres Strait Islander students was implemented to encourage the recruitment of local applicants to the medical program. The objective of this study was to assess the impact of the NTCS and the quota program on the NT health workforce at the intern and junior doctor levels. A database was constructed to compile the training location, quota participation, place of internship, and NT medical registration of 452 Flinders School of Medicine graduates (1999-2005). Statistical analysis of de-identified data yielded outcomes regarding length of placement in the NT, internship state, and registration by the NT medical board. Students enrolled with the NTCS elected to spend significantly more time in the NT during their final year of medical school than non-NTCS Flinders University students (16.7 +/- 7.9 weeks vs 1.9 +/- 3.9 weeks; p<0.01). Quota students undertook longer NT placements than their non-quota NTCS peers (20.4 +/- 8.9 weeks vs 15.3 +/- 6.9 weeks; p<0.05). A significant proportion (54%) of NTCS alumni completed their internship training in the NT, and NTCS students were more than 10 times more likely to spend their intern year in the NT than non-NTCS Flinders graduates. Of the quota cohort, 70% chose an internship position at NT hospitals. Likewise, NTCS students were more than 10 times as likely to have current or expired registration on the NT medical register as other Flinders School of Medicine graduates. The NTCS has trained over 140 medical students, many of which have joined the NT health workforce as interns and junior doctors. The quota program has been an effective method of enlisting local students who express an interest in living and studying in the NT. Current studies are underway to assess the impact of NTCS recruitment and training strategies on the regional workforce shortage. This preliminary data supports the concept that 'training locals locally' has had positive outcomes for the NT health workforce.

Job Stress in Young Physicians with an Emphasis on the Work-Home Interface: A Nine-Year, Nationwide and Longitudinal Study of its Course and Predictors

Although physicians are known to experience more stress than other workers, knowledge is lacking on the course of stress from a longitudinal perspective. This study explored the course of and contributors to, different dimensions of early career job-stress among physicians by means of a nationwide mail survey, with a particular emphasis on stress relating to the work-home interference. All physicians graduating from all four Norwegian universities in 1993 / 94 (N=631), responded during their final year of medical school (N=522), during their internship (N=402), in their 4th postgraduate year (N=422), and in their 10th postgraduate year (N=390). The mean observation period was 9.2 yr (SD=0.5). The main outcomes were job stress dimensions derived from an established job stress questionnaire (Cooper / Tyssen), with emphasis placed on dimensions of the work-home interference. Stress relating to the work-home interference increased during the observation period for both genders (repeated measures: beta=0.06, p<0.05), whereas stress relating to emotional pressure, time pressure, and fear of complaints and criticism, decreased. Stress relating to the work-home interference increased during their early career, mainly due to a lack of adaptive reduction in work hours and an increased number of children. Neuroticism, conscientiousness, and lack of support from one's partner and colleagues, appeared to be predictive of this stress.

Swiss residents' speciality choices – impact of gender, personality traits, career motivation and life goals

BackgroundThe medical specialities chosen by doctors for their careers play an important part in the development of health-care services. This study aimed to investigate the influence of gender, personality traits, career motivation and life goal aspirations on the choice of medical speciality.MethodsAs part of a prospective cohort study of Swiss medical school graduates on career development, 522 fourth-year residents were asked in what speciality they wanted to qualify. They also assessed their career motivation and life goal aspirations. Data concerning personality traits such as sense of coherence, self-esteem, and gender role orientation were collected at the first assessment, four years earlier, in their final year of medical school. Data analyses were conducted by univariate and multivariate analyses of variance and covariance.ResultsIn their fourth year of residency 439 (84.1%) participants had made their speciality choice. Of these, 45 (8.6%) subjects aspired to primary care, 126 (24.1%) to internal medicine, 68 (13.0%) to surgical specialities, 31 (5.9%) to gynaecology & obstetrics (G&O), 40 (7.7%) to anaesthesiology/intensive care, 44 (8.4%) to paediatrics, 25 (4.8%) to psychiatry and 60 (11.5%) to other specialities. Female residents tended to choose G&O, paediatrics, and anaesthesiology, males more often surgical specialities; the other specialities did not show gender-relevant differences of frequency distribution. Gender had the strongest significant influence on speciality choice, followed by career motivation, personality traits, and life goals. Multivariate analyses of covariance indicated that career motivation and life goals mediated the influence of personality on career choice. Personality traits were no longer significant after controlling for career motivation and life goals as covariates. The effect of gender remained significant after controlling for personality traits, career motivation and life goals.ConclusionGender had the greatest impact on speciality and career choice, but there were also two other relevant influencing factors, namely career motivation and life goals. Senior physicians mentoring junior physicians should pay special attention to these aspects. Motivational guidance throughout medical training should not only focus on the professional career but also consider the personal life goals of those being mentored.

Negative stress-coping strategies among novices in surgery correlate with poor virtual laparoscopic performance

This study explored the impact of habitual stress-coping strategies on the laparoscopic performance of novices in surgery using a virtual reality simulator. The SVF78 stress-coping questionnaire was administered to 12 medical students in their final year of medical school (camera holders) and to 12 inexperienced surgical residents (postgraduate years 1-3). The questionnaire included devaluation during stressful situations, distractions from stressful situations, control over stressful reactions and negative coping strategies such as stress avoidance and need for social support. Assessment of laparoscopic dexterity was based on the results of performance on a virtual reality simulator. The variables of time taken to complete the task, errors and economy of motion were analysed, with a higher score indicating poor performance. Pearson and non-parametric Spearman correlations were used to compare the subjects' results on the SVF78 with those on the LapSim. Time taken to complete the task correlated with high values in distractive stress-coping strategies (P = 0.002) and high values in negative stress-coping strategies (P = 0.042). Ineffective stress-coping strategies correlate with poor virtual laparoscopic performance. The need for effective intraoperative stress-coping strategies is evident.

97: 12-Lead Electrocardiogram Interpretation Skills of Senior Medical Students Entering Emergency Medicine, Family Practice, and Internal Medicine Residency Training Programs

Electrocardiogram (ECG) interpretation is an important clinical skill for senior medical students (MS) entering emergency medicine (EM), family practice (FP), and internal medicine (IM) residency programs. Research shows senior MS have deficiencies in ECG interpretation and that these skills do not change over the final year of medical school. However, little information is available describing these skills among senior MS entering these programs. This study aims to describe how residency aspiration impacts ECG interpretation skills.

Cardio-pulmonary resuscitation training, knowledge and attitudes of newly-qualified doctors in New Zealand in 2003

To assess the resuscitation knowledge and confidence of newly-qualified doctors in New Zealand (NZ) in 2003. Anonymous questionnaires were distributed to all newly-qualified doctors in NZ (n=279). Two hundred and thirty-three respondents from hospitals throughout NZ (84% response rate). Resuscitation training received during medical school and use of recommended text (Level 7 of NZ resuscitation manual), confidence in resuscitation skills and core knowledge of basic and advanced resuscitation. 98.3% of doctors received advanced resuscitation training during their final year of medical school, of these 64.6% had received training in the previous 6 months. The mean knowledge score was 56.6% and 45% of doctors made 'fatal errors'. Eighty-four percentage of doctors had read the Level 7 manual and 72.6% found it very or extremely useful. Those who had read the manual had higher scores and were less likely to make a 'fatal error'. Having attended a cardiac arrest and having received training within the last 6 months improved doctor confidence in resuscitation. The resuscitation knowledge and confidence of newly-qualified doctors in NZ are sub-optimal, with some doctors displaying dangerous deficiencies. Our results suggest mandatory attainment of an advanced resuscitation certificate, six-monthly practical resuscitation sessions and increased exposure to real resuscitation situations should be implemented to improve undergraduate resuscitation training.

Sleep Deprivation in Junior Doctors-House Officers in Singapore

House officers are known to endure marked levels of sleep deprivation in administration of their duties. We aim to establish sleep patterns of local house officers while on the job and the impact it might have on their mood and sleepiness state. We also studied their sleep during their final year of medical school and pre-university for identification of any prior sleep deprivation. Questionnaires were used to assess sleep and mood change. Sleepiness levels on the day after call were assessed using the Stamford Sleepiness Scale. Subjects were found to sleep a median of only 1.0 (+/- 2.0) h per night on call and 6.0 h (+/- 1.0) per non-call night. They suffered median of 5 interruptions (+/- 5) during sleep on one night call. Night call was found to adversely affect mood in 89.5% of the subjects while daytime sleepiness levels following call were found to increase the more the time spent at work after call. Subjects were found to have had 6.5 h (+/- 1.0) of sleep per night during final year of medical school and 8.0 h (+/- 1.0) in final year of pre-university. House officers enter the profession chronically sleep-deprived. The call schedule and general work regime further add to the existent sleep deprivation and may have adverse consequences on patient care and doctor's health. This calls for measures to be instituted for provision of proper sleep and work hours for them.

Selection of neurosurgical trainees.

Medical students in Canada must make career choices by their final year of medical school. Selection of students for a career in neurosurgery has traditionally been based on marks, reference letters and personal interviews. Studies have shown that marks alone are not accurate predictors of success in medical practice; personal skills and attributes which can best be assessed by letters of reference and interviews may be more important. This study was an attempt to assess the importance of, and ability to teach, personal skills and attitudes necessary for successful completion of a neurosurgical training program. A questionnaire was sent to 185 active members of the Canadian Neurosurgical Society, asking them to give a numerical rating of the importance of 22 personal skills and attributes, and their ability to teach those skills and attributes. They were asked to list any additional skills or attributes considered important, and rate their ability to teach them. Sixty-six (36%) questionnaires were returned. Honesty, motivation, willingness to learn, ability to problem solve, and ability to handle stress were the five most important characteristics identified. Neurosurgeons thought they could teach problem solving, willingness to consult informed sources, critical thinking, manual dexterity, and communication skills, but honesty, motivation, willingness to learn and ability to handle stress were difficult or impossible to teach. Honesty, motivation, willingness to learn, ability to problem solve and handle stress are important for success in a neurosurgical career. This information should be transmitted to medical students at "Career Day" venues. Structuring letters of reference and interviews to assess personal skills and attributes will be important, as those that can't be taught should be present before the start of training.

The shortened Study Process Questionnaire: an investigation of its structure and longitudinal stability using confirmatory factor analysis.

The Study Process Questionnaire (SPQ) is a widely used measure of learning approach and was proposed to have three orientations: surface, deep, and achieving, each with an underlying motive and strategy. This study aimed to examine the factor structure and longitudinal stability over five to seven years of a modified shortened 18-item version of the SPQ. A total of 1349 medical students completed the shortened SPQ at application and in their final year of medical school. Three additional cohorts of students completed the shortened SPQ during their third and fourth year of medical school (sample size: 194, 203, 174). Confirmatory factor analysis was used to examine the dimensionality and longitudinal stability of the shortened SPQ. Like the full 42-item version, the shortened SPQ has six subscales and the data are best fit by three second order shared indicator factors (surface, deep and achieving) and a single higher order composite deep-achieving factor. The longitudinal analysis found 26.8%, 26.3%, and 18.7% of the non-attenuated variance of the surface, deep and achieving factor scores in the final year is predicted from the shortened SPQ completed at application to medical school. The shortened 18-item SPQ has the same six subscales as the full SPQ as well as three second order shared indicator factors (surface, deep, achieving) and one higher order deep-achieving factor similar to that suggested by Biggs (1987). The longitudinal analysis supports this hypothesis and suggests that these learning approaches are partly stable during medical school undergraduate training and partly modifiable under the influence of the educational environment.

University of New Mexico School of Medicine.

University of New Mexico School of Medicine.

Simulated patients for the practical examination of medical students: intentions, procedures and experiences

This paper presents intentions, procedures and experiences related to a simple method for training simulated patients for undergraduate examinations set up as clinical consultations. The examinations took place in the final year of medical school, at the Division for General Practice, University of Bergen, Norway. Thirty-six medical students were assessed by the use of five primary-school teachers serving as simulated patients and 18 authentic patients. Field notes from the process, observations during the examinations, written evaluation from the students and transcript of audiotape from focus group setting with the simulants are presented. Simulants were trained and prepared to simulate common health problems during a brief procedure which seemed to be sufficient as long as standardization was not aimed for. Simulants were not detected from among the ordinary patients by the students. Even the authentic patients did some level of role playing, which must be accounted for in future preparation. Simulants may by means of brief preparatory instructions serve as useful and realistic supplements to authentic patients in the practical examination of undergraduate medical students.