Graduate Entry Medical Program Research Articles

Reflections of students graduating from a transforming medical curriculum in South Africa: a qualitative study

BackgroundThe six year medical programme at the University of the Witwatersrand admits students into the programme through two routes – school entrants and graduate entrants. Graduates join the school entrants in the third year of study in a transformed curriculum called the Graduate Entry Medical Programme (GEMP). In years I and 2 of the GEMP, the curriculum is structured into system based blocks. Problem-based learning, using a three session format, is applied in these two years. The curriculum adopts a biopsychosocial approach to health care, which is implemented through spiral teaching and learning in four main themes – basic and clinical sciences, patient-doctor, community- doctor and personal and professional development. In 2010 this programme produced its fifth cohort of graduates.MethodsWe undertook a qualitative, descriptive and contextual study to explore the graduating students’ perceptions of the programme. Interviews were conducted with a total of 35 participants who volunteered to participate in the study. The majority of the participants interviewed participated in focus group discussions. The interviews were transcribed verbatim and analysed thematically, using Tesch’s eight steps. Ethics approval for the study was obtained from the Human Research Ethics Committee of the University of the Witwatersrand. Participants provided written consent to participate in the interviews and for the interviews to be audio-taped.ResultsSix themes were identified. These were: two separate programmes, problem-based learning and Garmins® (navigation system), see patients for real, being seen as doctors, assessment: of mice and MCQ’s, a cry for support and personal growth and pride. Participants were vocal in their reflections of experiences encountered during the programme and made several insightful suggestions for curriculum transformation. The findings suggest that graduates are exiting the programme confident and ready to begin their internships.ConclusionsThe findings of this study have identified a number of areas which need attention in the curriculum. Specifically attention needs to be given to ensuring that assessment is standardized; student support structures and appropriate levels of teaching. The study demonstrated the value of qualitative methods in obtaining students’ perceptions of a curriculum.

Benefits and challenges of focus groups in the evaluation of a new Graduate Entry Medical Programme

Programme evaluation is essential for quality assurance in education. In this paper, we describe our evaluation strategy for the first year of a new medical programme. Although we used multiple methods in the evaluation, the use of the focus group method was core. This paper reports our experiences of focus groups for this purpose. We describe the implementation of the strategy including the development of topic guides, interviewer training, respondent recruitment, record keeping, template production, transcription, analysis and reporting of results. Using interviewer notes and individual interviews with focus group interviewers and participants, we evaluated focus groups as a method in educational programme evaluation. Focus groups are the most important evaluation method in helping us measure the extent to which we have met the goals of the first year of our programme. Benefits include generating detailed information in a relatively short time. Focus groups are largely valued by participants and appear to be contributing to the development of an ‘evaluation culture’ in our new medical school. They are also building our capacity and capability in qualitative research methods. Challenges include the human resource intensive nature of scheduling, transcribing, analysing and report writing.

Student approaches for learning in medicine: What does it tell us about the informal curriculum?

BackgroundIt has long been acknowledged that medical students frequently focus their learning on that which will enable them to pass examinations, and that they use a range of study approaches and resources in preparing for their examinations. A recent qualitative study identified that in addition to the formal curriculum, students are using a range of resources and study strategies which could be attributed to the informal curriculum. What is not clearly established is the extent to which these informal learning resources and strategies are utilized by medical students. The aim of this study was to establish the extent to which students in a graduate-entry medical program use various learning approaches to assist their learning and preparation for examinations, apart from those resources offered as part of the formal curriculum.MethodsA validated survey instrument was administered to 522 medical students. Factor analysis and internal consistence, descriptive analysis and comparisons with demographic variables were completed. The factor analysis identified eight scales with acceptable levels of internal consistency with an alpha coefficient between 0.72 and 0.96.ResultsNearly 80% of the students reported that they were overwhelmed by the amount of work that was perceived necessary to complete the formal curriculum, with 74.3% believing that the informal learning approaches helped them pass the examinations. 61.3% believed that they prepared them to be good doctors. A variety of informal learning activities utilized by students included using past student notes (85.8%) and PBL tutor guides (62.7%), and being part of self-organised study groups (62.6%), and peer-led tutorials (60.2%). Almost all students accessed the formal school resources for at least 10% of their study time. Students in the first year of the program were more likely to rely on the formal curriculum resources compared to those of Year 2 (p = 0.008).ConclusionsCurriculum planners should examine the level of use of informal learning activities in their schools, and investigate whether this is to enhance student progress, a result of perceived weakness in the delivery and effectiveness of formal resources, or to overcome anxiety about the volume of work expected by medical programs.

Student perception of a new integrated anatomy practical program: Does students' prior learning make a difference?

While there is evidence that science and non-science background students display small differences in performance in basic and clinical sciences, early in a 4-year, graduate entry medical program, this lessens with time. With respect to anatomy knowledge, there are no comparable data as to the impact previous anatomy experience has on the student perception of the anatomy practical learning environment. A study survey was designed to evaluate student perception of the anatomy practical program and its impact on student learning, for the initial cohort of a new medical school. The survey comprised 19 statements requiring a response using a 5-point Likert scale, in addition to a free text opportunity to provide opinion of the perceived educational value of the anatomy practical program. The response rate for a total cohort of 82 students was 89%. The anatomy practical program was highly valued by the students in aiding their learning of anatomy, as indicated by the high mean scores for all statements (range: 4.04-4.7). There was a significant difference between the students who had and had not studied a science course prior to entering medicine, with respect to statements that addressed aspects of the course related to its structure, organization, variety of resources, linkage to problem-based learning cases, and fairness of assessment. Nonscience students were more positive compared to those who had studied science before (P levels ranging from 0.004 to 0.035). Students less experienced in anatomy were more challenged in prioritizing core curricular knowledge. Clin. Anat. 24:664-670, 2011. © 2011 Wiley-Liss, Inc.

Student Facilitated PBL – A Capstone Collaborative Learning Experience in the Griffith University MBBS Program.

We report on an innovation in teaching and learning designed to extend the collaborative learning of PBL, that occurs during the first two years of a four year graduate entry medical program, to a capstone learning experience to assist the transition to a hospital based year 3. During the last five weeks of Year 2 the PBL sessions consist of an initial student facilitated session early in the week followed by a large format session for the entire class convened by two clinicians. The new format PBL was perceived positively by the students and staff involved and may have advantages over traditional formats in developing studentsâ?? clinical reasoning and differential diagnosis skills.

The evaluation of bedside teaching - an instrument for staff evaluation and student experience: A pilot study at a South African University

Background. Bedside teaching is the core teaching strategy in the clinical study years of the medical undergraduate degree at the University of the Witwatersrand. The quality of this teaching strategy has not been formally evaluated by students as other teaching strategies have been. Method. A quantitative, descriptive study was undertaken in the final year of study of the graduate entry medical programme (GEMP). The sample comprised medical students who were completing their surgical block during September and November 2008. There were approximately 30 students in each of these 2 blocks. A bedside teaching evaluation questionnaire was developed, based on previously validated peer review questionnaires used in evaluating small group formal classroom-based lectures. The purpose of the study was to determine the reliability of the instrument for evaluating bedside teaching. Results. A sample of 112 evaluations was obtained and the constructs and sub-constructs were subjected to an analysis using Cronbach’s alpha. Conclusion. The overall Cronbach’s alpha was 0.9627, demonstrating that the instrument is reliable and can be used to evaluate bedside teaching.

Cross-institutional progress testing: feasibility and value to a new medical school

This study aimed to examine the feasibility of using a progress test to compare the rate of knowledge acquisition among students at a new medical school with that of students at a comparable but long-established school. As part of an ongoing strategy, we administered the McMaster Personal Progress Index (PPI) on four occasions to the first two cohorts of students enrolled in the graduate-entry medical programme at the University of Limerick. We compared mean PPI scores for students at comparable stages in their courses at both schools. To date, the rate of knowledge acquisition is similar in students at both schools. Inter-institutional and international collaboration in progress testing is feasible and provides a useful quality assurance tool which can be used by new schools to reassure students, faculty members and accrediting bodies.

Effective teaching and learning on the wards: easier said than done?

The aim of this study was to evaluate the teaching and learning during a clinical placement, and to draw lessons from the findings to inform medical educators about more efficient and effective ways of teaching and learning. This study involved students and teachers from a final year clinical placement on a graduate-entry medical programme. Questionnaires, focus groups, unstructured observation and structured observation using time sampling were used to elicit student and clinician perceptions of various learning opportunities. Analysis revealed positive perceptions of the variety of different learning opportunities available to final year students undertaking a clinical rotation, as well as a high degree of congruency between student and clinician perceptions of these. Questionnaire data indicated that both groups valued hands-on learning and a broad knowledge base. Analysis of observation variables revealed a dominance of passive and low-level cognitive actions across learning sessions, particularly (and counter-intuitively) during bedside teaching. This study highlighted a number of strengths and weaknesses in the clinical teaching that took place during these rotations. In particular, it highlighted congruency between student and teacher perceptions of good teaching and learning. At the same time, it flagged a potential disjunct between student and teacher expectations (or understandings) of various learning opportunities, and revealed a much broader disconnection between what is most valued and what is easiest to deliver in the clinical context. The results emphasise the need for quality rather than quantity, contextual blended learning, protected teaching time, the valuing of close student-teacher interaction and faculty development.

The financial costs of delivering problem-based learning in a new, graduate-entry medical programme

In discussions of the merits and limitations of problem-based learning (PBL) as an educational methodology, the cost of its delivery is often cited as a significant issue. Although there appears to be no shortage of opinion as to the perceived cost of PBL, we know of no institution that has accurately measured its cost, even in financial terms. Where factual information is lacking, opinion and misconception tend to proliferate. In setting up a new, graduate-entry medical programme on a greenfield site at the University of Limerick, we took the opportunity to calculate both the initial and recurring costs of our particular approach to the delivery of PBL. We calculated the initial cost of providing purpose-built facilities to deliver PBL to 240 students in the first 2 years of our 4-year programme. We also calculated the annual recurring costs of delivering PBL, based on having a student : tutor ratio of 8 : 1 and on having tutors who are all medically qualified, who are reasonably well remunerated for their work and who each deliver 5 hours of PBL tutoring per week. The initial cost of delivering PBL was calculated as euro 1,526,952 (equivalent to pound sterling 1,369,138 or US$2,050,375). The annual recurring cost of PBL approximates euro 664,000/year (at time of writing equivalent to pound sterling 527,000 and US$988,000). This recurring cost equates to euro 2767/student/year, 89% of which relates to tutor salaries. Although the cost of delivering PBL will be greatly influenced by the approach taken at different institutions, we hope that a breakdown of costs at our institution will contribute to the ongoing debate on the strengths and weaknesses of PBL.

The ???Pyramid of Professionalism???: Seven Years of Experience With an Integrated Program of Teaching, Developing, and Assessing Professionalism Among Medical Students

The authors report on an integrated program of teaching, developing, and assessing professionalism as well as managing unprofessional behavior referrals and supporting students through the Personal and Professional Development Committee (PPDC) in the four-year, graduate-entry medical program at the School of Medicine, University of Queensland, Australia. Two thousand six hundred thirty medical students have participated in the ethics and professional practice teaching program from 2000 to 2006. They were assessed through formal examination; students who did not satisfy requirements completed supplementary examinations. One student failed a year on the basis of formal examination. Instructors referred 507 students (19% of all enrolled) during the seven-year period to the PPDC, which interviewed 142 (25%; 5% of all enrolled) at least once; 25 of these more than once. In all, 711 reports were submitted to the PPDC, 420 (55%) for unsatisfactory attendance only and 291 (45%) for other concerns. Most of these related to "responsibility/reliability" (46.7%) and "participation" (41.9%);12.4% related to "honesty/integrity [corrected] The PPDC referred four students to the board of examiners, and two students failed a year for persistent unprofessional behavior. The authors established a Pyramid of Professionalism whose foundation is a formal curriculum of medical ethics, law, and professionalism. At higher levels, the pyramid mirrors Australia's medical regulatory processes, combining nonpunitive support with the possibility of sanctions, by mediating and sometimes remediating a range of notified concerns. Students who persist in behaving unprofessionally or in seriously unacceptable ways have failed academically on professionalism grounds.

Clinical Location and Student Learning: Outcomes From the LCAP Program in Queensland, Australia

Background: Three students in the 3rd year of a graduate entry medical program self-selected to participate in a 1-year clinical placement, each with a rural general practitioner in central western Queensland, Australia. Description: Students completed 32 weeks in a rural generalist community immersion medical program and were compared with matched students who completed their year in urban tertiary hospitals. Evaluations included teaching and learning opportunities, assessment of clinical competencies, and semistructured interviews. Views of preceptors, spouses, and community were also evaluated. Evaluation: All outcome measures were positive and many were greater for the rural immersion students than for the matched urban group. Students were able to achieve the requirements of their medical program in a nontraditional placement. Views of preceptors indicated satisfaction with long-term medical student placements including enjoyment, negligible time or financial impact, and beneficial professional and collegial support. Conclusions: Long-term immersion placements benefited student learning and had a favorable impact on the preceptors.

Factors affecting the utility of the multiple mini-interview in selecting candidates for graduate-entry medical school

We wished to determine which factors are important in ensuring interviewers are able to make reliable and valid decisions about the non-cognitive characteristics of candidates when selecting candidates for entry into a graduate-entry medical programme using the multiple mini-interview (MMI). Data came from a high-stakes admissions procedure. Content validity was assured by using a framework based on international criteria for sampling the behaviours expected of entry-level students. A variance components analysis was used to estimate the reliability and sources of measurement error. Further modelling was used to estimate the optimal configurations for future MMI iterations. This study refers to 485 candidates, 155 interviewers and 21 questions taken from a pre- prepared bank. For a single MMI question and 1 assessor, 22% of the variance between scores reflected candidate-to-candidate variation. The reliability for an 8-question MMI was 0.7; to achieve 0.8 would require 14 questions. Typical inter-question correlations ranged from 0.08 to 0.38. A disattenuated correlation with the Graduate Australian Medical School Admissions Test (GAMSAT) subsection 'Reasoning in Humanities and Social Sciences' was 0.26. The MMI is a moderately reliable method of assessment. The largest source of error relates to aspects of interviewer subjectivity, suggesting interviewer training would be beneficial. Candidate performance on 1 question does not correlate strongly with performance on another question, demonstrating the importance of context specificity. The MMI needs to be sufficiently long for precise comparison for ranking purposes. We supported the validity of the MMI by showing a small positive correlation with GAMSAT section scores.

Medical student education in emergency medicine: New model from South Africa

Emergency medicine is a new specialty in South Africa. Postgraduate training, degrees and diplomas have been introduced and this should make a significant difference, in due course, to emergency care in the country. The University of the Witwatersrand, Johannesburg, South Africa, like many universities in Australia, embarked upon a Graduate Entry Medical Programme. This implied significant curriculum change and gave opportunity for the development of formal emergency medicine training for students, for the first time. After considerable debate over the needs of the graduate in South Africa a new block was developed, called the Acute and Perioperative Care block. This encompasses forensic medicine, emergency medicine, trauma and anaesthetics. The training is integrated and progressive. No similar programme has been detected elsewhere. At the end of the first year there is considerable satisfaction on the part of both teachers and students and many of the students, finding the module exciting, have indicated a wish to become involved in emergency medicine in the future. The structure of the course is laid out and might be of relevance to colleagues with an interest in medical education.

Independent student study groups

Teachers and students regulate learning to varying degrees in educational programmes in higher education. We present evidence that students in a student-centred medical programme self- and co-regulate their learning in independently formed study groups. We describe the perceived benefits of study groups and the effect of study group membership on student achievement. Years 1-2 of a 4-year, graduate-entry problem-based medical programme. We surveyed 233 year 2 students about features of their study groups and their study group membership in years 1-2. We compared study group membership with students' scores on a written summative assessment held at the end of their second year. For students who joined 1 study group, the length of time their group stayed together was positively related to achievement in the written summative assessment. There were no differences in summative assessment results between students who had been in a study group and students who had not been in a study group. Effective study groups are supportive, socially cohesive groups who generate mutual trust and loyalty, and self- and co-regulate their learning by giving and receiving explanations and summaries and motivating individual study. Teachers can support the formation of study groups by using small-group teaching/learning activities, providing clear learning outcomes and assessment criteria, minimising competition for grades and allocating room space.

Research within a medical degree: the combined MB BS-PhD program at the University of Sydney.

Along with its new graduate-entry medical program, the University of Sydney has introduced the Combined Degree (Research) Program which allows students to graduate with an MB BS and PhD. The program includes 2-3 years of full-time research between Years 2 and 3 of the 4-year MB BS program. The program aims to produce clinician-scientists committed to continuing research that reflects their experience of clinical practice. Eight women and 23 men have enrolled since the program began in 1998, with the first cohort graduating in 2003. The students have been active in helping to develop the program and establishing a society and other student support networks.

Group problems in problem-based learning

Successful small-group learning in problem-based learning (PBL) educational programmes relies on functional group processes. However, there has been limited research on PBL group problems, and no studies have been conducted on problems as perceived by both students and tutors in the same educational context. The authors investigated PBL group problems in a graduate-entry medical programme, and report the most common group problems, and those that hinder students’ learning the most. The possible causes of individual quietness and dominant behaviour, and potential influences that group problems may have on the tutorial process are summarized in an exploratory model of PBL group dysfunction that could be used to guide further research. Specifically, there is a need for further evidence on which to base guidelines for tutors and students to effectively manage group problems.

The association between student characteristics and the development of clinical reasoning in a graduate-entry, PBL medical programme

This study sought to assess the extent to which the entry characteristics of students in a graduate-entry medical programme predict the subsequent development of clinical reasoning ability. Subjects comprised 290 students voluntarily recruited from three successive cohorts of the University of Queensland’s MBBS Programme. Clinical reasoning was measured once a year over a period of three years using two methods, a set of 10 Clinical Reasoning Problems (CRPs) and the Diagnostic Thinking Inventory (DTI). Data on gender, age at entry into the programme, nature of primary degree, scores on selection criteria (written examination plus interview) and academic performance in the first two years of the programme were recorded for each student, and their association with clinical reasoning skill analysed using univariate and multivariate analysis. Univariate analysis indicated significant associations between CRP score, gender and primary degree with a significant but small association between DTI and interview score. Stage of progression through the programme was also an important predictor of performance on both indicators. Subsequent multivariate analysis suggested that female gender is a positive predictor of CRP score independently of the nature of a subject’s primary degree and stage of progression through the programme, although these latter two variables are interdependent. Positive predictors of clinical reasoning skill are stage of progression through the MBBS programme, female gender and interview score. Although the nature of a student’s primary degree is important in the early years of the programme, evidence suggests that by graduation differences between students’ clinical reasoning skill due to this factor have been resolved.

Preparedness for hospital practice among graduates of a problem‐based, graduate‐entry medical program

To compare preparedness for hospital practice between graduates from a problem-based, graduate-entry medical program and those from other programs (undergraduate problem-based and traditional). Survey of graduates (by mailed questionnaire) and organisers of clinical training (by semistructured interview); results were compared with published results of surveys of graduates from other programs. All graduates of the first intake of the University of Sydney graduate-entry medical program were surveyed at the end of their first intern year (2001), along with the director of clinical training or intern manager at each of the New South Wales hospitals that employed the graduates. Graduates' self-reported level of preparedness in the eight domains of the Preparation for Hospital Practice Questionnaire; and organisers' opinions of their strengths and weaknesses. 76 of 108 graduates from the graduate-entry program (70%) and organisers of clinical training at all 17 hospitals participated. Graduates from the program felt more prepared than did those from other programs in five of the eight domains assessed (interpersonal skills, confidence, collaboration, holistic care, and self-directed learning) and no less prepared in any domain. Organisers rated the graduates highly, especially in clinical competence, confidence, communication and professional skills. Opinions of interns' knowledge of basic sciences conflicted, with strengths and weaknesses mentioned with equal frequency. Graduates from the graduate-entry, problem-based program are at least as well prepared for their intern year as graduates from traditional and undergraduate problem-based programs.

Beyond the virtual library: electronic curriculum Web resources

The Faculty of Health Sciences at the University of the Witwatersrand is to implement an electronic curriculum for a new Graduate Entry Medical Program at the beginning of 2003. The literature relating to the provision of electronic problem‐based learning curricula indicates that most libraries involved in the provision of resources for such programs have simply provided a quickly outdated bibliographic list of databases and e‐resources for further consultation. As part of a multidisciplinary teaching and design team, the Witwatersrand Health Sciences Library (WHSL) has set up a proactive intranet of Web‐based links to e‐resources and multimedia that are integrated into the actual e‐case studies. It appears that WHSL has designed a truly integrated and interactive Web‐based resource intranet, with direct links from the actual curriculum material to the information resources themselves.

Disaster Medicine and the Flinders Graduate Entry Medical Program

Disaster Medicine and the Flinders Graduate Entry Medical Program