Elena Svirko

Attitudes to e-learning, learning style and achievement in learning neuroanatomy by medical students

Background: Two main learning approaches adopted by students have been identified by research: deep (seeking for meaning motivated by interest in the subject matter) and surface (rote-learning motivated by fear of failure). There is evidence that learning approach is influenced by learning environment (e.g. Trigwell et al. ). Online courses pose the challenge of designing software that will encourage the more desirable approach to learning. Aims: The aims were to evaluate how successful an online course is at encouraging deep approach to learning, which factors might influence the approach adopted towards it, and whether the approach adopted is related to academic performance. Method: Using 205 second-year pre-clinical medical students, we compared their approach to learning, as measured by Biggs et al. () 2F-SPQ-R, for a computer-aided learning (CAL) course in Neuroanatomy with that for their studies in general. We then examined student attitudes towards the CAL course and the ratings of the course Web pages in terms of the learning approach they encourage (done by 18 independent raters). Results: The students reported using significantly less deep approach to learning for the CAL course. However, their approach for the course was not related to results on a neuroanatomy assessment based on it. Enjoyment of the course, assessment of the amount of information in it as appropriate, and ease of understanding the course were all associated with a deeper approach. The only agreement between the raters of the CAL course was for some pages that included patient case studies, which were unanimously given a very high deep rating. Assessment marks for questions referring to these pages were higher than for the rest of the assessment. Conclusions: The study suggests that maximizing the use of clinical relevance should increase the interest and enjoyableness of the course and thereby aid deep learning and retention of information.

Career choices of the United Kingdom medical graduates of 2005, 2008 and 2009: Questionnaire surveys

Objectives: To compare specialty choices of the UK medical graduates of 2005, 2008 and 2009, one year after graduation, with those of graduates from previous years and with the distribution of senior medical practitioners working in England. Method: Postal questionnaire surveys. Results: The proportion of graduates giving more than one specialty choice rose in the most recent cohorts. Among men, choices for surgical careers fell from 37% of 2005 graduates to 25% of 2008 and 2009 graduates. The percentages who specified anaesthetics, general practice and obstetrics and gynaecology rose. Among women, general practice and surgery were unchanged in popularity, but increasing percentages specified paediatrics, anaesthetics and obstetrics and gynaecology. Choices for psychiatry and emergency medicine showed no trend. General practice was substantially under-represented, and hospital surgical and medical specialties were over-represented, in choices when compared to the distribution of senior National Health Service doctors. Conclusion: More current graduates consider two or more specialties than did their predecessors, which may reflect an increase in uncertainty about obtaining a post in their favoured specialty. The specialty preferences expressed by newly qualified doctors, notably the shortfall in numbers choosing general practice, remain inconsistent with future service needs.

Foundation doctors’ views on whether their medical school prepared them well for work: UK graduates of 2008 and 2009

Purpose of the study The transition from medical student to junior doctor is a critical stage in career progression. We report junior doctors’ views 1 year after graduation on whether their medical school prepared them well for clinical work. Study design Questionnaire surveys of the medical graduates of 2008 and 2009, from all UK medical schools, 1 year after graduation. Responses were compared with those of UK medical graduates of 1999, 2000, 2002 and 2005. The main outcome measure was the doctors’ level of agreement that medical school had prepared them well for work. Results 53% of 2008 graduates and 49% of 2009 graduates agreed that their medical school had prepared them well. The percentage who felt unprepared has fallen from 31% of the 1999–2005 graduates, combined, to 19% of the 2008 and 2009 graduates (the remainder gave neutral responses). Combining 2008 and 2009 graduates’ responses, percentages who agreed that they had been well prepared ranged from 83% (95% CI 78 to 89) at the medical school with the highest level of agreement to 27% (95% CI 20 to 34) at the lowest. 25% of doctors specified that feeling unprepared had been a serious or medium-sized problem for them (only 2.7% regarded it as serious). Conclusions Medical schools need feedback from their graduates about elements of medical school training that could improve preparedness for medical work. It also seems likely that there are some reasonably straightforward lessons that medical schools could learn from each other.

The significance of base deficit in acidemic term neonates.

OBJECTIVE Much emphasis is placed on the metabolic component of umbilical cord acidemia at birth, with an importance attached to an arterial level of <7.00 accompanied by a base deficit of 12 mmol/L. We hypothesized that in acidemic neonates, the level of arterial base deficit provides no prognostic information beyond that provided by the level of arterial pH. STUDY DESIGN This is a cohort study using a database of deliveries from a major teaching hospital, with additional information from neonatal records. A total of 8797 term, singleton, nonanomalous neonates were identified who had paired and validated cord blood gas analysis. Of these, 520 were acidemic (pH <7.1) and 84 were severely acidemic (pH <7.0). Outcomes examined were encephalopathy grade 2/3 and/or death, Apgar <7 at 5 minutes, neonatal unit admission, and composite outcomes of neurological and systemic involvement. Hierarchical logistic regressions were done using IBM SPSS Statistics 20.0 (Armonk, NY) to assess the predictive value of arterial pH and arterial base deficit. RESULTS For each outcome the median pH and base deficit of those neonates affected by the adverse outcome was significantly lower than for those who were unaffected. Hierarchical logistic regressions showed that pH is a significant predictor of all adverse outcomes studied (P < .001 for all outcomes). When base deficit, and then the cross-product, are added to the model, neither add predictive value. CONCLUSION In acidemic neonates, the metabolic component does not predict those at risk of adverse outcomes once pH is taken into account. The apparently worse outcomes with greater base deficit simply reflect a greater degree of acidemia. The prognostic significance attached to the base deficit among acidemic neonates is questionable.

Gender, ethnicity and graduate status, and junior doctors' self-reported preparedness for clinical practice: national questionnaire surveys

Objectives Medical schools need to ensure that graduates feel well prepared for their first medical job. Our objective was to report on differences in junior doctors’ self-reported preparedness for work according to gender, ethnicity and graduate status. Design Postal and electronic questionnaires. Setting UK. Participants Medical graduates of 2008 and 2009, from all UK medical schools, one year after graduation. Main outcome measures The main outcome measure was the doctors’ level of agreement with the statement that ‘My experience at medical school prepared me well for the jobs I have undertaken so far’, to which respondents were asked to reply on a scale from ‘strongly agree’ to ‘strongly disagree’. Results Women were slightly less likely than men to agree that they felt well prepared for work (50% of women agreed or strongly agreed vs. 54% of men), independently of medical school, ethnicity, graduate entry status and intercalated degree status, although they were no more likely than men to regard lack of preparedness as having been a problem for them. Adjusting for the other subgroup differences, non-white respondents were less likely to report feeling well prepared than white (44% vs. 54%), and were more likely to indicate that lack of preparedness was a problem (30% non-white vs. 24% white). There were also some gender and ethnic differences in preparedness for specific areas of work. Conclusions The identified gender and ethnic differences need to be further explored to determine whether they are due to differences in self-confidence or in actual preparedness.

Career choices for emergency medicine: national surveys of graduates of 1993–2009 from all UK medical schools

Background In the UK, recruitment of adequate numbers of doctors to emergency medicine (EM) has been problematic. With this as background, we analysed data about career choice for, and progression in, EM in a large multi-purpose study of doctors’ careers. Methods Questionnaire surveys of medical graduates of 1993, 1996, 1999, 2000, 2002, 2005, 2008 and 2009 from all UK medical schools. Results EM was specified as a first choice of career by 4.2% of graduates in postgraduate year 1, 4.8% in year 3, and 3.8% in year 5. Graduates who chose EM were much less likely to be certain about their choice than those who chose other specialties. Of those who specified EM as their first choice of career in year 1, only 26% still had it as their first choice in year 5. Of those who gave EM as their first career choice in year 5, only 27% had given EM as their first choice in year 1. Switches to EM were made, notably, by doctors who previously favoured surgical specialties, hospital physician-led specialties and anaesthetics. Conclusions Early career choices for EM are less predictive of career destinations than choices for other specialties, and, compared with many other specialties, doctors who pursue it may turn to it relatively late. Training policies on transferable competencies should enable clinical trainees in other related specialties to bank some of their skills if they transfer to EM, rather than necessarily having to start core training in year 1 of EM specialty training.

Career progression of men and women doctors in the UK NHS: a questionnaire study of the UK medical qualifiers of 1993 in 2010/2011.

Summary Objectives To report the career progression of a cohort of UK medical graduates in mid-career, comparing men and women. Design Postal and questionnaire survey conducted in 2010/2011, with comparisons with earlier surveys. Setting UK. Participants In total, 2507 responding UK medical graduates of 1993. Main outcome measures Doctors’ career specialties, grade, work location and working pattern in 2010/2011 and equivalent data in earlier years. Results The respondents represented 72% of the contactable cohort; 90% were working in UK medicine and 7% in medicine outside the UK; 87% were in the UK NHS (87% of men and 86% of women). Of doctors in the NHS, 70.6% of men and 52.0% of women were in the hospital specialties and the great majority of the others were in general practice. Within hospital specialties, a higher percentage of men than women were in surgery, and a higher percentage of women than men were in paediatrics, obstetrics and gynaecology, clinical oncology, pathology and psychiatry. In the NHS, 63% of women and 8% of men were working less-than-full-time (in general practice, 19% of men and 83% of women; and in hospital specialties, 3% of men and 46% of women). Among doctors who had always worked full-time, 94% of men and 87% of women GPs were GP principals; in hospital practice, 96% of men and 93% of women had reached consultant level. Conclusions The 1993 graduates show a continuing high level of commitment to the NHS. Gender differences in seniority lessened considerably when comparing doctors who had always worked full-time.

Influence of training changes on the stability of specialty choices of UK medical graduates: surveys of the graduates of 2002 and 2008.

Objectives To explore the impact of Modernising Medical Careers (MMC) training on the stability of medical career choices in the UK. Setting UK Participants Graduates of 2002 and 2008 from all UK medical schools, 1 and 3 years postgraduation. Design Questionnaire surveys were conducted of 2002 and 2008 graduates from all UK medical schools 1 and 3 years post graduation. Main outcome measures Doctors gave their specialty choice(s) and rated the influence of each of 11 factors on their career choice. Results 2008 graduates were a little more likely than graduates of 2002 to retain their year 1 choice in year 3 (77.3% vs. 73.3%; p = 0.002). Among 2008 graduates, the percentage retaining their year 1 choice varied between 42% (clinical oncology) and 79% (general practice). Enthusiasm for a specialty, student experience and inclinations before medical school were associated with choice retention; consideration of domestic circumstances and hours/working conditions were associated with changes of choice. 2008 graduates were more likely than 2002s to be influenced by enthusiasm for a specialty, self-appraisal of their skills, working hours and their domestic circumstances; and less likely to be influenced by their experience of jobs, a particular teacher/department or eventual financial prospects. Conclusions Post-MMC, graduates were less likely to change their career choice and more likely to be motivated by personal factors and self-assessment of their suitability to a particular area of work.

Umbilical cord arterial base deficit and arterial pH as predictors of adverse outcomes among term neonates

To determine the importance of arterial pH and arterial base deficit (ABD) for predicting adverse outcomes among all term neonates, regardless of acidemic status.

Arteriovenous differences in cord blood gas analysis and the prediction of adverse neonatal outcome

The aim of this paper was to determine whether arteriovenous differences of pH and pCO2 are useful predictors of adverse neonatal outcome in acidemic neonates.