Helen Hynes

Medical School Attrition-Beyond the Statistics A Ten Year Retrospective Study

BackgroundMedical school attrition is important - securing a place in medical school is difficult and a high attrition rate can affect the academic reputation of a medical school and staff morale. More important, however, are the personal consequences of dropout for the student. The aims of our study were to examine factors associated with attrition over a ten-year period (2001–2011) and to study the personal effects of dropout on individual students.MethodsThe study included quantitative analysis of completed cohorts and qualitative analysis of ten-year data. Data were collected from individual student files, examination and admission records, exit interviews and staff interviews. Statistical analysis was carried out on five successive completed cohorts. Qualitative data from student files was transcribed and independently analysed by three authors. Data was coded and categorized and key themes were identified.ResultsOverall attrition rate was 5.7% (45/779) in 6 completed cohorts when students who transferred to other medical courses were excluded. Students from Kuwait and United Arab Emirates had the highest dropout rate (RR = 5.70, 95% Confidence Intervals 2.65 to 12.27;p < 0.0001) compared to Irish and EU students combined. North American students had a higher dropout rate than Irish and EU students; RR = 2.68 (1.09 to 6.58;p = 0.027) but this was not significant when transfers were excluded (RR = 1.32(0.38, 4.62);p = 0.75). Male students were more likely to dropout than females (RR 1.70, .93 to 3.11) but this was not significant (p = 0.079).Absenteeism was documented in 30% of students, academic difficulty in 55.7%, social isolation in 20%, and psychological morbidity in 40% (higher than other studies). Qualitative analysis revealed recurrent themes of isolation, failure, and despair. Student Welfare services were only accessed by one-third of dropout students.ConclusionsWhile dropout is often multifactorial, certain red flag signals may alert us to risk of dropout including non-EU origin, academic struggling, absenteeism, social isolation, depression and leave of absence. Psychological morbidity amongst dropout students is high and Student Welfare services should be actively promoted. Absenteeism should prompt early intervention. Behind every dropout statistic lies a personal story. All medical schools have a duty of care to support students who leave the medical programme.

Designing Learning Outcomes for Handover Teaching of Medical Students using Group Concept Mapping

Purpose To develop, by consultation with an expert group, agreed learning outcomes for the teaching of handoff to medical students using group concept mapping. Method In 2013, the authors used group concept mapping, a structured mixed-methods approach, applying both quantitative and qualitative measures to identify an expert group’s common understanding about the learning outcomes for training medical students in handoff. Participants from four European countries generated and sorted ideas, then rated generated themes by importance and difficulty to achieve. The research team applied multidimensional scaling and hierarchical cluster analysis to analyze the themes. Results Of 127 experts invited, 45 contributed to the brainstorming session. Twenty-two of the 45 (48%) completed pruning, sorting, and rating phases. They identified 10 themes with which to select learning outcomes and operationally define them to form a basis for a curriculum on handoff training. The themes “Being able to perform handoff accurately” and “Demonstrate proficiency in handoff in workplace” were rated as most important. “Demonstrate proficiency in handoff in simulation” and “Engage with colleagues, patients, and carers” were rated most difficult to achieve. Conclusions The study identified expert consensus for designing learning outcomes for handoff training for medical students. Those outcomes considered most important were among those considered most difficult to achieve. There is an urgent need to address the preparation of newly qualified doctors to be proficient in handoff at the point of graduation; otherwise, this is a latent error within health care systems. This is a first step in this process.

A study of innovative patient safety education

Background:  Medical error continues to significantly harm patients, notwithstanding the continued efforts to improve the situation over the past decade. We report a pilot project using high‐fidelity simulation to integrate the World Health Organisation (WHO) patient safety curriculum into undergraduate medical education.

A metric-based analysis of structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation.

Objectives In this study we aimed to analyse the structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation. The purpose was to identify any areas of deficiency within structure and content in the effective transfer of clinical information via the telephone of final-year medical students. Design An educational study. Setting Simulation centre in a medical school. Participants 113 final-year medical students. Primary and secondary outcomes The primary outcome was to analyse the structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation. The secondary outcome was to identify any areas of deficiency within structure and content in the effective transfer of clinical information via the telephone of final-year medical students. Results During phone calls to a senior colleague 30% of students did not positively identify themselves, 29% did not identify their role, 32% did not positively identify the recipient of the phone call, 59% failed to positively identify the patient, 49% did not read back the recommendations of their senior colleague and 97% did not write down the recommendations of their senior colleague. Conclusions We identified a deficiency in our students skills to communicate relevant information via the telephone, particularly failure to repeat back and write down instructions. We suggest that this reflects a paucity of opportunities to practice this skill in context during the undergraduate years. The assumption that this skill will be acquired following qualification constitutes a latent error within the healthcare system. The function of undergraduate medical education is to produce graduates who are fit for purpose at the point of graduation.

Fit for practice: are we there yet?

The transition from medical student to medical practitioner is known to be difficult. Medical education has undergone great change in recent years in an attempt to address this and to produce doctors who are fit for purpose. In spite of these changes, it appears that newly qualified medical graduates continue to describe their transition to practice as stressful, particularly in relation to issues of responsibility, uncertainty and lack of support from senior colleagues (Brennan et al. 2010). In 2005 Finucane and O’Dowd found that 68% of interns working in Ireland felt that they had been inadequately prepared for internship by medical school. Subsequently, the Medical Council of Ireland made a number of recommendations to ensure that undergraduate training is an effective preparation for internship. In an attempt to assess the success or otherwise of these changes and recommendations, we carried out a qualitative assessment of intern preparedness for practice in a large teaching hospital in the South of Ireland in 2010. This study found that there are still many difficulties with the transition from medical student to medical practitioner. Although participants believed that they had good theoretical knowledge, they felt poorly prepared to apply it in practice. Particular areas of concern were the practical application of acute medicine and day-to-day issues regarding prescribing and common calls. Challenges of the job for which the participants had felt unprepared included task overload, prioritization, and sleep deprivation. They described many negative emotions, including anxiety, uncertainty, isolation and guilt. This study identifies that interns in Ireland continue to feel unprepared for several key aspects of practice in the first year of their medical career. This has implications for what is taught and how it is taught in the undergraduate medical curriculum, suggesting a need for change to produce graduates who are better prepared for the job they do.

Cross‐professional education on a simulated ward

Our highfi delity simulated ward was developed to support the education of fi nalyear medical students about patient safety, with a specifi c emphasis on preventable medical error, and is an example of crossprofessional education (CPE). 2 In this instance, a nurse educator with years of clinical experience is supporting medical students’ learning by playing the role of a ward nurse while students play the role of newly qualifi ed doctors. Box 1 summarises the simulation and associated tasks.

Medical safety: using end objectives to drive learning.

calling medical educators’attention to simulation and meta-cognition within the acquisition ofclinical skills. Their scholarlyreflections on the interplaybetween the mental model andassessable competence contributedto our discussions on the simula-tion to medical errors.For some months we searched foreducational strategies to teach andassess safe medical practice, aspromoted in the curricular guid-ance for undergraduate medicaleducation proposed by the WorldHealth Organization (WHO).