I. C. McManus

Handedness, language dominance and aphasia: a genetic model

A simple two-allele Mendelian model of the genetics of handedness is described and fitted to data in the literature. The model proposes that there are two alleles, D (dextral) and C (chance), the homozygous DD genotype producing only right-handers (directional asymmetry), the homozygous CC genotype producing a racemic mixture of 50% right-handers and 50% left-handers (fluctuating asymmetry), and the heterozygote, DC, being intermediate between the homozygotes and producing 25% left-handers, and 75% right-handers. It is also suggested that the true population incidence of left-handedness is 7.75%, deviations from this figure being due to either criterion shifts or selection biases. The same model is then fitted, by means of a number of minor conceptual extensions, to data from the literature on the relationship of handedness to language dominance, acute and permanent aphasia, and visual processing dominance.

Meta-analysis of corpus callosum size in schizophrenia.

Studies with MRI have shown differences in corpus callosum size between schizophrenic patients and controls. Most have found that the corpus callosum is smaller in schizophrenic patients, but in only a minority was this finding statistically significant, perhaps due to small sample sizes. Therefore a meta-analysis of 11 published studies of corpus callosum morphology in schizophrenia was conducted to ascertain whether there was a significant difference in corpus callosum size between schizophrenic patients and normal controls. These studies combined comprised 313 patients and 281 controls. Measures of corpus callosum midsagittal area, length, and corpus callosum area:brain area ratio were used in the meta-analysis. There was overall a statistically significant reduction in corpus callosum area in schizophrenic patients compared with controls (P < 0.02). Differences between patients and controls in measures of corpus callosum: brain area and corpus callosum length were not statistically significant. Age and corpus callosum area were related in both patients and controls. The influences on the corpus callosum of overall alterations of brain size, sex, handedness, and psychiatric illness in general remains to be determined.

The causal links between stress and burnout in a longitudinal study of UK doctors.

Burnout and stress are common, linked problems in health-care workers. We aimed to clarify their causal associations. We assessed stress and the three components of burnout (emotional exhaustion, depersonalisation, and low personal accomplishment) using structural equation modelling in a 3-year longitudinal study of a representative sample of 331 UK doctors. Emotional exhaustion and stress showed reciprocal causation: high levels of emotional exhaustion caused stress (beta=0 189), and high levels of stress caused emotional exhaustion (beta=0 175). High levels of personal accomplishment increased stress levels (beta=0 080), whereas depersonalisation lowered stress levels (beta=-0 105).

Turning the left cheek

This article explores the fact that portrait painters have tended to paint the left cheek rather than the right one.

Objects look different sizes in the right and left eyes.

Coren and Porac (1976) reported that objects looked larger in the right eye of right-eye dominant subjects and in the left eye of left-eye dominant subjects. This paper attempts to repeat that finding. Two circles of same or different size were presented haploscopically in a binocular three-field tachistoscope, to right or left visual half-field and to the upper or lower visual field, one to the right eye and one to the left. A total of 43 subjects reported which of the two circles was the larger, each subject carrying out 120 trials of the experiment. Overall subjects reported that the stimulus to the left eye was significantly larger than that presented to the right eye. There was no association with eye dominance, and therefore the Coren and Porac finding could not be repeated. There was however a very significant association with handedness, left-handed subjects tending to report that the stimulus in the right eye looked larger, and right-handed subjects reporting that the stimulus in the left eye looked larger.Do people perceive humility as a strength or a weakness? The current study examined this question in a sample of 127 undergraduates. Contrary to common dictionary definitions of humility, which often emphasize its association with self-abasement, participants reported consistently positive views of humility. When recalling situations in which they felt humble, they typically reported success experiences associated with positive emotion. Participants clearly associated humility with good psychological adjustment, although they were less decisive about whether humility was associated with confidence or leadership. Although participants viewed humility as a strength across all social roles sampled, humility was viewed most favorably as a quality of religious seekers, less favorably as a quality of close others or subordinates, and least favorably as a quality of leaders or entertainers. Positive views of humility were associated with high self-esteem and religiosity. Less favorable views of humility were associated with narcissism—particularly its exploiting/entitled dimension.

Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis

Objective To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance. Design Systematic review and meta-analysis. Data sources Online databases PubMed, Scopus, and ERIC; Google and Google Scholar; personal knowledge; backwards and forwards citations; specific searches of medical education journals and medical education conference abstracts. Study selection The included quantitative reports measured the performance of medical students or UK trained doctors from different ethnic groups in undergraduate or postgraduate assessments. Exclusions were non-UK assessments, only non-UK trained candidates, only self reported assessment data, only dropouts or another non-academic variable, obvious sampling bias, or insufficient details of ethnicity or outcomes. Results 23 reports comparing the academic performance of medical students and doctors from different ethnic groups were included. Meta-analyses of effects from 22 reports (n=23 742) indicated candidates of “non-white” ethnicity underperformed compared with white candidates (Cohen’s d=−0.42, 95% confidence interval −0.50 to −0.34; P<0.001). Effects in the same direction and of similar magnitude were found in meta-analyses of undergraduate assessments only, postgraduate assessments only, machine marked written assessments only, practical clinical assessments only, assessments with pass/fail outcomes only, assessments with continuous outcomes only, and in a meta-analysis of white v Asian candidates only. Heterogeneity was present in all meta-analyses. Conclusion Ethnic differences in academic performance are widespread across different medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More detailed information to track the problem as well as further research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of assessing current and future doctors.

Intellectual aptitude tests and A levels for selecting UK school leaver entrants for medical school

An extension of A level grades is the most promising alternative to intellectual aptitude tests for selecting students for medical school

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

BACKGROUND 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. AIMS 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. SAMPLES 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). METHOD Confirmatory factor analysis was used to examine the dimensionality and longitudinal stability of the shortened SPQ. RESULTS 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. CONCLUSIONS 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.

Is insight important? Measuring capacity to change performance

Background  Some doctors who perform poorly appear not to be aware of how their performance compares with accepted practice. The way that professionals maintain their existing expertise and acquire new knowledge and skills – that is, maintain their ‘currency’ of practice – requires a capacity to change. This capacity to change probably requires the individual doctor to possess insight into his or her performance as well as motivation to change. There may be a range of levels of insight in different individuals. At some point this reaches a level which is inadequate for effective self‐regulation. Insight and performance may be critically related and there are instances where increasing insight in the presence of decreasing performance can also cause difficulties.

Intercalated degrees, learning styles, and career preferences: prospective longitudinal study of UK medical students

Abstract Objectives: To assess the effects of taking an intercalated degree (BSc) on the study habits and learning styles of medical students and on their interest in a career in medical research Design: Longitudinal questionnaire study of medical students at application to medical school and in their final year. Setting: All UK medical schools Participants: 6901 medical school applicants for admission in 1991 were studied in the autumn of 1990. 3333 entered medical school in 1991 or 1992 and 2695 who were due to qualify in 1996 or 1997 were studied 3 months before the end of their clinical course. Response rates were 92% for applicants and 56% for final year students. Main outcome measures: Study habits (surface, deep, and strategic learning style) and interest in different medical careers, including medical research. Identical questions were used at time of application and in final year. Results: Students who had taken an intercalated degree had higher deep and strategic learning scores than at application to medical school Those with highest degree classes had higher strategic and deep learning scores and lower surface learning scores. Students taking intercalated degrees showed greater interest in careers in medical research and laboratory medicine and less interest in general practice than their peers. The effects of the course on interest in medical research and learning styles were independent. The effect of the intercalated degree was greatest in schools where relatively few students took intercalated degrees. Conclusions: Intercalated degrees result in a greater interest in research careers and higher deep and strategic learning scores. However, the effects are much reduced in schools where most students intercalate a degree Introduction of intercalated degrees for all medical students without sufficient resources may not therefore achieve its expected effects. Key messages Although intercalated degrees are well established, little is known about their effect on medical students In this longitudinal study final year students who had taken intercalated degree were more interested in medical research, and had higher deep and strategic learning style scores than other students The effects of the intercalated degree were dose dependent, being greatest in those gaining a first class degree The effects of the intercalated degree were greatest in medical schools where a relatively small proportion of medical students took the degree Differences between medical schools are most easily explained by resource dilution