Wayne Woloschuk

Career choice of new medical students at three Canadian universities: family medicine versus specialty medicine

Background: Over the last 10 years the number of medical students choosing family medicine as a career has steadily declined. Studies have demonstrated that career preference at the time that students begin medical school may be significantly associated with their ultimate career choice. We sought to identify the career preferences students have at entry to medical school and the factors related to family medicine as a first-choice career option. Methods: A questionnaire was administered to students entering medical school programs at the time of entry at the University of Calgary (programs beginning in 2001 and 2002), University of British Columbia (2001 and 2002) and University of Alberta (2002). Students were asked to indicate their top 3 career choices and to rank the importance of 25 variables with respect to their career choice. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbachs alpha coefficients; biserial correlations between the factors and career choice were also calculated. A logistic regression was performed using career choice (family v. other) as the criterion variable and the factors plus demographic characteristics as predictor variables. Results: Of 583 students, 519 (89%) completed the questionnaire. Only 20% of the respondents identified family medicine as their first career option, and about half ranked family medicine in their top 3 choices. Factor analysis produced 5 factors (medical lifestyle, societal orientation, prestige, hospital orientation and varied scope of practice) that explained 52% of the variance in responses. The 5 factors demonstrated acceptable internal consistency and correlated in the expected direction with the choice of family medicine. Logistic regression revealed that students who identified family medicine as their first choice tended to be older, to be concerned about medical lifestyle and to have lived in smaller communities at the time of completing high school; they were also less likely to be hospital oriented. Moreover, students who chose family medicine were much more likely to demonstrate a societal orientation and to desire a varied scope of practice. Interpretation: Several factors appear to drive students toward family medicine, most notably having a societal orientation and a desire for a varied scope of practice. If the factors that influence medical students to choose family medicine can be identified accurately, then it may be possible to use such a model to change medical school admission policies so that the number of students choosing to enter family medicine can be increased.

Helping Students Learn To Think Like Experts When Solving Clinical Problems.

Analysis of problem-solving strategies reveals that although there is no universal, generic problem-solving process, there is a clinical reasoning process that is specific and highly tailored to the complexity of each clinical problem. Research reveals that successful problem solvers must possess comprehensive knowledge, but that the way they organize and understand their knowledge is even more critical. Moreover, using “schemes” for both learning and problem solving provides the advantage of combining the creation of a knowledge structure and a search-and-retrieval strategy into a single operation. (A “scheme” in this context is a mental categorization of knowledge that includes a particular organized way of understanding and responding to a complex situation.) The implication for medical education is that a comprehensive knowledge domain must be appropriately organized for knowledge mastery, which in turn is essential for clinical problem solving. Problem-solving strategies must be specific for each problem and not based on the assumption of a universal generic process. Consequently, a new taxonomy of medical problems is recommended, along with an altered problem-based learning (PBL) format. The “hypothetico-deductive” strategy traditionally used in PBL should be replaced by scheme-driven search strategies so that students develop a more organized and logical approach to problem solving.

Does a rural educational experience influence students' likelihood of rural practice? Impact of student background and gender

The family medicine clerkship at the University of Calgary is a 4‐week mandatory rotation in the final year of a 3‐year programme. Students are given the opportunity to experience rural practice by training at 1 of several rural practices.

Do students from rural backgrounds engage in rural family practice more than their urban-raised peers?

Introduction  In a previous prospective study, students from rural backgrounds were found to be significantly more likely to consider rural practice than their urban‐raised peers. The purpose of this study was to determine whether the students with rural backgrounds who participated in the original investigation were more likely than their urban‐raised peers to be currently engaged in rural family practice.

Twelve tips for blueprinting

Background: Content validity is a requirement of every evaluation and is achieved when the evaluation content is congruent with the learning objectives and the learning experiences. Congruence between these three pillars of education can be facilitated by blueprinting. Aims: Here we describe an efficient process for creating a blueprint and explain how to use this tool to guide all aspects of course creation and evaluation. Conclusions: A well constructed blueprint is a valuable tool for medical educators. In addition to validating evaluation content, a blueprint can also be used to guide selection of curricular content and learning experiences.

Use of scheme-based problem solving: an evaluation of the implementation and utilization of schemes in a clinical presentation curriculum.

The University of Calgary has implemented a new curriculum which is organized according to 120 ways in which patients may present to a physician. Students are taught scheme‐based problem solving rather than the more typical hypothetico‐deductive or search and scan approach to problem resolution.

Reliability and validity of interviewers' judgments of medical school candidates.

No abstract available.

Academic Performance of Longitudinal Integrated Clerkship Versus Rotation-based Clerkship Students: A Matched-cohort Study

Purpose Prior studies suggest that students on a longitudinal integrated clerkship (LIC) have comparable academic performance to those on a rotation-based clerkship (RBC); however, most of these studies did not adjust for preclerkship academic performance. The objective of this study was to compare the academic performance of LIC and RBC students matched on prior academic performance over a three-year period. Method Each LIC student in the University of Calgary classes of 2009, 2010, and 2011 (n = 34) was matched with four RBC students (n = 136) of similar prior academic performance. Knowledge and clinical skills performance between the streams was compared. Knowledge was evaluated by internal summative examinations and the Medical Council of Canada Part 1 licensing exam. Clinical skills were evaluated via in-training evaluation report (ITERs) and performance on the clerkship objective structured clinical examination (OSCE). Meta-analysis was used to compare knowledge evaluations and clinical performance for all core clerkship disciplines, and pooled effect sizes from the fixed-effect models were reported. Results Meta-analyses showed no statistically significant heterogeneity. There were no differences between LIC and RBC students on knowledge evaluations (pooled effect size 0.019; 95% confidence interval [−0.155, 0.152], P = .8), ITERs (pooled effect size −0.015 [−0.157, 0.127], P = .8), or mean OSCE ratings (67.9 [SD = 4.6] versus 68.6 [SD = 5.8], P = .5). Conclusions After matching on prior academic performance, LIC and RBC students at one school had comparable performance on summative evaluations of knowledge, clinical performance, and clinical skills over three years.

Family medicine graduates' perceptions of intimidation, harassment, and discrimination during residency training

BackgroundDespite there being considerable literature documenting learner distress and perceptions of mistreatment in medical education settings, these concerns have not been explored in-depth in Canadian family medicine residency programs. The purpose of the study was to examine intimidation, harassment and/or discrimination (IHD) as reported by Alberta family medicine graduates during their two-year residency program.MethodsA retrospective questionnaire survey was conducted of all (n = 377) family medicine graduates from the University of Alberta and University of Calgary who completed residency training during 2001-2005. The frequency, type, source, and perceived basis of IHD were examined by gender, age, and Canadian vs international medical graduate. Descriptive data analysis (frequency, crosstabs), Chi-square, Fishers Exact test, analysis of variance, and logistic regression were used as appropriate.ResultsOf 377 graduates, 242 (64.2%) responded to the survey, with 44.7% reporting they had experienced IHD while a resident. The most frequent type of IHD experienced was in the form of inappropriate verbal comments (94.3%), followed by work as punishment (27.6%). The main sources of IHD were specialist physicians (77.1%), hospital nurses (54.3%), specialty residents (45.7%), and patients (35.2%). The primary basis for IHD was perceived to be gender (26.7%), followed by ethnicity (16.2%), and culture (9.5%). A significantly greater proportion of males (38.6%) than females (20.0%) experienced IHD in the form of work as punishment. While a similar proportion of Canadian (46.1%) and international medical graduates (IMGs) (41.0%) experienced IHD, a significantly greater proportion of IMGs perceived ethnicity, culture, or language to be the basis of IHD.ConclusionsPerceptions of IHD are prevalent among family medicine graduates. Residency programs should explicitly recognize and robustly address all IHD concerns.

What factors affect students' overall ratings of a course?

Purpose Medical students are typically asked to complete course evaluations, but little is known about how students decide to rate courses. This study sought to examine the student feedback process by exploring the dimensionality of a course evaluation tool and examining the relationship between resulting factors and the overall rating of a course. Method During the 2007–2008 academic year, all first- and second-year students were asked to provide feedback on various aspects of curricular content, delivery, and assessment for seven courses taught in the first two years of a clinical presentation curriculum. The authors examined the structure of the evaluation instrument using principal component factor analysis and used multiple linear regression to study the relationship between factors and overall course ratings. Results Four stable and reliable factors were identified (assessment of students, small-group learning, basic science teaching, and teaching diagnostic approaches) that accounted for about 50% of the total variance in overall course ratings. Student assessment displayed the strongest association with overall course ratings, and for second-year students it was the only variable associated with overall course ratings. Conclusions Of the four factors, student assessment was by far the strongest predictor of overall course ratings, and this association strengthened over time. These results are consistent with the “peak-end rule” and “negativity dominance” for rating emotional experiences.