Swimming with the Big Fish: An Exploration of the Influences on Academic Self Concept During Early Years Undergraduate Medical Education.

Academic self-concept (ASC) has been studied extensively in school-age children, less so in under-graduate students, with even fewer studies focusing on ASC in medical students. ASC is the perception of one’s academic ability and evidence suggests it starts to develop in very early childhood. The link between ASC and academic achievement has been previously demonstrated but not specifically in medical students. The role of the Big Fish Little Pond Effect (BFLPE) has also been implicated in the development of ASC, but research suggests that the BFLPE does not occur in medical students. ASC scores were collected at four data points from a complete cohort of medical students at a UK medical school using the Medical Student Self-Description Questionnaire (MSSDQ) to provide a set of ASC scores for each student. There was a statistically significant increase in ASC scores between data collection points 1 and 4. A sample of the cohort participated in a series of semi-structured interviews to explore the perceptions and experiences which are thought to affect ASC. Six themes emerged from the interview data – Self-esteem (S), Tenacity (T), Academic Behaviour (A), Social Interaction (I), Resilience (R), and Feeling Secure (S) - STAIRS. These themes do not appear to hierarchical and point to aspects of student experience that create positive or negative situations. Students can use the STAIRS to move up towards positive self- regard and good experiences, or down towards negative ones and lowered self-worth. ASC increased in medical students as they progressed through the programme, but the BFLPE was apparent. Targeted support for students using the STAIRS themes as guidance could be beneficial for students experiencing the detrimental effects of the BFLPE

A study to investigate the effectiveness of SimMan® as an adjunct in teaching preclinical skills to medical students

Background: Following the GMC’s report on Tomorrow’s Doctors, greater emphasis has been placed on training in clinical skills, and the integration of clinical and basic sciences within the curriculum to promote the development of effective doctors. The use of simulation in the learning environment has the potential to support the development of clinical skills in preclinical medical students whilst in a ‘safe’ environment, but currently there is little evidence on its effectiveness. Methods: Seventy nine year one medical students were divided into two groups. A pre-test was conducted by both groups, after which one group performed chest examination on their peers whilst the other group examined the SimMan® manikin. Both groups subsequently performed a mid-test and crossed over so that the group that conducted peer examination examined the manikin and vice-versa. Finally a post-test was conducted. The students were scored for formative feedback whilst performing examinations. Students completed a feedback questionnaire at the end of the session. Data were analysed using a one-way ANOVA, independent t-test and 2- proportion Z test. Results: When the two groups were compared, there was no significant difference in their pre-test and post-test knowledge scores, whereas mid-test knowledge scores increased significantly (P < 0.001), with the group using SimMan® initially scoring higher. A significant increase in the test scores was seen in both groups after using SimMan® (P < 0.001). Students’ confidence increased significantly in differentiating between normal and abnormal signs (P < 0.001). Students highly valued the use of the manikin in the session with 96% of students reporting that it enhanced their learning experience. Conclusions: The study demonstrated a significant improvement in the students’ knowledge after examining the manikin and students also reported an increase in their confidence. Students’ feedback was generally very positive and they perceived the incorporation of manikin-based examinations useful to prepare them for future patient contact. The use of simulation in this context supports an integrated learning approach when used as an adjunct to peer examination, and can benefit the acquisition of clinical skills in preclinical medical students

The major genetic determinants of HIV-1 control affect HLA class I peptide presentation.

Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified &gt;300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA-viral peptide interaction as the major factor modulating durable control of HIV infection