Exploring factors affecting undergraduate medical students’ study strategies in the clinical years: a qualitative study

The aim of this study is to explore the effects of clinical supervision, and assessment characteristics on the study strategies used by undergraduate medical students during their clinical rotations. We conducted a qualitative phenomenological study at King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia during the period from November 2007 to December 2008. We conducted semi-structured focus groups interviews with students and conducted individual interviews with teachers and students to explore students’ and clinical teachers’ perceptions and interpretations of factors influencing students’ study strategies. Data collection was continued until saturation was reached. We used Atlas-ti Computer Software (Version 5.2) to analyse the data, apply the obtained themes to the whole dataset and rearrange the data according to the themes and sub-themes. Analysis of data from interviews with twenty-eight students and thirteen clinical supervisors yielded three major themes relating to factors affecting students’ study strategies: “clinical supervisors and supervision”, “stress and anxiety” and “assessment”. The three themes we identified played a role in students’ adoption of different study strategies in the “community of clinical practice”. It appeared that teachers played a key role, particularly as assessors, clinical supervisors and as a source of stress to students

Evaluation of off-service rotations at National Guard Health Affairs: Results from a perception survey of off-service residents

Context: "Off-service" clinical rotations are part of the necessary requirements for many residency training programs. Because these rotations are off-service, little attention is given to their structure and quality of training. This often leads to suboptimal educational experience for the residents on these rotations. Aims: The aim of this study was to assess medical residents′ perceptions, opinions, and levels of satisfaction with their "off-service" rotations at a major residency training site in Saudi Arabia. It was also to evaluate the reliability and validity of a questionnaire used for quality assurance in these rotations. Improved reliability and validity of this questionnaire may help to improve the educational experience of residents in their "off-service" rotations. Materials and Methods: A close-ended questionnaire was developed, Pilot tested and distributed to 110 off-service residents in training programs of different specializations at King Fahad Naitonal Guard Hospital and King Abdulziz Medical City, Riyadh, Saudi Arabia, between September 2011 and December 2011. Results: A total of 80 out of 110 residents completed and returned the questionnaire. Only 33% of these residents had a clear set of goals and educational learning objectives before the beginning of their off-service rotations to direct their training. Surgical specializations had low satisfaction mean scores of 57.2 (11.9) compared to emergency medicine, which had 70.7 (16.2), P value (0.03). The reliability of the questionnaire was Cronbach′s alpha 0.57. The factor analysis yielded a 4-factor solution (educational environment, educational balance, educational goals and objectives, and learning ability); thus, accounting for 51% variance in the data. Conclusion: Our data suggest that there were significant weaknesses in the curriculum for off-service clinical rotations in KAMC and that residents were not completely satisfied with their training

Integration of evidence based medicine into the clinical years of a medical curriculum

Teaching Evidence Based Medicine (EBM) helps medical students to develop their decision making skills based on current best evidence, especially when it is taught in a clinical context. Few medical schools integrate Evidence Based Medicine into undergraduate curriculum, and those who do so, do it at the academic years only as a standalone (classroom) teaching but not at the clinical years. The College of Medicine at King Saud bin Abdulaziz University for Health Sciences was established in January 2004. The college adopted a four-year Problem Based Learning web-based curriculum. The objective of this paper is to present our experience in the integration of the EBM in the clinical phase of the medical curriculum. We teach EBM in 3 steps: first step is teaching EBM concepts and principles, second is teaching the appraisal and search skills, and the last step is teaching it in clinical rotations. Teaching EBM at clinical years consists of 4 student-centered tutorials. In conclusion, EBM may be taught in a systematic, patient centered approach at clinical rounds. This paper could serve as a model of Evidence Based Medicine integration into the clinical phase of a medical curriculum

The Influence of Time Pressure and Case Complexity on Physicians׳ Diagnostic Performance

Purpose: Practicing medicine is a cognitively demanding task that consists of the ability to assess the patient, judge the nature of his or her complaints, and make an appropriate diagnosis. A number of factors have the potential to affect the physician׳s diagnostic performance negatively. Two of these factors are time pressure and case complexity. However, the empirical evidence that supports this negative influence is scant. This study experimentally investigated the effect of time pressure and the complexity of clinical cases on diagnostic accuracy. Method: Thirty-seven senior internal medicine residents participated in this study. These residents were randomly allocated to two experimental groups (with time pressure vs. without time pressure). These residents were instructed to diagnose 8 case scenarios (4 straightforward and 4 complex cases) presented on a computer by using E-Prime® 2.0. The time pressure group received feedback after each case that they were behind schedule, whereas the control group did not receive such information. The dependent variables were the mean diagnostic accuracy and the mean processing time spent on each case during diagnosis. Results: Participants under time pressure spent nearly the same time as the group without time pressure in diagnosing the clinical cases. The diagnostic accuracy scores did not differ significantly between the experimental and control group (F(1,35)=0.07, P=0.79, and η2=0.002). Conversely, a main effect of case complexity was found (F(1,35)=203.19, P<0.001, and η2=0.85). Participants processed straightforward cases faster and more accurately compared with complex cases. No interaction was found between time pressure and case complexity on diagnostic accuracy (F(1,35)=0.003, P=0.96, and η2<0.001). Conclusions: Time pressure did not impact the diagnostic performance, whereas the complexity of the clinical case negatively influenced the diagnostic accuracy. Further studies with the enhanced experimental manipulation of time pressure are needed to reveal the effect of time pressure, if any, on a physician׳s diagnostic performance

The Effect of Patients׳ Appearance on Doctors’ Diagnostic Decision Making: Do Poor People Get Poorer Medical Care?

Purpose Health inequalities are of great concern to health providers. Studies on the influence of social class on diagnostic performance are rare and inconclusive. We investigated whether patients’ appearance (poor versus rich) affects physicians thinking and their ability to reach a correct diagnosis. Method Forty-six internal medicine residents participated in this purposely designed computerized study. Every participant solved four case scenarios with one of two versions of a patient׳s picture for each scenario. In this study simulated patients’ pictures were used to play the role of poor and dirty patients in one condition and rich and clean in another condition. The basic analysis was aimed at diagnostic accuracy. Time needed to reach a decision and participants’ ratings of how extensively they had processed the case, the latter composed by ratings of confidence in the diagnosis, case complexity and mental effort required to diagnose the cases, were measured for each participant and used as indications of the extent to which participants diagnosed the case analytically. Results There were no significant differences between the two conditions in terms of diagnostic accuracy and time spent in diagnosing the cases. However, even if the cases were exactly the same, participants reported to have processed the cases more extensively when the patient appeared poor than in rich-looking patients (p =.04). Discussion Social class seems to influence how extensively doctors think about the patient׳s problem during the diagnostic process but does not influence diagnostic accuracy. Given our findings, it may be worthwhile to replicate the study with a larger number of cases and larger differences in experience between groups of physicians

General practitioners pre and post training knowledge and attitude towards psychiatry

Objectives: General practitioners (GPs) often lack sufficient knowledge of psychiatric diagnoses and have unfavorable attitudes towards mental illness. The first aim of this intervention study is to assess the pre-and post-psychiatric training knowledge and attitudes of GPs. The second aim is to explore certain factors, which predict gain in knowledge and changes in attitude. Methods: This study was executed at Buraidah Mental Health Hospital in the year 2003. The research design consisted of a pre- and post-test comparison of GPs responses. The instruments were a Knowledge Test and an Attitude Questionnaire. Results: The psychiatric training had a discernible impact on GPs' knowledge. Though most of their pre-training attitudes were well-known either as positive or negative, certain attitudes were significantly changed post-intervention. Gain in knowledge was significantly predicted by the type of psychiatric help offered by the GPs. Gender and duration of GPs' practice significantly predicted the attitudinal changes. Conclusion: Psychiatric training courses significantly enhance GPs' knowledge together with significant changes in certain attitudes that have vast psychiatric implications including destigmatization, early diagnosis and better treatment of primary care patients with mental disorders.</p

Do poor patients suffer from inaccurate diagnoses more than well-to-do patients? A randomized control trial

Background: Poor patients have greater morbidity and die up to 10 years earlier than patients who have higher socio-economic status. These findings are often attributed to differences in life-style between groups. The present study aimed at investigating the extent to which physicians contribute to the effect by providing relative poorer care, resulting in relative neglect in terms of time spent with a poor patient and more inaccurate diagnoses. Methods: A randomised experiment with 45 internal medicine residents. Doctors diagnosed 12 written clinical vignettes that were exactly the same except for the description of the patients' socio-economic status. Each participant diagnosed four of the vignettes in a poor-patient version, four in a rich-patient version, and four in a version that did not contain socio-economic markers, in a balanced within-subjects incomplete block design. Main measurements were: diagnostic accuracy scores and time spent on diagnosis. Results: Mean diagnostic accuracy scores (range 0-1) did not significantly differ among the conditions of the experiment (for poor patients: 0.48; for rich patients: 0.52; for patients without socio-economic markers: 0.54; p > 0.05). While confronted with patients not presenting with socio-economic background information, the participants spent significantly less time-to-diagnosis ((for poor patients: 168 s; for rich patients: 176 s; for patients without socio-economic markers: 151 s; p < 0.01), however due to the fact that the former vignettes were shorter. Conclusion: There is no reason to believe that physicians are prejudiced against poor patients and therefore treat them differently from rich patients or patients without discernible socio-economic background