Role of social comparison in preparedness for practice as a junior doctor in Singapore: A longitudinal qualitative study

Objectives To date, most research on medical graduates’ preparedness for practice has conceptualised preparedness as something possessed by the individual. However, new doctors work within social settings with other people and, given this, we argue that preparedness has a social and comparative dimension. The aim of this paper is to explore medical students’/graduates’ self-assessments of their preparedness for practice using the lens of social comparison theory. Setting We invited medical students from one of Singapore’s three medical schools who were in their final-year Student Assistantship Programme to participate in semi-structured interviews, and follow-up interviews 6 months later when they were working as junior doctors. Data was collected from two cohorts, in 2018 and 2019. Initial analysis of interview transcripts was inductive and thematic. Social comparison theory was used for subsequent theory-driven analysis. Participants 31 participants took part, of whom 21 also engaged in follow-up interviews. Results We identified three uses of social comparison: as coping strategy to manage uncertainties in transitions where there was no formal, objective testing of their performance; as a means to confirm their self-perceived preparedness (upwards or downwards, eg, being better or worse prepared than comparator others); and as the basis for decision-making (eg, changing career choices). Conclusions Senior medical students and newly-graduated doctors compare themselves with peers and near-peers in terms of prior learning and current performance to evaluate and understand their own performance at work. Future studies need to examine further how the feeling of preparedness or unpreparedness generated from social comparisons may affect subsequent clinical performance and professional development

Evidence supporting dual-process theory of medical diagnosis : a functional near-infrared spectroscopy study

Purpose: The objective of this study was to determine the extent to which the dual‐process theory of medical diagnosis enjoys neuroscientific support. To that end, the study explored whether neurological correlates of system‐2 thinking could be located in the brain. It was hypothesised that system‐2 thinking could be observed as the activation of the prefrontal cortex. Method: An experimental paradigm was applied that consisted of a learning and a test phase. During the learning phase, 22 medical students were trained in diagnosing chest X‐rays. Four of these eight cases were presented repeatedly, to develop a high level of expertise for these cases. During the test phase, all eight cases were presented and the participants’ prefrontal cortex was scanned using functional near‐infrared spectroscopy. Response time and diagnostic accuracy were recorded as behavioural indicators. Results: The results revealed that participants’ diagnostic accuracy in the test phase was significantly higher for the trained cases as compared with the untrained cases (F [1, 21] = 138.80, p < 0.001, η2 = 0.87). Also, their response time was significantly shorter for these cases (F [1, 21] = 18.12, p < 0.001, η2 = 0.46). Finally, the results revealed that only for the untrained cases, could a significant activation of the anterolateral prefrontal cortex be observed (F [1, 21] = 21.00, p < 0.01, η2 = 0.34). Conclusion: The fact that only untrained cases triggered higher levels of blood oxygenation in the prefrontal cortex is an indication that system‐2 thinking is a cognitive process distinct from system 1. Implications of these findings for the validity of the dual‐process theory are discussed.NRF (Natl Research Foundation, S’pore