The challenges of widening access to the medical profession: how to facilitate medical careers for those at a genuine disadvantage

Widening Participation (WP) for medical school entry has been politically encouraged to ensure access and participation for underrepresented groups rarely able to gain access to this high demand profession. Those who reside in the 20-40% most deprived postcodes in Scotland (SIMD20) are much less likely to apply for medical school entrance, and even less likely to succeed. The National Reach programme in Scotland aims to rectify the existing situation by encouraging and supporting students from working class backgrounds to apply to high demand courses, including medicine, and has achieved great success in helping pupils from target secondary schools to gain a place in Glasgow Medical School. However, some of the Reach students have similar demographics to the rest of the medical school class and arguably do not genuinely belong in the target group. To address this, a second flag based on SIMD20 residence was employed. However, applying more than one WP flag - while substantially improving the targeting of this programme and helping those who truly are multiply deprived - reduces the Reach-eligible applicant pool to the point of undermining the high WP targets imposed on Universities. But using only a single criterion of MD20 residence or school progression rate would unfairly advantage some pupils that are actually not disadvantaged. Ideally, individualised indicators such as eligibility for Free School Meals, possession of an Educational Maintenance Allowance or receipt of a UKCAT bursary, would complement residential data and school progression rates. This paper reflects on the evolution of the admissions practices in our medical school designed to comply with the targets, but also create a medical workforce reflecting the population it serves

Predictive power of UKCAT and other pre-admission measures for performance in a medical school in Glasgow: a cohort study

<b>Background</b><p></p> The UK Clinical Aptitude Test (UKCAT) and its four subtests are currently used by 26 Medical and Dental Schools in the UK for admissions. This longitudinal study examines the predictive validity of UKCAT for final performance in the undergraduate medical degree programme at one Medical School and compares this with the predictive validity of the selection measures available pre-UKCAT.<p></p> <b>Methods</b><p></p> This was a retrospective observational study of one cohort of students, admitted to Glasgow Medical School in 2007. We examined the associations which UKCAT scores, school science grades and pre-admissions interview scores had with performance indicators, particularly final composite scores that determine students' postgraduate training opportunities and overall ranking (Educational Performance Measure - EPM, and Honours and Commendation - H&C). Analyses were conducted both with and without adjustment for potential socio-demographic confounders (gender, age, ethnicity and area deprivation).<p></p> <b>Results</b><p></p> Despite its predictive value declining as students progress through the course, UKCAT was strongly associated with the final composite scores. In mutually adjusted analyses (also adjusted for socio-demographic confounders), only UKCAT total showed independent relationships with both EPM (p = 0.005) and H&C (p = 0.004). School science achievements predicted EPM (p = 0.009); pre-admissions interview score predicted neither. UKCAT showed less socio-demographic variation than did TSS.<p></p> <b>Conclusion</b><p></p> UKCAT has a modest predictive power for overall course performance at the University of Glasgow Medical School over and above that of school science achievements or pre-admission interview score and we conclude that UKCAT is the most useful predictor of final ranking

Increasing collaborative discussion in case-based learning improves student engagement and knowledge acquisition

Background: In the transition from academic to clinical learning, the development of clinical reasoning skills and teamwork is essential, but not easily achieved by didactic teaching only. Case-based learning (CBL) was designed to stimulate discussions of genuine clinical cases and diagnoses but in our initial format (CBL’10) remained predominantly tutor-driven rather than student-directed. However, interactive teaching methods stimulate deep learning and consolidate taught material, and we therefore introduced a more collaborative CBL (cCBL), featuring a structured format with discussions in small breakout groups. This aimed to increase student participation and improve learning outcomes. Method: A survey with open and closed questions was distributed among 149 students and 36 tutors that had participated in sessions of both CBL formats. A statistical analysis compared exam scores of topics taught via CBL’10 and cCBL. Results: Students and tutors both evaluated the switch to cCBL positively, reporting that it increased student participation and enhanced consolidation and integration of the wider subject area. They also reported that the cCBL sessions increased constructive discussion and stimulated deep learning. Moreover, tutors found the more structured cCBL sessions easier to facilitate. Analysis of exam results showed that summative assessment scores of subjects switched to cCBL significantly increased compared to previous years, whereas scores of subjects that remained taught as CBL’10 did not change. Conclusions: Compared to our initial, tutor-led CBL format, cCBL resulted in improved educational outcomes, leading to increased participation, confidence, discussion and higher exam scores

Evaluation of a new data collection process for assessment can be used to review student professionalism

Aims: To improve assessment by encouraging student involvement, increase the efficiency of returns and investigate students’ professionalism.<p></p> Summary of work: Previously on completion of each 10 clinical attachments in year 4/5, supervisors complete a written record of the students’ assessment (~5000/year) consisting of 10 parameters and an overall mark. An electronic system was generated to facilitate transfer of data from supervisors to the Medical School, which was also made available to students to log their own record. This program identified discrepancies between staff and student returns, which are reviewed by faculty staff.<p></p> Summary of results: Previously, 73% of returns arrived within two weeks, which improved to 92% & 99% from supervisors and students respectively, by using electronic transfer. In twelve months nine students failed to reach the required overall assessment standard. In each, rapid identification was facilitated by returns from student, staff or both. Some parameters and descriptors were inappropriate leading to form redesign, and some discrepancies (<2%) resulted from inaccurate form filling which training should correct.<p></p> Conclusion: Efficiency of assessment can be improved by involving students and the increase in awareness leads to a further improvement. Students are honest in returning agreed overall marks and a modified assessment process has been developed following the study.<p></p&gt

Factors determining student satisfaction with Fixed Resource Sessions (FRS) in the first two years of the medical curriculum

Background: FRSs supplement our curriculum with labs, seminars and workshops and are provided to augment core learning, impart basic research skills and foster evidence based learning. Students judge these sessions routinely in web-based questionnaires. Despite the satisfactory evaluation of FRSs, there is a perception that students shy away from laboratory sessions, especially those involving open-ended experiments. So, we aimed to evaluate these sessions in order to investigate what constitutes a successful FRS and what guides students’ feedback.<p></p> Summary of work: Four semi-structured focus groups have produced a series of statements on different aspects of FRSs and rank them in order of importance. The entire 1st and 2nd years validated the findings by means of online questionnaires.<p></p> Summary of results: 51% of students from year 1 and 55% from year 2 have identified the relevance, guidance and length of sessions, enthusiasm of staff and the handouts as the main contributors to a positive feedback, while non-enthusiastic staff and badly informed demonstrators were judged to affect the learning outcomes negatively.<p></p> Conclusions: Based on students’ feedback, we have formed an overview of their opinion and produced a document for the teaching staff with suggestions which were discussed further in a setting of the staff focus group.<p></p> Take-home messages: We have produced a document for the teaching staff with suggestions which were discussed further in a setting of the staff focus group.<p></p&gt

A response to the letter to the Editor by Jian Wen Chong and Joseph C. Lee

No abstract available

An investigation into FRS (Fixed Resource Session) offered in support of PBL (Problem Based Learning) in Year 1-2 of the medical curriculum in Glasgow

Aims: To evaluate the FRS sessions provided for undergraduate students in their non-clinical years in a PBL based curriculum in order to investigate what constitutes a successful FRS and what guides students’ feedback. FRSs supplement our PBL-based curriculum with labs, seminars and workshops and are provided to augment core learning, impart basic research skills and the confidence to engage in clinical research. Students judge these sessions in web-based questionnaires with recommendations for improvement. Despite the satisfactory evaluation of FRSs in the non-clinical years, there is a perception that medical students shy away from laboratory sessions, especially those involving open-end experiments.<p></p> Summary of work: Four semi-structured focus groups of 6 members each were formed. The groups have produced a series of statements on different aspects of FRSs and rank them in order of importance. The entire 1st and 2nd years validated the findings by means of an on-line questionnaire.<p></p> Summary of results: 51% of students identified the relevance, guidance, length of sessions, enthusiasm of staff and the handouts as the main contributors to a positive feedback (in this order).<p></p> Conclusion: Based on students’ feedback, we have formed an overview of their opinion and identified the areas for further improvement.<p></p&gt