Implications of not matching to a first-choice discipline: a family medicine perspective

Background: Family medicine is often selected as an alternate career choice by medical students who do not match to their first choice discipline. Consequently, family medicine residency programs accept and train some residents who prepared for and intended a career in another specialty. The implications of this warrant investigation.Methods: Graduates (2006-2011) of Albertan family medicine residency programs were surveyed to examine differences between physicians who indicated family medicine was their first choice discipline and those who indicated that it was not their first choice. Survey questions targeted practice location, preparedness for practice, perceptions of family medicine, lifestyle satisfaction, and well-being. Principal components analysis was used to examine the factor structure of our survey items and ANOVA and Chi square were used to compare mean scores and proportions, respectively.Results: The overall response rate was 47.2% (307/651). Most (263) respondents reported that family medicine was their first choice discipline (yes-group); 42 respondents indicated that it was not (no-group) and two did not answer. The two groups were similar demographically. The no-group reported significantly lower mean scores on perceptions of family medicine. There were no significant differences between the two groups in their preparedness for practice and measures of lifestyle satisfaction and well-being.Conclusion: Irrespective of their perceptions of the discipline, the respondents who did not match to their first choice discipline found family medicine to be a viable career option

Comparison of Student Performance on Internally Prepared Clerkship Examinations and NBME Subject Examinations

Background: This pilot study compared performance of University of Calgary students on internal clerkship examinations with corresponding National Board of Medical Examiners (NBME) subject examinations.Methods: Between April and October 2007, students completed internal and NBME subject examinations following six mandatory rotations. Local faculty within each discipline set the minimum performance level (MPL) for internal examinations. Two methods of standard setting were considered for NBME exams and a sensitivity analysis was performed. Corresponding internal and NBME examination scores were compared using McNemar’s discordant pair analysis.Results: A significant and unexpected difference in failure rate between internal and external examinations was found in all clerkships. 1.4% of students were below the MPL for internal examinations and 27.3% (modified Angoff) or 25.9% (mean Hofstee compromise) (p<0.0001 for both) for the NBME. The proportion of students below MPL for internal examinations was also below the lower limit of the Hofstee compromise (14.4%).Conclusion: Possible explanations include leniency bias in internal standard setting, discrepant content validity between local curriculum and NBME examinations, difference in student perception of examinations, and performance bias due to unfamiliar units

Peut-on prédire l'échec aux examens d’aptitude à partir des résultats scolaires des étudiants en médecine?

Background: In 2015, the Medical Council of Canada increased the minimum pass level for the Medical Council of Canada Qualifying Examination Part I, and students had a higher rate of failure than in previous years. The purpose of this study was to predict students at an increased odds of examination failure to allow for early, targeted interventions.   Methods: We divided our dataset into a derivation cohort and two validation cohorts and used multiple logistic regression to predict licensing examination failure. We then performed receiver operating characteristics and a sensitivity analysis using different cutoffs for explanatory variables to identify the cutoff threshold with the best predictive value at identifying students at increased odds of failure. Results: After multivariate analysis, only pre-clerkship GPA was a significant independent predictor of failure (OR 0.76, 95% CI [0.66, 0.88], p < 0.001). The probability of failure increased steeply when the pre-clerkship GPA fell below 80% and 76% was found to be the most efficient cutoff for predicting failure (OR 9.37, 95% CI [3.08, 38.41]). Conclusions: Pre-clerkship performance can predict students at increased odds of licensing examination failure. Further studies are needed to explore whether early interventions for at-risk students alter their examination performance.Contexte : En 2015, le Conseil médical du Canada a resserré les exigences de réussite à l’examen d’aptitude du Conseil médical du Canada, partie I, entraînant un taux d’échec plus élevé que les années précédentes. L’objectif de cette étude était de détecter les étudiants ayant de plus grande probabilité d’échec à l’examen afin de permettre des interventions ciblées en temps utile. Méthodes : Nous avons comparé les données d’une cohorte de dérivation et deux cohortes de validation et nous avons utilisé la régression logistique multiple pour prédire l’échec à l’examen d’aptitude. Nous avons ensuite effectué une analyse de la fonction d’efficacité du récepteur et une analyse de sensibilité en utilisant différents seuils pour les variables explicatives afin de déterminer la meilleure valeur prédictive seuil pour cibler une forte possibilité d’échec chez les étudiants. Résultats : L’analyse multivariée a révélé que seule la moyenne générale des étudiants était un prédicteur indépendant significatif de l’échec (OR 0.76, 95 % CI [0.66, 0.88], p < 0.001). La probabilité d'échec augmentait fortement lorsque l'indice de moyenne générale tombait en dessous de 80 %. Le seuil le plus efficace pour prédire l’échec s'est avéré être 76 % (OR 9,37, 95 % CI [3,08, 38,41]). Conclusions : Les résultats scolaires des étudiants en médecine constituent un indicateur de risque d’échec à l’examen d’aptitude. Des études supplémentaires sont nécessaires pour vérifier si une intervention précoce auprès des étudiants à risque peut améliorer leurs résultats à l’examen

Ego Identity Status of Medical Students in Clerkship

Background: Medical students encounter a variety of experiences that have an impact on their emerging professional identity. Clerkship, in particular, presents opportunities for students to consider their career options and decide upon a career path. The process of developing their professional identity begins well before clerkship, however. Anecdotal evidence suggests that interests in medicine begin as early as childhood. This study retrospectively examines the decision-making process clerks make in choosing medicine as a career.Methods: A total of 76 clerks (36 male, 34 female, 6 not reported) responded to four open-ended and two follow-up questions that measure career interests and pursuits. Questions addressed when and how students developed interests in medicine and alternate careers before beginning medical school. An additional eight closed questions drawn from the Ego Status Extended Objective Measure of Ego Identity Status II (EOM-EIS-II) were administered. Content analyses and inter-rater reliability analyses were conducted to classify students according to Marcia’s1  four ego identity statuses.Results: Having obtained high inter-rater consistency (Cohen’s Kappa coefficient of 0.92), responses to the open-ended questions resulted in the classification of three identity statuses. In total, 49.3% of students were in the ‘achieved’ (high exploration and commitment to choices) status and 48.1% were in the ‘foreclosed’ (low exploration but high commitment to choices) status. A small percentage (1.3%) of students were in the ‘moratorium’category (high exploration but low commitment to choices), while none of the students were in the ‘diffused’ (low exploration and low commitment to choices) category.Conclusions: With approximately half of the students demonstrating a ‘foreclosed’ status, this study reveals that despite exposure to a variety of careers when attending university, only half of the students had seriously pursued a career outside of medicine. The majority of students, moreover, developed an interest in medicine before adulthood, and did so independently from parental influence

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

<p>Abstract</p> <p>Background</p> <p>Despite 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.</p> <p>Methods</p> <p>A 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, Fisher's Exact test, analysis of variance, and logistic regression were used as appropriate.</p> <p>Results</p> <p>Of 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.</p> <p>Conclusions</p> <p>Perceptions of IHD are prevalent among family medicine graduates. Residency programs should explicitly recognize and robustly address all IHD concerns.</p

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 Cronbach's 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

Intimidation, harassment, and discrimination during family medicine residency training: a mixed methods study

Abstract Background The importance of wellbeing of family medicine residents is recognized in accreditation requirements which call for a supportive and respectful learning environment; however, concerns exist about learner mistreatment in the medical environment. The purpose of this study was to to describe family medicine graduates’ perceived experience with intimidation, harassment and discrimination (IHD) during residency training. Methods A mixed-methods study was conducted on a cohort of family medicine graduates who completed residency training during 2006–2011. Phase 1, the quantitative component, consisted of a retrospective survey of 651 graduates. Phase 2, the qualitative component, was comprised of 11 qualitative interviews. Both the survey and the interviews addressed graduates’ experience with IHD with respect to frequency and type, setting, perpetrator, perceived basis for IHD, and the effect of the IHD. Results The response rate to the survey was 47.2%, with 44.7% of respondents indicating that they experienced some form of mistreatment/IHD during residency training, and 69.9% noting that it occurred more than once. The primary sources of IHD were specialist physicians (75.7%), hospital nurses (47.8%), and family physicians (33.8%). Inappropriate verbal comments were the most frequent type of IHD (86.8%). Graduates perceived the basis of the IHD to be abuse of power (69.1%), personality conflict (36.8%), and family medicine as a career choice (30.1%), which interview participants also described. A significantly greater proportion IMGs than CMGs perceived the basis of IHD to be culture/ethnicity (47.2% vs 10.5%, respectively). The vast majority (77.3%) of graduates reported that the IHD experience had a negative effect on them, consisting of decreased self-esteem and confidence, increased anxiety, and sleep problems. As trainees, they felt angry, threatened, demoralized, discouraged, manipulated, and powerless. Some developed depression or burnout, took medication, or underwent counselling. Conclusions IHD continued to be prevalent during family medicine residency training, with it occurring most frequently in the hospital setting and specialty rotations. Educational institutions must work with hospital administrators to address issues of mistreatment in the workplace. Residency training programs and the medical establishment need to be cognizant that the effects of IHD are far-reaching and must continuously work to eradicate it

Can we predict failure in licensure exams from medical students’ undergraduate academic performance?

Background: In 2015, the Medical Council of Canada increased the minimum pass level for the Medical Council of Canada Qualifying Examination Part I, and students had a higher rate of failure than in previous years. The purpose of this study was to predict students at an increased odds of examination failure to allow for early, targeted interventions.  Methods: We divided our dataset into a derivation cohort and two validation cohorts and used multiple logistic regression to predict licensing examination failure. We then performed receiver operating characteristics and a sensitivity analysis using different cutoffs for explanatory variables to identify the cutoff threshold with the best predictive value at identifying students at increased odds of failure.Results: After multivariate analysis, only pre-clerkship GPA was a significant independent predictor of failure (OR 0.76, 95% CI [0.66, 0.88], p < 0.001). The probability of failure increased steeply when the pre-clerkship GPA fell below 80% and 76% was found to be the most efficient cutoff for predicting failure (OR 9.37, 95% CI [3.08, 38.41]).Conclusions: Pre-clerkship performance can predict students at increased odds of licensing examination failure. Further studies are needed to explore whether early interventions for at-risk students alter their examination performance.Contexte : En 2015, le Conseil médical du Canada a resserré les exigences de réussite à l’examen d’aptitude du Conseil médical du Canada, partie I, entraînant un taux d’échec plus élevé que les années précédentes. L’objectif de cette étude était de détecter les étudiants ayant de plus grande probabilité d’échec à l’examen afin de permettre des interventions ciblées en temps utile.Méthodes : Nous avons comparé les données d’une cohorte de dérivation et deux cohortes de validation et nous avons utilisé la régression logistique multiple pour prédire l’échec à l’examen d’aptitude. Nous avons ensuite effectué une analyse de la fonction d’efficacité du récepteur et une analyse de sensibilité en utilisant différents seuils pour les variables explicatives afin de déterminer la meilleure valeur prédictive seuil pour cibler une forte possibilité d’échec chez les étudiants.Résultats : L’analyse multivariée a révélé que seule la moyenne générale des étudiants était un prédicteur indépendant significatif de l’échec (OR 0.76, 95 % CI [0.66, 0.88], p < 0.001). La probabilité d'échec augmentait fortement lorsque l'indice de moyenne générale tombait en dessous de 80 %. Le seuil le plus efficace pour prédire l’échec s'est avéré être 76 % (OR 9,37, 95 % CI [3,08, 38,41]).Conclusions : Les résultats scolaires des étudiants en médecine constituent un indicateur de risque d’échec à l’examen d’aptitude. Des études supplémentaires sont nécessaires pour vérifier si une intervention précoce auprès des étudiants à risque peut améliorer leurs résultats à l’examen