Medical educators' experiences on medically unexplained symptoms and intercultural communication

Background Medically unexplained symptoms (MUS) are highly prevalent and remain challenging in healthcare and medical education, along with the increase in the importance of intercultural issues regarding MUS. However, less is known about the challenges of professionally addressing patients with MUS in the interprofessional and intercultural contexts. Thus, the present study aims to provide the first exploration of the experiences of medical specialists regarding treating MUS in intercultural contexts and inputs for training development on the intercultural aspects of MUS. Methods Three focus groups (total n = 13) consisting of medical specialists from a Hungarian university who were teaching at the medical faculty in intercultural settings and also worked for the university health services were interviewed. The topics covered the participants' personal experiences on addressing MUS and the challenges of intercultural communication and the intercultural educational context. Thematic analysis was used to yield a qualitative account of the interviews as guided by the research questions. Results Representing the different aspects of medical specialists, the study identified three main themes in the experiences of medical specialists, namely, 1) the need to adapt to the personal world of patients and search for common frames to understand MUS, 2) the need to discover methods for adapting to cultural differences and 3) the need to enhance the interprofessional coordination of knowledge and practices. Conclusions The results are in line with the distinct conclusions of previous studies. Moreover, an integrated educational program on the intercultural aspects of MUS may address the main themes separately and, subsequently, support their integration. Therefore, the study discusses the manner in which an integrated educational program on the intercultural aspects of MUS may address the needs recognized in these aspects

Academic dismissal policy for medical students:effect on study progress and help-seeking behaviour

CONTEXT Medical students often fail to finish medical school within the designated time. An academic dismissal (AD) policy aims to enforce satisfactory progress and to enable early identification and timely support or referral of struggling students. In this study, we assessed whether the implementation of an AD policy improved study progress in the first 2 years of medical school. Additionally, we analysed its effect on the help-seeking behaviour of struggling students. METHODS We compared two AD cohorts (entering in 2005 and 2006, respectively) and two non-AD cohorts (entering in 2003 and 2004, respectively) on dropout rates, Year 1 curriculum completion rates and the percentage of students with an optimal study rate (i.e. all modules completed) at 1 and 2 years after enrolment. We also measured the effect on study progress of attending the support meetings offered. RESULTS The AD (n = 809) and non-AD cohorts (n = 809) did not differ significantly in dropout rate at 5 months, in Year 1 completion rate at 2 years and in the percentage of optimally performing students at 1 year after enrolment. At 2 years after enrolment, more students from the AD cohorts had left and more non-AD students demonstrated optimal performance, but effect sizes (ESs) for these differences were small. Voluntary support at 4 months was attended by AD students more often than by non-AD students (68.9% versus 39.8%; chi(2)((1)) = 43.95, p <0.001, ES = 0.29). The AD students who attended the support meetings completed the Year 1 curriculum more often than those who did not (73.4% versus 52.5%; chi(2)((1)) = 10.92, p <0.001, ES = 0.20). Attending the obligatory support meeting at 7 months had a similar effect (70.5% versus 33.3%; chi(2)((1)) = 13.60, p <0.001, ES = 0.23). CONCLUSIONS The presence of an AD policy did not lead to earlier dropout, higher completion rates or an improved study rate during the first 2 years at medical school. However, uptake of the support offered increased to almost 70%. Although support participants finished the Year 1 curriculum more often than non-participants, the current support system was not sufficient to improve overall study progress

The role of the assessment policy in the relation between learning and performance

__Context:__ Optimising student learning and academic performance is a continuous challenge for medical schools. The assessment policy may influence both learning and performance. Previously, the joint contribution of self-regulated learning (SRL) and participation in scheduled learning activities towards academic performance has been reported. However, little is known about the relationships between SRL, participation and academic performance under different assessment policies. __Objectives:__ The goal of this study was to investigate differences in average scores of SRL, participation and academic performance of students under two assessment policies: (i) a conjunctive lower stakes, lower performance standard (old) assessment policy and (ii) a compensatory higher stakes, higher performance standard (new) assessment policy. In addition, this research investigated whether the relationships between academic performance, SRL and participation are similar across both assessment policies. __Methods:__ Year-1 medical students (i) under the old assessment policy (n = 648) and (ii) under the new assessment policy (n = 529) completed the Motivated Strategies for Learning Questionnaire on SRL, and additional items on participation. Year-1 performance was operationalised as students’ average Year-1 course examination grades. manova and structural equation modelling were used for analyses. __Results:__ Generally, students under the new assessment policy showed significantly higher Year-1 performance, SRL and participation, compared with students under the old assessment policy. The relationships between Year-1 performance, SRL and participation were similar across assessment policies. __Conclusions:__ This study indicates that the higher academic performance under a compensatory higher stakes, higher performance standard assessment policy, results from higher SRL and participation, but not from altered relationships between SRL, participation and performance. In sum, assessment policies have the potential to optimise student learning and performance

Do norms unintentionally increase stereotypical expressions? A randomised controlled trial

INTRODUCTION: Implicit biases of health professionals could cause biased judgements. Many anti‐bias interventions seem to be ineffective, and some even counterproductive. People tend to be compliant to standards describing what the majority of people finds or does, and this could cause people to think in a stereotype‐consistent manner. This study examines whether descriptive social norms such as ‘the majority of people have stereotypes’ (majority message), as often stated in interventions, actually increase people's stereotypes. To examine the effect of descriptive social norms (Hypothesis 1) and the effect of individual perceptions and preferences (Hypothesis 2a and 2b) on stereotypical expressions towards medical students. METHODS: First, we determined which ethic stereotypes regarding medical students prevail in Dutch medical education (N = 52). Next, two similar randomised controlled trials, both with teachers and students, were carried out (N = 158 and N = 123, respectively), one with an East Asian student picture (ethnic minority) and one with a native Dutch student picture (ethnic majority). Participants were randomly assigned to either a majority‐message, minority‐message or no‐message condition, and rated the presented minority or majority picture on specific stereotypical features. Subsequently, participants described a typical day of that same student's life. These descriptions were rated for stereotypicality by two independent raters, who were blind for condition and stimulus. Inclusive work environment (IWC) and social dominance orientation (SDO) of participants were measured as indicators of individual perceptions and preferences. RESULTS: Stereotypes were expressed towards both picture stimuli, yet message condition did not affect stereotypical expressions. SDO positively related to stereotypical expressions towards the East Asian student, whereas IWC positively related to stereotypical expressions towards the native Dutch student. CONCLUSION: Interventions do not unintentionally increase stereotypes by communicating what the majority of people thinks or does. Individual perceptions and preferences are predictive of stereotypes, whereas descriptive social norms are not

Gender-specific effects of raising Year-1 standards on medical students' academic performance and stress levels

Context: Medical schools are challenged to create academic environments that stimulate students to improve their study progress without compromising their well-being. Objectives: This prospective comparative cohort study investigated the effects of raising Year-1 standards on academic performance and on students' chronic psychological and biological stress levels. Methods: In a Dutch medical school, students within the last Bachelor's degree cohort (n = 410) exposed to the 40/60 (67%) credit Year-1 standard (67%-credit cohort) were compared with students within the first cohort (n = 413) exposed to a 60/60 (100%) credit standard (100%-credit cohort). Main outcome measures were Year-1 pass rate (academic performance), mean score on the Perceived Stress Scale (PSS, psychological stress) and hair cortisol concentration (HCC, biological stress). Results: Year-1 pass rates were significantly higher in the 100%-credit cohort (odds ratio [OR] 4.65). Interestingly, there was a significant interaction effect (OR 0.46), indicating that raising the standard was more effective for male than for female students. PSS scores (n = 234 [response rate [RR]: 57%] and n = 244 [RR: 59%] in the 67%- and 100%-credit cohorts, respectively) were also significantly higher in the 100%-credit cohort (F(1,474) = 15.08, P <.001). This applied specifically to female students in the 100%-credit cohort. Levels of HCC (n = 181 [RR: 44%] and n = 162 [RR: 39%] respectively) did not differ between co

Unraveling the medical residency selection game

The diversity of modern society is often not represented in the medical workforce. This might be partly due to selection practices. We need to better understand decision-making processes by selection committees in order to improve selection procedures with regard to diversity. This paper reports on a qualitative study with a socio-constructivist perspective conducted in 2015 that explored how residency selection decision-making occurred within four specialties in two regions in the Netherlands. Data included transcripts of the decision-making meetings and of one-on-one interviews with committee members before and after the group decision-making meetings. Candidates struggled to portray themselves favorably as they had to balance playing by the rules and being authentic; between fitting in and standing out. Although admissions committees had a welcoming stance to diversity, their practices were unintentionally preventing them from hiring underrepresented minority (URM) candidates. While negotiating admissions is difficult for all candidates, it is presumably even more complicated for URM candidates. This seems to be having a negative influence on attaining workforce diversity. Current beliefs, which make committees mistakenly feel they are acting fairly, might actually justify biased practices. Awareness of the role of committee members in these processes is an essential first step