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Neurosurgery is a demanding specialty, and a trainee’s exposure to its tenets is usually achieved through residency. Medical students only access neurosurgical knowledge via brief stints in clerkships/electives and often lack mentorship and early exposure. This study sought to investigate the varying expectations about neurosurgical training held by Canadian medical students, with the goal of determining the impact of early exposure through educational opportunities and mentorship in developing interest and familiarity in the field.
Methods:
A cross-sectional study across Canada was conducted where students were provided with a 35-point questionnaire pertaining to mentorship, educational opportunities and interests regarding neurosurgery through REDcap. Questions were open-ended, closed-ended (single choice) or five-point Likert scale (matrix format). Interest in pursuing neurosurgery was selected as the primary outcome of this study and was dichotomized into high or low interest. Predictors of interest were determined using multivariable logistic regressions.
Results:
A total of 136 students from 14 accredited Canadian medical schools responded to the study. Most (55.9%) had prior exposure, and the most commonly reported deterring factors were work–life balance (94.5%) and family (84.6%). Predictors of interest included participation in relevant case-based discussion (OR = 2.644, 95% CI [1.221–5.847], p = 0.015) and involvement in neurosurgical research encouraged by home institution (OR = 1.619, 95% CI [1.124–2.396], p = 0.012).
Discussion
Future efforts to improve student interest should focus on early exposure to the field such as developing pre-clerkship neurosurgical electives or medical student groups focused on neurosurgery.
Abstract: Anne learned quickly when she came to Boston that running a department meant she spent most of her time taking care of the fallout from some troublemakers and less time on productive team players. Anne highlighted the issues surrounding conflicts of interest; they were inevitable and common but difficult to navigate. Hospitals competed for people and resources. For example, Anne told the story of a young woman who was caught in the midst of secret moves by two hospitals to obtain resources from a third hospital all the while setting the woman up for national embarrassment. After being announced publicly that the woman had been appointed to a prestigious position, the offer from the first two hospitals was suddenly rescinded and her boss and mentor at the third hospital was appointed instead. The woman was told by the chief medical officer at the Brigham that she no longer had the appointment because the hospital had decided to appoint her boss at the Beth Israel Hospital to the position. She was shocked.
Abstract: Anne continued to attend medical school, working toward her PhD in Sol’s lab. She spent more time with Jack; he moved in with her and shared her twin bed. She lived with her best friend, Les Moore, who eventually moved out. Anne was disappointed, but she found a new roommate, Nancy Serrell. Anne cooked meals with Nancy, Jack and our friend Walter. Anne and Jack got along well for the most part and she enjoyed Jack because of his encyclopedic knowledge and memory of everything he read. She began skimming through her reading assignments and picking Jack’s brain for more detailed information. She found this was more efficient for her learning style. Jack and Anne adopted mice, who they named Beula and Ruby. The mice eventually reproduced. Jack proposed in the summer of 1975. Anne was hesitant because she didn’t believe in marriage and wanted Jack to know he was getting into marrying a determined and ambitious woman who would be focused on her career. Jack said he knew that; it was one of the reasons he wanted to marry her. Plus, his family would never approve of them sleeping in the same bed if they weren’t married. They married that August in Ohio on Anne’s family farm with close relatives and friends attending. They spent their honeymoon in Aspen.
This article provides an overview of the historiography of medical education and calls for greater attention to the connections between medical schools. It begins by reviewing research on medical education in imperial metropoles. Researchers have compared medical schools in different national contexts, traced travellers between them or examined the hierarchies that medical education created within the medical profession. The article then shows how historians have emphasised the ways in which medicine in colonial empires was shaped by negotiation, exchange, hybridisation and competition. The final part of the article introduces the special issue ‘Medical Education in Empires’. Drawing on a variety of sources in English, French, Dutch and Chinese, the special issue builds on these historiographies by juxtaposing cases of medical schools in imperial contexts since the eighteenth century. It considers who funded these medical schools and why, what models of medicine underpinned their creation, what social changes they contributed to, what life was like in these schools, who the students and teachers were and what graduates did with their medical careers. This special issue thus contributes to clarifying the role of medical education in empires and the long-term impact of empires on the medical world.
This study aimed to evaluate the proportion of Irish medical students exposed to ‘badmouthing’ of different specialities and to ascertain: the degree of criticism of specialities based on the seniority of clinical or academic members of staff; if ‘badmouthing’ influenced student career choice in psychiatry; and attitudes of medical students towards psychiatry as a speciality and career choice.
Methods:
Medical students in three Irish universities were invited to complete an online survey to determine the frequency and effect of non-constructive criticism on choice of medical specialty. The online questionnaire was distributed to Royal College of Surgeons in Ireland (RCSI), University of Galway (UoG) and University College Dublin (UCD) in the academic year 2020–2021.
Results:
General practice (69%), surgery (65%) and psychiatry (50%) were the most criticised specialties. Criticism was most likely to be heard from medical students. 46% of students reported reconsidering a career in psychiatry due to criticism from junior doctors. There was a positive perception of psychiatry with 27% of respondents considering psychiatry as a first-choice specialty.
Conclusions:
Criticism of psychiatry by doctors, academics and student peers negatively influences students’ career choice, which could be contributing to recruitment difficulties in psychiatry.
We conducted a cross-sectional survey to examine how undergraduate psychiatry is taught and assessed across medical schools in the UK that have at least one cohort of graduated students.
Results
In total, 27 medical schools completed the survey. Curriculum coverage of common mental disorders, assessment skills and mental health law was broadly consistent, although exposure to psychiatric subspecialties varied. Significant variation existed regarding the duration of psychiatry placements and availability of enrichment activities. Small-group teaching, lectures and e-learning were the most frequent teaching modalities and various professionals and lived experience educators (patient and/or carers) contributed to teaching. Objective structured clinical examinations and multiple-choice questions dominated assessments.
Clinical implications
Medical schools should consider increasing students’ exposure to different psychiatric subspecialties and integrating physical and mental health training to address comorbidity and promote holistic care. Future research should explore whether specific undergraduate experiences promote greater career interest and skills in psychiatry.
Intelligence, as measured by grades and/or standardized test scores, plays a principal role in the medical school admissions process in most nations. Yet while sufficient intelligence is necessary to practice medicine effectively, no evidence suggests that surplus intelligence beyond that threshold is correlated with providing higher quality medical care. This paper argues that using perceived measures of intelligence to distinguish between applicants, at levels that exceed the level of intelligence required to practice medicine, is both unfair to applicants and fails to serve the interests of patients.
Matthew Mangold provides a detailed overview of Chekhov’s medical education, tracing Chekhov’s writerly formation in light of the environmental approach to medicine emerging at the time in the areas of hygiene, anatomy, and psychiatry, and in the new connections that were being conceived between the outer material world and the life of the psyche.
The COVID-19 pandemic has impacted medical students in many ways. They are not exempt from personal struggles caused by the health crisis, and many have faced similar challenges adapting to a new learning experience. The University of East Anglia (UEA) has initiatives in place to support medical students including the society Headucate UEA and the Wellbeing Champions scheme established by Norwich Medical School (NMS).
Objectives
Headucate aims to improve mental wellbeing by educational online webinars and social events aimed at university students. NMS Wellbeing Champions offer support and signpost students to resources and the wider student support system at the UEA.
Methods
Headucate was established in 2012 by NMS students that began running workshops at local secondary schools. Their work has expanded to include wellbeing workshops, social events for students and mental health first aid training, so members can provide peer support. Wellbeing Champions are medical student representatives responsible for completing mental health first aid training, communication between students and faculty, providing resources and signposting, creating mental health bulletin newsletters, and running socials exclusively for medical students.
Results
100% of Headucate workshop attendees who completed anonymous feedback agreed that they enjoyed it and that it was useful. No feedback has been collected regarding the success of the Wellbeing Champions. This should be carried out to assess and enhance the project further.
Conclusions
More data is needed to establish the success of the initiatives at NMS and their impact on medical student’s wellbeing.
All too often, we see the leadership above us as obstructionist, miserly, or otherwise misguided or misaligned. This is usually not the case, but there are often communication issues up and down that create that impression and sometimes lead to an adversarial relationship. Both groups benefit by aligning their goals, and the earlier they do so, the better. This chapter will speak mostly to aligning your goals with that of your hospital, with some time at the end devoted to the medical school. They have many similarities, but some important differences. Understanding their priorities will help you to align yours. We discuss the paramount importance of understanding the finances both of your group and the group above you, hospital or medical school. There are ways to maximize your productivity to a mutually beneficial end, and being overt with leadership about this is always welcome. You should gain an understanding of what a “return on investment” or ROI means to the leadership above you, as this is a central concept to their willingness to invest in you and your group. You will gain an understanding of the downstream effect of your group’s efforts, particularly financial. It emphasizes the importance of understanding the key individuals you communicate with and how to approach situations where you are having communication issues. It concludes with how to align goals with the leadership above your group.
The recent increase in natural disasters and mass shootings highlights the need for medical providers to be prepared to provide care in extreme environments. However, while physicians of all specialties may respond in emergencies, disaster medicine training is minimal or absent from most medical school curricula in the United States. A voluntary Disaster Medicine Certificate Series (DMCS) was piloted to fill this gap in undergraduate medical education.
Report:
Beginning in August of 2017, second- and third-year medical students voluntarily enrolled in DMCS. Students earned points toward the certificate through participation in activities and membership in community organizations in a flexible format that caters to variable schedules and interests. Topics covered included active shooter training, decontamination procedures, mass-casualty triage, Incident Command System (ICS) training, and more. At the conclusion of the pilot year, demographic information was collected and a survey was conducted to evaluate student opinions regarding the program.
Results:
Sixty-eight second- and third-year medical students participated in the pilot year, with five multi-hour skills trainings and five didactic lectures made available to students. Forty-eight of those 68 enrolled in DMCS completed the retrospective survey. Student responses indicated that community partners serve as effective means for providing lectures (overall mean rating 4.50/5.0) and skills sessions (rating 4.58/5.0), and that the program created avenues for real-world disaster response in their local communities (rating 4.40/5.0).
Conclusions:
The DMCS voluntary certificate series model served as an innovative method for providing disaster medicine education to medical students.
Kommor MB, Hodge B, Ciottone G. Development and implementation of a Disaster Medicine Certificate Series (DMCS) for medical students. Prehosp Disaster Med. 2019;34(2):197–202
To examine the delivery and assessment of psychiatry at undergraduate level in the six medical schools in the Republic of Ireland offering a medical degree programme.
Methods
A narrative description of the delivery and assessment of psychiatry at undergraduate level by collaborative senior faculty members from all six universities in Ireland.
Results
Psychiatry is integrated to varying degrees across all medical schools. Clinical experience in general adult psychiatry and sub-specialities is provided by each medical school; however, the duration of clinical attachment varies, and the provision of some sub-specialities (i.e. forensic psychiatry) is dependent on locally available resources. Five medical schools provide ‘live’ large group teaching sessions (lectures), and all medical schools provide an array of small group teaching sessions. Continuous assessment encompasses 10–35% of the total assessment marks, depending on the medical school. Only one medical school does not provide a clinical examination in the form of an Objective Structured Clinical Examination with viva examinations occurring at three medical schools.
Conclusions
Many similarities exist in relation to the delivery of psychiatry at undergraduate level in Ireland. Significant variability exists in relation to assessment with differences in continuous assessment, written and clinical exams and the use of vivas noted. The use of e-learning platforms has increased significantly in recent years, with their role envisaged to include cross-disciplinary teaching sessions and analysis of examinations and individual components within examinations which will help refine future examinations and enable greater sharing of resources between medical schools.
An understanding of disaster medicine and the health care system during mass-casualty events is vital to a successful disaster response, and has been recommended as an integral part of the medical curriculum by the Association of American Medical Colleges (AAMC). It has been documented that medical students do not believe that they have received adequate training for responding to disasters. The purpose of this pilot study was to determine the inclusion of disaster medicine in the required course work of medical students at AAMC schools in the United States, and to identify the content areas addressed.
Methods
An electronic on-line survey was developed based upon published core competencies for health care workers, and distributed via e-mail to the education liaison for each medical school in the United States that was accredited by the AAMC. The survey included questions regarding the inclusion of disaster medicine in the medical school curricula, the type of instruction, and the content of instruction.
Results
Of the 29 (25.2%) medical schools that completed the survey, 31% incorporated disaster medicine into their medical school curricula. Of those schools that included disaster medicine in their curricula, 20.7% offered disaster material as required course work, and 17.2% offered it as elective course work. Disaster medicine topics provided at the highest frequency included pandemic influenza/severe acute respiratory syndrome (SARS, 27.5%), and principles of triage (10.3%). The disaster health competency included most frequently was the ability to recognize a potential critical event and implement actions at eight (27.5%) of the responding schools.
Conclusions
Only a small percentage of US medical schools currently include disaster medicine in their core curriculum, and even fewer medical schools have incorporated or adopted competency-based training within their disaster medicine lecture topics and curricula.
>SmithJ, LevyMJ, HsuEB, LevyJL. Disaster Curricula in Medical Education: Pilot Survey. Prehosp Disaster Med.2012;27(5):1-3.
This chapter addresses the question of whether professionalism can be effectively taught, by examining what it means to teach professionalism, proposed strategies to teach it, evidence of effectiveness of interventions aimed at teaching or improving professionalism and evidence of ability to identify or predict unprofessional behaviour. In one of the primary texts on professionalism education, Hafferty notes that professionalism lies in an interface between possession of specialized knowledge, and using that knowledge for the betterment of others'. Learning the professionalism of Hafferty and Smith occurs in the culture of medical school and residency, where examples, narratives and role modelling occur. To improve this learning would require changes in the culture of medical schools. In addition to the efforts to teach professionalism to all students, many schools have programmes specifically to identify, presumably for the purpose of remediation, and students with unprofessional behaviours.
Studies indicate that a student's career interest at medical school entry is related to his or her ultimate career. We sought to determine the level of interest in emergency medicine among students at the time of medical school entry, and to describe characteristics associated with students primarily interested in emergency medicine.
Methods:
We surveyed students in 18 medical school classes from 8 Canadian universities between 2001 and 2004 at the commencement of their studies. Participants listed their top career choice and the degree to which a series of variables influenced their choices. We also collected demographic data.
Results:
Of 2420 surveys distributed, 2168 (89.6%) were completed. A total of 6.1% (95% confidence interval 5.1%–7.1%) of respondents cited emergency medicine as their first career choice. When compared with students primarily interested in family medicine, those primarily interested in emergency medicine reported a greater influence of hospital orientation and a lesser influence of social orientation on their career choice. When compared with students primarily interested in the surgical specialties, those primarily interested in emergency medicine were more likely to report medical lifestyle and varied scope of practice as important influences. When compared with students primarily interested in the medical specialties, those who reported interest in emergency medicine were more likely to report that a hospital orientation and varied scope of practice were important influences, and less likely to report that social orientation was important.
Conclusion:
Students primarily interested in emergency medicine at medical school entry have attributes that differentiate them from students primarily interested in family medicine, the surgical specialties or the medical specialties. These findings may help guide future initiatives regarding emergency medicine education.
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