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Medical students' attitudes to community engagement
Sarah Mahoney (Flinders University, Onkaparinga Clinical Education Program, PO Box 494, Noarlunga Centre, Adelaide 5168, Australia) Linnea Boileau (Flinders University, Onkaparinga Clinical Education Program, Adelaide, Australia)
Background: The WHO (1995) defined social accountability for medical schools as "...the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community....they have a mandate to serve". An urban community-based medical education program in Australia has incorporated a focus on social accountability into its program. In this activity (called 'The Cube') medical students worked with secondary school staff and adolescents in an area of disadvantage
to understand adolescent health issues and to develop resources and services that might benefit adolescents. Summary of work: Medical student responses to the social accountability activity were obtained through: 1. A critique immediately following the activity; 2. A survey completed after the students had moved onto their next year of study.
Summary of results: Preliminary findings suggest that The Cube offers valuable learning opportunities for medical students. They learn about the issues that are important to adolescents, and their perceptions of health priorities and concerns. Medical students felt they were 'giving back' to the community, and that their work was providing a learning and teaching resource for both the school and future medical students. Conclusions: Early evaluation of The Cube project demonstrates that a university-community partnership can provide worthwhile learning for medical students. Further development and research is needed to determine whether the intended social impact for adolescents is being achieved.
Take-home messages: Medical schools can incorporate social accountability in their own back yard.
7E Research Papers: Student Selection
Location: Meeting Hall V, PCC 7E/1
The Reliability and Validity of the Resident Selection Process in Relation to the Evaluation of Professionalism: A Pilot Study
Nadia Bajwa (Universitaires de Geneve, Hopital des Enfants, Pediatrics, 6, rue Willy-Donze, Geneva 1211, Switzerland)
Introduction: The American Board of Internal Medicine defines problem residents as "trainees who demonstrate a significant enough problem that requires intervention by someone of authority" (1). At the University of Geneva Pediatric Residency Program approximately two residents per year (10%) are identified as having knowledge deficits, professionalism issues or both. A limited number of studies document our ability to predict resident performance from the selection process (2), and there are few validated assessment methods to evaluate professionalism (3). An emerging assessment method of professionalism is the Professionalism Mini-Evaluation Exercise (P-MEX) (4), which ranks high in terms of construct validity. We have chosen the P-MEX as a novel approach to supplement the other instruments (structured interview (SI), structured letter of recommendation (SLR), personal characteristics score (PCS), and global evaluation score) currently used in the selection process. The primary objectives of this pilot study are to answer the following questions:
1) How reliable and valid is the existing Geneva pediatric resident selection process?
2) Does the integration of the P-MEX add incremental reliability and validity to the existing Geneva pediatric resident selection process?
Methods: Candidates that were pre-selected for an interview were approached to participate in this study. To establish the validity and reliability of the current selection process, Pearson's correlation coefficients (r) were calculated to determine validity evidence of relationship to other variables among the selection instruments. Kappa analysis was performed to calculate inter-rater reliability among raters. The integration of the P-MEX was analyzed in relationship to the selection process to determine if there is incremental validity with the addition of the P-MEX. Two examiners assessed candidates using the P-MEX during two standardized patient cases. Generalizability theory was used to establish reliability. A point-biserial correlation and a logistic regression were used to calculate the efficacy of the P-MEX in predicting acceptance to residency. Results: In 2012, 32 candidates were assessed. Inter-rater reliability was high for the global evaluation (kappa 0.69), moderate for SI (kappa 0.42-0.47), and poor for SLR (kappa 0.27) and the PCS (kappa 0.28). Significant correlations were found between SI and Global 0.638 (p<0.01), between the P-MEX and Global 0.445 (p=0.012), P-MEX and SI 0.360 (p=0.047), P-MEX and SLR
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0.370 (p=0.041), and the P-MEX and PCS 0.598 (p<0.001). The G-study of the P-MEX, with two cases, demonstrated a G coefficient of 0.44 and a Phi coefficient of 0.43. The P-MEX was the only selection instrument that was correlated with acceptance (r=0.529, p=0.002) and effective at predicting acceptance (OR=3.35, p=0.028). Discussion and Conclusion: The selection of residents for post-graduate training is a high-stakes process that deserves a rigorous evaluation of the reliability and validity of the battery of instruments used. The integration of the P-MEX adds another important dimension to this process. The preliminary results are encouraging regarding the reliability and validity of the P-MEX. Further study and analysis will be needed to strengthen the preliminary results and to determine the predictive validity of the P-MEX on residents' performance evaluations.
References: 1. Yao DC, Wright SM. National survey of internal medicine residency program directors regarding problem residents. Jama 2000;284(9):1099-104.
2. Hodges BD, Ginsburg S, Cruess R, Cruess S, Delport R, Hafferty F, et al. Assessment of professionalism: recommendations from the Ottawa 2010 Conference.
Med Teach 2011;33(5):354-63.
3. Cruess R, McIlroy JH, Cruess S, Ginsburg S, Steinert Y. The Professionalism Mini-evaluation Exercise: a preliminary investigation. Acad Med 2006;81(10
4. Wilkinson TJ, Wade WB, Knock LD. A blueprint to assess professionalism: results of a systematic review.
Acad Med 2009;84(5):551-8.
From Flexner to Gadamer and Habermas: A Critical Hermeneutic Analysis of the Practice of Student Selection for Medical School
Saleem Razack (McGill University, Centre for Medical Education and Department of Pediatrics, Montreal Children's Hospital, 2300 Rue Tupper, Montreal H3H 1P3, Canada)
Matthias Lalisse (McGill University, Centre for Medical Education, Montreal, Canada)
Mary Maguire (McGill University, Faculty of Education, Montreal, Canada)
Brian Hodges (University of Toronto, Wilson Centre and Department of Psychiatry, Toronto, Canada) Yvonne Steinert (McGill University, Centre for Medical Education, Montreal, Canada)
Introduction: "Social accountability" discourses have been the leitmotif of several high level appeals for transformed medical education to meet the changing needs of society. With respect to student selection, the appeals generally focus on increasing the diversity of medical classes. In this paper, we present a hermeneutic analysis of medical admissions committee members' discourses of medical student selection. Our research questions were:
1. How do committee members construct concepts of equity, excellence, and diversity in conversations and
2. How do these constructs shape their actions in the selection of future medical students? Hermeneutics can be defined as the interpretation of texts, and student applications to medical school (files and interviews) can be viewed as texts interpretable for meaning. Discourses regulate social institutional practices, and such an analysis may shed light on how the discourses might be reframed to promote selection practice with greater social accountability. Methods: 11 committee members were interviewed on 4 occasions, each interview with specific texts that study participants discussed. Texts used included: 1) committee members' own journeys to medicine, 2) sample applications, 3) university websites, & 4) committee members' reflections on transformed selection practice. We framed our analysis within the hermeneutic tradition of the Gadamer-Habermas debate and Trede's critical transformative dialogues (CTD) methodology based upon it. Our goals were to develop a critical understanding of the discursive phenomenon of student selection, and, through dialogic engagement, "emancipatory knowledge" free of domination, coercion, and constraint.
Results: We uncovered a dialectical tension between members' perceptions of the selection of the future medical profession and the policy imperatives of service to a diverse society. Within interview transcripts, arguments favoring increased attention to diversity/equity in medical admissions were challenged by the concern that this might lead to the erosion of the core pillars of excellence that define medicine. Within the dialectic tension, however, we did find traces of emancipatory knowledge that might serve an agenda of greater social accountability. Participants saw the potential to widen definitions of excellence ("excellences" vs. "excellence") through dialogic engagement within their community of practice. These opportunities all shared the characteristic of avoiding the dichotomization of excellence and social accountability in student selection. Discussion and Conclusion: Opportunities exist to transform student selection practice for entry into medical school in ways that address important social accountability concerns, while also respecting medical schools' unique discursive environments. The CTD methodology, rooted in critical hermeneutics, provided an interesting vehicle for the development of committee members' transformative knowledge to this end. We posit that this research methodology may be adaptable to faculty development aimed at addressing issues of social accountability in health professions training. If the Gadamer-Habermas debate provided the philosophical underpinnings of our analysis, perhaps the reform-minded ghost of Abraham Flexner was there as well, allowing us to understand what the pedagogical elements of a future "Critical Faculty Development" might be for greater social accountability in medical education, beyond that which just pertains to student selection.
ABSTRACT BOOK: SESSION 7 TUESDAY 27 AUGUST: 1045-1230
References: Trede, et al. (2009). Critical transformative dialogues: A research method beyond the fusion of horizons. Forum: Qualitative Social Research, 10(1).
Student admission based on GPA, selection or lottery: a controlled study
NR Schripsema (University Medical Center Groningen, Center for Research and Innovation in Medical Education, A. Deusinglaan 1, FC40, Groningen 9713 AV, Netherlands)
AM van Trigt (University Medical Center Groningen, Institute for Medical Education, Groningen, Netherlands) JCC Borleffs (University Medical Center Groningen, Groningen, Netherlands) J Cohen-Schotanus (University Medical Center Groningen, Center for Research and Innovation in Medical Education, Groningen, Netherlands)
Introduction: There is an ongoing debate about the effectiveness of medical school admissions procedures. Arguments have been presented for the use of either cognitive or non-cognitive selection criteria, random selection, or a combination [1,2,3]. Comparative studies on different admissions procedures are scarce, as in most medical schools all students are admitted by the same set of criteria. However, in the Netherlands students enter medical school through one of the following procedures: (1) based on a pre-university GPA (pu-GPA)>8, (2) based on a selection procedure, or (3) through a national weighted lottery. This situation offers a unique opportunity to examine the effects of different admissions procedures on study performance and progress.
Methods: Participants were all medical students admitted to the University of Groningen, the Netherlands in 2009, 2010 or 2011 (N=1055) based on either a pu-GPA>8 (8+;n=143), a selection procedure which included a multiple mini-interview (MMI)  (SEL;n=295), or the national weighted lottery. The lottery-group was divided into students who had participated in the selection procedure and were not selected, but had subsequently gained access through the lottery (LOT+SEL;n=315) and students who had only participated in the lottery (LOT;n=302). Outcome measures were scores on four written knowledge tests, scores on a professional development course which focuses on non-cognitive skills, passing the first-year blocks, and completing all first-year courses within the year. We assessed differences in written test scores using ANCOVA with Bonferroni post hoc multiple-comparison tests. We used logistic regression to assess whether groups differed in the percentage of students who (a) passed the first-year blocks, (b) were assessed as 'good' in the professional development course, and (c) completed all first-year courses within the year. We controlled for gender and cohort. Results: Written test scores differed between groups (F(6)= 21.9-37.9; p<.001). 8+students scored higher than the other groups on all tests (Mean difference MD=.78-1.45;SE=.10-.13;p<.001). On test 1, SEL and
LOT+SELstudents scored higher than LOTstudents (MD=.27-.28;SE=.09;p<.05). On test 3, SELstudents scored higher than LOTstudents (MD=.30;SE=.11;p<.05). 8+students passed all blocks more often than the other groups (OR=3.65-13.61;p<05) except the fourth block, where SEL and 8+students did not differ. SELstudents passed all blocks more often than LOTstudents
(OR=1.54-2.13;p<.05). LOT+SELstudents passed two blocks more often than LOTstudents (OR=1.65;p<.05). 8+students passed the professional development course more often than LOTstudents (OR=11.78;p<.05). In this course, SEL and 8+students were assessed as 'good' more often than LOT+SEL and LOTstudents. 8+-students completed all first-year courses within the year more often than the other groups (OR=6.39-9.89;p<.01), whereas SEL and LOT+SELstudents completed all first-year courses within the year more often than LOTstudents (OR=1.46-1.55;p<.05). Discussion and Conclusion: The results showed that students who were admitted based on a high pu-GPA performed best. Selected and non-selected students' performance did not differ, except in the professional development course which focuses on non-cognitive skills. This finding is consistent with existing research on the MMI . A remarkable outcome is that lottery-students who had participated in the selection procedure performed better than students who had only participated in the lottery. Further research is necessary to analyze whether this can be explained by higher motivation.
References: (1) Benbassat J, Baumal R. 2007. Uncertainties in the selection of applicants for medical school. Adv Health Sci Educ 12:509-521.
(2) Salvatori P. 2001. Reliability and validity of admissions tools used to select students for the health professions. Adv in Health Sci Educ 6:159-175.
(3) Siu E, Reiter, HI. 2009. Overview: What's worked and what hasn't as a guide towards predictive admissions tool development. Adv Health Sci Educ 14:759-775.
(4) Eva K, Rosenfeld J, Reiter H, Norman GR. 2004. An admissions OSCE: The multiple mini-interview. Med Educ 38:314-326.
(5) Eva KW, Reiter HI, Trinh K, Wasi P, Rosenfeld J, Norman GR. 2009. Predictive validity of the multiple mini-interview for selecting medical trainees. Med Educ
Factors behind MCAT-Scores: A systematic review
M Habersack (Medical University Graz, Office of the Vice-Rector for Teaching & Studies, Auenbruggerpl. 2, Graz 8010, Austria)
G Luschin (Ass. of Womens Health, Graz, Austria)
HP Dimai (Medical University Graz, Teaching & Studies,
Introduction: The selection of students is increasingly becoming a (socio)political discussion point. Especially the selection process for medical college is criticized with regards to (un)fairness, discrimination of socially disadvantaged population groups, perpetuation of a gender gap or simply maintenance of a desired status
ABSTRACT BOOK: SESSION 7 TUESDAY 27 AUGUST: 1045-1230
quo (1,2). However, selection criteria in the context of the selection process for medical college have to be analyzed with regards to whether an invalidation of the above mentioned arguments is possible. The purpose of the present study is the systematic and critical review of publications which discuss the factors that are associated with medical-college-admission-test-scores. Methods: A systematic, critical literature search was carried out in EMBASE, Medline, Pascal, ERIC and PsycINFO. Limits were the last 10 years as well as the languages German or English. The review includes qualitative as well as quantitative studies that discuss factors associated with medical college admission test scores. The review excludes studies that do not focus on the medical-college-admission-test, studies that deal with drop-out and/or statistical correlations between admission (test-scores) and student success. Full texts were evaluated regarding methodical / theoretical rigor by means of the applicable quality checklist for quantitative / qualitative studies of the Alberta Heritage Foundation for Medical Research. As cut-point for the exclusion of full texts, the value of < 0.75 was chosen
Results: After applying the selection criteria according to the title and abstract screening, 28 publications (of initially 655 references) remained for further evaluation. 15 publications had to be excluded because, e.g., their focus was not of interest. Four additional articles were included from the reference lists. Two articles had to be excluded due to low quality (quality score <0.75). Ultimately, 15 publications met the inclusion criteria and were subjected to further analysis and evaluation. Extracted data were compared and categorized with regards to the research question. The main statements of the publications were divided in two categories: (i) Factors attributable to the Medical College Admission Test and (ii) Factors associated with the SES (in the broader sense) of potential candidates. Discussion and Conclusion: The results of the systematic review describe two factors associated with medical college admission test scores that are discussed in the literature. Especially the Medical college admission test does not - and that with regards to construction/design/weighting as well as with regards to the construction of the items or the statistical depiction of the results - succeed in invalidating arguments of discrimination in the broader sense (4, 5). The second category comprises factors that are linked to the socioeconomic status, as for example inequality of opportunities depending on the allocating college, or programs and actions that are (occasionally) performed to decrease "uneven distributions" at the university or college level. In this precise context, these factors are also an indication that a pre-selection of potential students is known and accepted as a given. In order to be able to invalidate the mentioned arguments against medical college admission tests, a systematical examination of the mentioned categories is needed References: 1. Cohen JJ. The consequences of premature abandonment of affirmative action in medical school admissions. Jama. 2003 Mar
5;289(9):1143-9. PubMed PMID: 12622585. English.
2. Emery JL, Bell JF, Vidal Rodeiro CL. The BioMedical Admissions Test for medical student selection: issues of fairness and bias. Medical teacher. 2011;33(1):62-71. PubMed PMID: 21182386.
3. AHFMR. Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. HTA Initiative. 2004;2004(02).
4. Tiffin PA, Dowell JS, McLachlan JC. Widening access to UK medical education for under-represented socioeconomic groups: modelling the impact of the UKCAT in the 2009 cohort. Bmj. 2012;344:e1805.
PubMed PMID: 22511300. Pubmed Central PMCID: PMC3328544. English.
5. Alexander C, Chen E, Grumbach K. How leaky is the health career pipeline? Minority student achievement in college gateway courses. Academic Medicine. 2009
Jun;84(6):797-802. PubMed PMID: 2009-16807-011.
Exploring Resilience to Stress and Trauma in Medical Students
Vicki R LeBlanc (University of Toronto, Wilson Centre, 200 Elizabeth St, 1ES-565, Toronto M5G 2C4, Canada)
Introduction: In the last decade, there has been growing interest in documenting the prevalence of mental health issues, as well as identifying sources of stress, during medical training (1). In contrast, there has been little research exploring the individually-based factors contributing to student resilience or vulnerability to stressors. Research in the broader stress domain has been targeted towards determining the factors, labeled resilience resources, either within the person or in his/her environment that foster the ability to maintain functioning despite repetitive or long-lasting demands
(2) . Emerging factors include perceived social support
(3) and personality traits such as coping styles (4) and ego resilience (5). The goal of this study was to examine the relative contributions of these individual-level factors to reported chronic stress and trauma symptoms in medical students.
Methods: Fourth year medical students from an urban Canadian medical school participated in the study. They completed the Perceived Stress Scale (PSS) and the Impact of Events Scale-Revised (IES-R: measure of posttraumatic stress symptoms). Students also completed the Ego Resiliency Scale (capacity to adapt one's control to situational demands), the Social Provisions Scale (perceived social support), the Coping Inventory for Stressful Situations (thoughts and behaviours to manage stressful situations) and a demographic survey assessing age, gender, relationship status, debt level, prior education level, and the number of positive life events and major stressors encountered in the previous year. Separate stepwise regression analyses were conducted with the total scores on the PSS and the IES-R as the dependent variables, and the remaining measures as the predictor variables. Results: One hundred and sixteen students, out of a possible 200, participated in the study (response rate:
58%). Emotion oriented coping (e.g. focusing on, and venting of, emotions) and ego resilience (e.g. more likely to endorse statements such as "I like to do new and different things") significantly predicted students' reported stress levels, explaining 39% of the variance in PSS scores (p<.01). Students high in emotion-oriented coping were more likely to report higher levels of chronic stress (standardized beta coefficient = .56, p< .01). Students high in ego resilience were less likely to report higher levels of chronic stress (standardized beta coefficient = -.16, p<.05). Emotion oriented coping and perceived social support significantly predicted students' reported trauma levels, explaining 38% of the variance in IES-R scores (p<.01). Students high in emotion-oriented coping were more likely to report trauma symptoms (standardized beta coefficient = .55, p< .01). Students high in perceived social support were less likely to report trauma symptoms (standardized beta coefficient= -.17, p<.05). Prior education level, age, debt level, number of positive events or stressors were not significant predictors of reported chronic stress or trauma levels.
Discussion and Conclusion: Individuals who habitually use emotion-oriented coping appear vulnerable to chronic stress and trauma symptoms. In contrast, students who are high in ego resilience and who perceive greater social support are less likely to report chronic stress or trauma symptoms. Findings from this research can inform the development and delivery of wellness interventions targeted to individuals vulnerable to the stressors encountered as part of medical training. References: 1. Dyrbye LN, Thomas MR, Shanafelt TD. (2006). Systematic Review of Depression, Anxiety, and Other Indicators of Psychological Distress Among U.S. and Canadian Medical Students. Academic Medicine.
2. Schetter, C. D. and Dolbier, C. (2011), Resilience in the Context of Chronic Stress and Health in Adults. Social and Personality Psychology Compass, 5: 634-652.
3. Letzringa TD, Block J, Funder DC. (2005). Ego-control and ego-resiliency: Generalization of self-report scales based on personality descriptions from acquaintances, clinicians, and the self. Journal of research in