Comparison of Subjective/Objective Evaluation of Medical Students at Social Medicine Training between Different Grades in the Same Academic Year: Focus on Student Readiness / 医学教育

Background: The aims of the present study were to reveal the impact of the introduction of social medicine training one year earlier in a new university curriculum on subjective/objective evaluation of medical students, and to discuss the readiness of said students. Methods: In this natural experiment study, subjects comprised 73 third- (n = 31) and fourth-grade (n = 42) medical students who participated in social medicine training, namely “Family Health Practice Tutorial,” in 2017. The data consisted of student’s self-assessment and assessment from clients. The associations between these assessments and student grade were analyzed using the Mann-Whitney U test and ordinal logistic regression. Results: The score for “Language” in the assessment from the clients was significantly lower in the third-grade students than in the fourth-grade students after adjustment for gender (odds ratio = 0.147; 95% confidence interval = [0.027, 0.797]). Discussion: Insufficient readiness for language to residents in the community was found in third-grade medical students. Advanced communication training prior to practice for third-grade students may contribute to sustainable social medicine training in the community.

El experimento natural como un nuevo diseño cuasi-experimental en investigación social y de salud / Natural experiment as a new quasi-xperimental design in social and health-related sciences

En las ciencias sociales y de la salud actualmente comienza a ser conocido un diseño denominado como "experimento natural", que se caracteriza por ser un tipo de cuasi-experimento en que la asignación de tratamiento no es hecha por el investigador sino por un agente exógeno tal como una ley, una política sectorial o un fenómeno natural. Esa intervención exógena implícita permite que se formen grupos con bajos niveles de sesgos de selección inicial, por lo que la comparación de resultados encontrados en esos grupos (grupos afectados por la ley, la política o fenómeno natural respecto del grupo contrafáctico que no es afectado) permite predecir los efectos de la ley, política sectorial o fenómeno natural casi tan eficientemente como en la creación de grupos aleatorios de tratamiento y control.

Currently in social science research it is used a new research design defined as a "natural experiment", where the researcher has none participation in the treatment assignment because it has been directly done for an exogenous agent such as a law, a social policy or a natural event. This implicit exogenous intervention allows that low-level pre-determined selection bias groups be formed. Therefore, the comparison on results being found between these groups (law-affected group, social policy-affected group, or natural event-affected group versus contrafactic groups not being affected) allow to predict the effect of this law, social policy, or natural event almost so efficiently like happen in randomly created treatment-and-control groups.