A multi-site study on medical school selection, performance, motivation and engagement.

Medical schools seek ways to improve their admissions strategies, since the available methods prove to be suboptimal for selecting the best and most motivated students. In this multi-site cross-sectional questionnaire study, we examined the value of (different) selection procedures compared to a weighted lottery procedure, which includes direct admission based on top pre-university grade point averages (≥8 out of 10; top-pu-GPA). We also considered whether students had participated in selection, prior to being admitted through weighted lottery. Year-1 (pre-clinical) and Year-4 (clinical) students completed standard validated questionnaires measuring quality of motivation (Academic Self-regulation Questionnaire), strength of motivation (Strength of Motivation for Medical School-Revised) and engagement (Utrecht Work Engagement Scale-Student). Performance data comprised GPA and course credits in Year-1 and clerkship performance in Year-4. Regression analyses were performed. The response rate was 35% (387 Year-1 and 273 Year-4 students). Top-pu-GPA students outperformed selected students. Selected Year-1 students reported higher strength of motivation than top-pu-GPA students. Selected students did not outperform or show better quality of motivation and engagement than lottery-admitted students. Participation in selection was associated with higher engagement and better clerkship performance in Year-4. GPA, course credits and strength of motivation in Year-1 differed between students admitted through different selection procedures. Top-pu-GPA students perform best in the medical study. The few and small differences found raise questions about the added value of an extensive selection procedure compared to a weighted lottery procedure. Findings have to be interpreted with caution because of a low response rate and small group sizes.

Influence of PBL with open-book tests on knowledge retention measured with progress tests.

The influence of problem-based learning (PBL) and open-book tests on long-term knowledge retention is unclear and subject of discussion. Hypotheses were that PBL as well as open-book tests positively affect long-term knowledge retention. Four progress test results of fifth and sixth-year medical students (n = 1,648) of three medical schools were analyzed. Two schools had PBL driven curricula, and the third one had a traditional curriculum (TC). One of the PBL schools (PBLob) used a combination of open-book (assessing backup knowledge) and closed-book tests (assessing core knowledge); the other two schools (TC and PBLcb) only used closed-book tests. The items of the progress tests were divided into core and backup knowledge. T tests (with Bonferroni correction) were used to analyze differences between curricula. PBL students performed significantly better than TC students on core knowledge (average effect size (av ES) = 0.37-0.74) and PBL students tested with open-book tests scored somewhat higher than PBL students tested without such tests (av ES = 0.23-0.30). Concerning backup knowledge, no differences were found between the scores of the three curricula. Students of the two PBL curricula showed a substantially better long-term knowledge retention than TC students. PBLob students performed somewhat better on core knowledge than PBLcb students. These outcomes suggest that a problem-based instructional approach in particular can stimulate long-term knowledge retention. Distinguishing knowledge into core and backup knowledge and using open-book tests alongside closed-book tests could enhance long-term core knowledge retention.

Faculty and student perceptions of the feasibility of individual student-faculty meetings.

The extent to which students feel involved in their education positively influences academic achievement. Individual student-faculty meetings can foster student involvement. To be effective, faculty acknowledgement of the benefit of these meetings is a prerequisite. The aim of this study was to explore faculty perceptions of individual student-faculty meetings. In addition we investigated students' perceptions. As part of the undergraduate programme, mandatory individual intake and follow-up meetings between first-year medical students (n = 425) and senior faculty members (n = 34) have been implemented from 2009 onwards. We administered a questionnaire on faculty perceptions of the benefit and impact of intake meetings. Subsequently, after both meetings had been held, strong and weak points of the mandatory programme were explored using open-ended questions. Students' perceptions were investigated by open-ended questions as a part of the curriculum evaluation process. Faculty enjoyed the meetings (90 %), perceived the meetings to be beneficial (74 %) and expected a positive effect on student involvement (74 %). Faculty appreciated the opportunity to give advice tailored to students' personal needs and levels of performance. The students appreciated the meetings and the attention given to their personal situation and study progress. Faculty and student appreciation of the meetings seems to support the assumption that the individual meetings increase students' social and academic involvement. Further research should focus on the impact of individual student-faculty meetings on students' learning behaviours.

Directing students to profound open-book test preparation: the relationship between deep learning and open-book test time.

BACKGROUND: Considering the growing amount of medical knowledge and the focus of medical education on acquiring competences, using open-book tests seems inevitable. A possible disadvantage of these tests is that students underestimate test preparation. AIMS: We examined whether students who used a deep learning approach needed less open-book test time, and how students performed on open-book questions asked in a closed-book setting. METHOD: Second- (N = 491) and third-year students (N = 325) prepared half of the subject matter to be tested closed-book and half to be tested open-book. In agreement with the Board of Examiners, some questions in the closed-book test concerned open-book subject matter, and vice versa. Data were gathered about test time, deep learning and preparation time. Repeated measurement analysis, t-tests and partial correlations were used to analyse the data. RESULTS: We found a negative relationship between deep learning and open-book test time for second-year students. Students scored the lowest on closed-book questions about open-book subject matter. CONCLUSIONS: Reduction of the available test time might force students to prepare longer and deeper for open-book tests. Further research is needed to identify variables that influence open-book test time and to determine how restrictive this time should be.

Learning strategies during clerkships and their effects on clinical performance.

BACKGROUND: Previous research revealed relationships between learning strategies and knowledge acquisition. During clerkships, however, students' focus widens beyond mere knowledge acquisition as they further develop overall competence. This shift in focus can influence learning strategy use. AIM: We explored which learning strategies were used during clerkships and their relationship to clinical performance. METHODS: Participants were 113 (78%) clerks at the university hospital or one of six affiliated hospitals. Learning strategies were assessed using the 'Approaches to Learning at Work Questionnaire' (deep, surface-rational and surface-disorganised learning). Clinical performance was calculated by taking the mean of clinical assessment marks. The relationship between learning strategies and clinical performance was explored using regression analysis. RESULTS: Most students (89%) did not clearly prefer a single learning strategy. No relationship was found between learning strategies and clinical performance. DISCUSSION: Since overall competence comprises integration of knowledge, skills and professional behaviour, we assume that students without a clear preference use more than one learning strategy. Finding no relationship between learning strategies and clinical performance reflects the complexity of clinical learning. Depending on circumstances it may be important to obtain relevant information quickly (surface-rational) or understand material thoroughly (deep). In future research we will examine when and why students use different learning strategies.

Open-book tests to complement assessment-programmes: analysis of open and closed-book tests.

Today's health sciences educational programmes have to deal with a growing and changing amount of knowledge. It is becoming increasingly important for students to be able to use and manage knowledge. We suggest incorporating open-book tests in assessment programmes to meet these changes. This view on the use of open-book tests is discussed and the influence on test quality is examined. To cope with the growing amount of medical knowledge, we have divided the body of knowledge into core knowledge, which students must know without need for references, and backup knowledge, which students need to understand and use properly with the help of references if so desired. As a result, all tests consist of a subtest for reproduction and understanding of core knowledge (a closed-book test) and a subtest for the ability to understand and manage backup knowledge (an open-book test). Statistical data from 14 such double-subtest exams for first and second-year students were analyzed for two cohorts (N = 435 and N = 449) with multilevel analysis, in accordance with generalizability theory. The reliability of the open and closed-book sections of the separate tests varied between 0.712 and 0.850. The open-book items reduce reliability somewhat. The estimated disattenuated correlation was 0.960 and 0.937 for cohorts 1 and 2 respectively. It is concluded that the use of open-book items with closed-book items slightly decreases test reliability but the overall index is acceptable. In addition, open and closed-book sections are strongly positively related. Therefore, open-book tests could be helpful in complementing today's assessment programmes.

Cross institutional collaboration in assessment: a case on progress testing.

The practice of assessment is governed by an interesting paradox. On the one hand good assessment requires substantial resources which may exceed the capacity of a single institution and we have reason to doubt the quality of our in-house examinations. On the other hand, our parsimonity with regard to our resources makes us reluctant to pool efforts and share our test material. This paper reports on an initiative to share test material across different medical schools. Three medical schools in The Netherlands have successfully set up a partnership for a specific testing method: progress testing. At present, these three schools collaboratively produce high-quality test items. The jointly produced progress tests are administered concurrently by these three schools and one other school, which buys the test. The steps taken in establishing this partnership are described and results are presented to illustrate the unique sort of information that is obtained by cross-institutional assessment. In addition, plans to improve test content and procedure and to expand the partnership are outlined. Eventually, the collaboration may even extend to other test formats. This article is intended to give evidence of the feasibility and exciting potential of between school collaboration in test development and test administration. Our experiences have demonstrated that such collaboration has excellent potential to combine economic benefit with educational advantages, which exceed what is achievable by individual schools.

[Physicians for ten years: a longitudinal survey of the career development of physicians who began their studies in Groningen, the Netherlands]. / Tien jaar arts: een longitudinaal onderzoek naar de loopbaan van artsen die hun studie begonnen in Groningen.

OBJECTIVE: To analyse the career development of two cohorts of medical graduates from the University of Groningen, the Netherlands. DESIGN: Structured interviews. METHOD: For all 333 graduates who commenced undergraduate medical training in 1982 and 1983, data were collected for the period 1993-2000 with respect to resident training, income, job load, job satisfaction and scientific research. Gender differences were analysed for all of the variables. This was done by means of structured interviews as well as a strategic search in Medline and the on-line public catalogue of the University of Groningen. RESULTS: In the year 2000, 73% of the graduates had enrolled in resident training, 8% had not succeeded in finding a place. The wish to work part-time had increased strongly over the years. In general, job satisfaction was reasonable. In total 31% of the cohort had published one or more English articles or written a thesis. Gender differences were found for job load and publications. CONCLUSIONS: Ten years after graduation, medical careers had become established. Men had not succeeded in fulfilling their wishes to work part-time. Women were disadvantaged with respect to their scientific career.

An Inter- and Intra-University Comparison With Short Case-Based Testing.

Comparisons between PBL and non-PBL medical schools on problem-solving ability often show no differences. This could be either due to the fact that no difference in problem-solving skills exists or that the instruments used are inadequate. In this study a key-feature approach case-based examination was used to compare two medical schools in the Netherlands, one of which has a PBL curriculum (Maastricht) and one which has a program half way a transition from a non-PBL towards a PBL curriculum (Groningen). Differences were found both in proficiency scores and in the pattern of response times, both supporting the assumption that a PBL approach would lead to a higher level of problem solving ability. The effect size, however, is not as large as originally assumed by the PBL proponents. Conclusions must be drawn with caution, but it seems likely that a test based on large numbers of short cases is the most sensitive in detecting differences in problem solving ability between students of different curricula.

[Status of the job market of physicians who started their education in Groningen in 1982 and 1983]. / De plaats op de arbeidsmarkt van artsen die in 1982 en 1983 in Groningen gingen studeren.

OBJECTIVE: To determine the working experience and desires of doctors, who started their medical training approximately 10 years ago. DESIGN: Telephone inquiry. SETTING: University of Groningen, the Netherlands. METHOD: In the summer of 1993, 98% of medical graduates who started their training at the University of Groningen in 1982 of 1983 were questioned about working experience and wishes for the future. RESULTS: Over 70% worked as medical assistants in hospitals; most of them were not (yet) in training. Almost all male subjects and 4 out of 5 female subjects worked full time. Half of them wished to keep a full time job (two-thirds of the men, one-third of the women). CONCLUSION: When all working desires would be fulfilled, the future work time per doctor would be 86%. There is a great need for specialist training places.

Smoking habits in medical students and physicians in Groningen, The Netherlands.

Smoking habits and attitudes towards smoking of medical students (n = 725), house officers (n = 126) and consultants (n = 236) of the University Hospital of Groningen were studied, in 1989 by means of a World Health Organization (WHO) questionnaire. Overall response rate was 84%. Twenty seven percent of the medical students are current smokers, 28% of the house officers and 34% of the consultants. There is a remarkable difference among medical specialists i.e: smoking prevalence is highest among psychiatrists and lowest among paediatricians. The prevalence of smoking in medical students and house officers is lower than in the Dutch population. Smoking habits of the consultants are similar to those of the general population. About 75% of the doctors reported having no experience with smoking cessation programmes. Doctors report a need for more skills and knowledge on smoking cessation programmes.

[Smoking behavior of medical students, house officers and specialists in Groningen, 1989]. / Rookgedrag van medische studenten, arts-assistenten en specialisten in Groningen, 1989.

Smoking habits and attitudes towards smoking of medical students (n = 725), house officers (n = 126) and consultants (n = 236) of the University Hospital of Groningen were studied in 1989 using a WHO questionnaire. Overall response was 84%. Twenty-seven percent of the medical students, 28% of the house officers and 34% of the consultants are current smokers. The prevalence of smoking in medical students and house officers is lower than that in the Dutch population. Smoking habits of consultants are similar to the general population. The prevalence of smoking Dutch physicians which was 56% in 1983 is decreasing rapidly. Doctors report they want more information about smoking cessation programs.