Preparing for the MD: How Long, at What Cost, and With What Outcomes?

PURPOSE: To assess educational and professional outcomes of an accelerated combined bachelor of science-doctor of medicine (BS-MD) program using data collected from 1968 through 2018. METHOD: Participants of this longitudinal study included 2,235 students who entered medical school between 1968 and 2014: 1,134 in the accelerated program and 1,101 in the regular curriculum (control group)-matched by year of entrance to medical school, gender, and Medical College Admission Test (MCAT) scores. Outcome measures included performance on medical licensing examinations, academic progress, satisfaction with medical school, educational debt, first-year residency program directors' ratings on clinical competence, specialty choice, board certification, and faculty appointments. RESULTS: The authors found no practically important differences between students in the accelerated program and those in the control group on licensing examination performance, academic progress, specialty choice, board certification, and faculty appointments. Accelerated students had lower mean educational debt (P < .01, effect sizes = 0.81 and 0.45 for, respectively, their baccalaureate debt and medical school debt), lower satisfaction with their second year of medical school (P < .01, effect size = 0.21), and lower global satisfaction with their medical school education (P < .01, effect size = 0.35). Residency program directors' ratings in 6 postgraduate competency areas showed no practically important differences between the students in the accelerated program and those in the control group. The proportion of Asian students was higher among program participants (P < .01, effect size = 0.43). CONCLUSIONS: Students in the accelerated program earned BS and MD degrees at a faster pace and pursued careers that were comparable to students in a matched control who were in a regular MD program. Findings indicate that shortening the length of medical education does not compromise educational and professional outcomes.

Personality assessments and outcomes in medical education and the practice of medicine: AMEE Guide No. 79.

In a paradigm of physician performance we propose that both "cognitive" and "noncognitive" components contribute to the performance of physicians-in-training and in-practice. Our review of the relevant literature indicates that personality, as an important factor of the "noncognitive" component, plays a significant role in academic and professional performances. We describe findings on 14 selected personality instruments in predicting academic and professional performances. We question the contention that personality can be validly and reliably assessed from admission interviews, letters of recommendation, essays, and personal statements. Based on conceptual relevance and currently available empirical evidence, we propose that personality attributes such as conscientiousness and empathy should be considered among the measures of choice for the assessment of pertinent aspects of personality in academic and professional performance. Further exploration is needed to search for additional personality attributes pertinent to medical education and patient care. Implications for career counseling, assessments of professional development and medical education outcomes, and potential use as supplementary information for admission decisions are discussed.

The predictive validity of three versions of the MCAT in relation to performance in medical school, residency, and licensing examinations: a longitudinal study of 36 classes of Jefferson Medical College.

PURPOSE: The Medical College Admission Test (MCAT) has undergone several revisions for content and validity since its inception. With another comprehensive review pending, this study examines changes in the predictive validity of the MCAT's three recent versions. METHOD: Study participants were 7,859 matriculants in 36 classes entering Jefferson Medical College between 1970 and 2005; 1,728 took the pre-1978 version of the MCAT; 3,032 took the 1978-1991 version, and 3,099 took the post-1991 version. MCAT subtest scores were the predictors, and performance in medical school, attrition, scores on the medical licensing examinations, and ratings of clinical competence in the first year of residency were the criterion measures. RESULTS: No significant improvement in validity coefficients was observed for performance in medical school or residency. Validity coefficients for all three versions of the MCAT in predicting Part I/Step 1 remained stable (in the mid-0.40s, P < .01). A systematic decline was observed in the validity coefficients of the MCAT versions in predicting Part II/Step 2. It started at 0.47 for the pre-1978 version, decreased to between 0.42 and 0.40 for the 1978-1991 versions, and to 0.37 for the post-1991 version. Validity coefficients for the MCAT versions in predicting Part III/Step 3 remained near 0.30. These were generally larger for women than men. CONCLUSIONS: Although the findings support the short- and long-term predictive validity of the MCAT, opportunities to strengthen it remain. Subsequent revisions should increase the test's ability to predict performance on United States Medical Licensing Examination Step 2 and must minimize the differential validity for gender.

Reliability and validity of the Jefferson Scale of Empathy in undergraduate nursing students.

Evidence has been reported in support of the reliability and validity of the Jefferson Scale of Physician Empathy (JSPE) when used with physicians, medical students, and nurses. This study examined the psychometrics of a modified version of the scale in undergraduate nursing students. The modified version of the JSPE was administered to 333 nursing students at different levels of training. Three underlying constructs, that is, "Perspective Taking," "Compassionate Care," and "Standing in Patient's Shoes" emerged from the factor analysis of the scale that were consistent with the conceptual framework of empathy, thus supporting the construct validity of the scale. The coefficient alpha was .77. Scores of the empathy scale were significantly correlated with the scores of the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (r = .38, p < .001). Women scored higher than men, and those with more clinical experiences scored higher than others. It was concluded that the empathy scale used in this study is a psychometrically sound instrument for measuring empathy in undergraduate nursing students.

The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration: a study with undergraduate nursing students.

The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) was administered to 333 undergraduate nursing students. The underlying factors, item-total score correlations and reliability of the JSAPNC were examined. A significant correlation was observed between scores of the JSAPNC and the Jefferson Scale of Empathy (r = 0.38). It was hypothesized that: (1) Women would score higher than men on the JSAPNC, (2) Scores on the JSAPNC would increase as students progress in their nursing education, (3) Scores on the JSAPNC would be higher for students with work experiences in health care, and (4) Scores on the JSAPNC would be higher for those with a higher level of education prior to nursing school. Hypotheses 1, 3 and 4 were confirmed at a conventional statistical level of significance (p < 0.05), and hypothesis 2 was confirmed at a marginal significance level (p = 0.06). No significant differences were observed on scores of the JSAPNC among undergraduate nursing students grouped by ethnic minority, specialty plan, academic major prior to nursing school, or marital status. Implications for future studies in nursing education are discussed.

Components of postgraduate competence: analyses of thirty years of longitudinal data.

CONTEXT: The conceptualisation and measurement of competence in patient care are critical to the design of medical education programmes and outcome assessment. OBJECTIVE: We aimed to examine the major components and correlates of postgraduate competence in patient care. METHODS: A 24-item rating form with additional questions about resident doctors' performance and future residency offers was used. Study participants comprised 4560 subjects who graduated from Jefferson Medical College between 1975 and 2004. They pursued their graduate medical education in 508 hospitals. We used a longitudinal study design in which the rating form was completed by programme directors to evaluate residents at the end of the first postgraduate year. Factor analysis was used to identify the underlying components of postgraduate ratings. Multiple regression, t-test and correlational analyses were used to study the validity of the components that emerged. RESULTS: Two major components emerged, which we labelled 'Knowledge and Clinical Capabilities' and 'Professionalism', and which addressed the science and art of medicine, respectively. Performance measures during medical school, scores on medical licensing examinations, and global assessment of Medical Knowledge, Clinical Judgement and Data-gathering Skills showed higher correlations with scores on the Knowledge and Clinical Capabilities component. Global assessments of Professional Attitudes and ratings of Empathic Behaviour showed higher correlations with scores on the Professionalism component. Offers of continued residency and evaluations of desirable qualities were associated with both components. CONCLUSIONS: Psychometric support for measuring the components of Knowledge and Clinical Capabilities, and Professionalism provides an instrument to empirically evaluate educational outcomes to medical educators who are in search of such a tool.

Assessing physicians' orientation toward lifelong learning.

BACKGROUND: Despite the importance of lifelong learning as an element of professionalism, no psychometrically sound instrument is available for its assessment among physicians. OBJECTIVE: To assess the validity and reliability of an instrument developed to measure physicians' orientation toward lifelong learning. DESIGN: Mail survey. PARTICIPANTS: Seven hundred and twenty-one physicians, of whom 444 (62%) responded. MEASUREMENT: The Jefferson Scale of Physician Lifelong Learning (JSPLL), which includes 19 items answered on a 4-point Likert scale, was used with additional questions about respondents' professional activities related to continuous learning. RESULTS: Factor analysis of the JSPLL yielded 4 subscales entitled: "professional learning beliefs and motivation,""scholarly activities,""attention to learning opportunities," and "technical skills in seeking information," which are consistent with widely recognized features of lifelong learning. The validity of the scale and its subscales was supported by significant correlations with a set of criterion measures that presumably require continuous learning. The internal consistency reliability (coefficient alpha) of the JSPLL was 0.89, and the test-retest reliability was 0.91. CONCLUSIONS: Empirical evidence supports the validity and reliability of the JSPLL.

An empirical study of decline in empathy in medical school.

CONTEXT: It has been reported that medical students become more cynical as they progress through medical school. This can lead to a decline in empathy. Empirical research to address this issue is scarce because the definition of empathy lacks clarity, and a tool to measure empathy specifically in medical students and doctors has been unavailable. OBJECTIVE: To examine changes in empathy among medical students as they progress through medical school. MATERIALS AND SUBJECTS: A newly developed scale (Jefferson Scale of Physician Empathy [JSPE], with 20 Likert-type items) was administered to 125 medical students at the beginning (pretest) and end (post-test) of Year 3 of medical school. This scale was specifically developed for measuring empathy in patient care situations and has acceptable psychometric properties. METHODS: In this prospective longitudinal study, the changes in pretest/post-test empathy scores were examined by using t-test for repeated measure design; the effect size estimates were also calculated. RESULTS: Statistically significant declines were observed in 5 items (P < 0.01) and the total sores of the JSPE (P < 0.05) between the 2 test administrations. CONCLUSIONS: Although the decline in empathy was not clinically important for all of the statistically significant findings, the downward trend suggests that empathy could be amenable to change during medical school. Further research is needed to identify factors that contribute to changes in empathy and to examine whether targeted educational programmes can help to retain, reinforce and cultivate empathy among medical students for improving clinical outcomes.

Economic diversity in medical education: the relationship between students' family income and academic performance, career choice, and student debt.

Providing access to higher education across all income groups is a national priority. This analysis assessed the performance, career choice, and educational indebtedness of medical college students whose educational pursuits were assisted by the provision of financial support. The study looked at designated outcomes (academic performance, specialty choice, accumulated debt) in relation to the independent variable, family (parental) income, of 1,464 students who graduated from Jefferson Medical College between 1992 and 2002. Students were classified into groups of high, moderate, and low income based on their parental income. During the basic science years, the high-income group performed better; however, in the clinical years, performance measures were similar. Those in the high-income group tended to pursue surgery, while those in the low-income group preferred family medicine. The mean of accumulated educational debt was significantly higher for the low-income group. The study provides support for maintaining economic diversity in medical education.

An empirical study of the predictive validity of number grades in medical school using 3 decades of longitudinal data: implications for a grading system.

Context It is important to establish the predictive validity of medical school grades. The strength of predictive validity and the ability to identify at-risk students in medical schools depends upon assessment systems such as number grades, pass/fail (P/F) or honours/pass/fail (H/P/F) systems. Objective This study was designed to examine the predictive validity of number grades in medical school, and to determine whether any important information is lost in a shift from number to P/F and H/P/F grading systems. Subjects The participants in this prospective, longitudinal study were 6656 medical students who studied at Jefferson Medical College over 3 decades. They were grouped into 10 deciles based on their number grades in Year 1 of medical school. Methods Participants were compared on academic accomplishments in Years 2 and 3 of medical school, medical school class rank, delayed graduation and attrition, performance on medical licensing examinations and clinical competence ratings in the first postgraduate year. Results Results supported the short- and longterm predictive validity of the number grades. Ratings of clinical competence beyond medical school were predicted by number grades in medical school. We demonstrated that small differences in number grades are statistically meaningful, and that important information for identifying students in need of remedial education is lost when students who narrowly meet faculty's expectations are included with the rest of the class in a broad 'pass' category. Conclusions The findings refute the argument that knowledge of sciences basic to medicine is not critical to subsequent performance in medical school and beyond if an appropriate evaluation system is used. Furthermore, the results of this study raise questions about abandoning number grades in favour of a pass/fail system. Consideration of these findings in policy decisions regarding assessment systems of medical students is recommended.

Medical education and health services research: the linkage.

The medical community is coming under increased scrutiny. Challenges to the integrity of the healthcare system have been raised due to reports about the prevalence of medical errors. A heightened level of vigilance is required. Equally important is the need to isolate and correct the source of any problem, perceived or real. We are faced with challenging questions. Is the selection of students and residents appropriate? Are their education and evaluation valid? These questions must be answered at least in part by understanding the climate in which the services to the patients are rendered. Otherwise deficiencies noted in practice may be inappropriately attributed to the educational process. This article addresses the importance, implications and impact of the link between medical education and health services research. The goal of medical education is to prepare physicians to meet the challenges of practice by fulfilling their roles of clinician, educator and resource manager. Health services research can be linked to any of these physician roles. An understanding of health services is necessary to assess how well this goal is being met in the context of the changing healthcare system. A partnership between medical education and health services research is essential for academic health centers and health services institutions in assessing issues of health manpower and for the public good. Academic health centers have an important role in this partnership providing an infrastructure and expertise for both education and health services research.

An operational measure of physician lifelong learning: its development, components and preliminary psychometric data.

Despite the emphasis placed on physicians' lifelong learning, no psychometrically sound instrument has been developed to provide an operational measure of the concept and its components among physicians. The authors designed this study to develop a tool for measuring physician lifelong learning, to identify its underlying components and to assess its psychometric properties. A 37-item questionnaire was developed, based on a review of literature and the results of two pilot studies. Psychometric analyses of the responses of 160 physicians identified 19 items that were included in the Jefferson Scale of Physician Lifelong Learning. Factor analysis of the 19 items showed five meaningful factors that were consistent with the definition and major features of lifelong learning. They were 'need recognition', 'research endeavor', 'self-initiation', 'technical skills' and 'personal motivation'. The method of contrasted groups provided evidence in support of the validity of the five factors. The factors' reliability was assessed by coefficient alpha. It is concluded that lifelong learning is a multifaceted concept, and its operational measure is feasible for evaluating different educational programs and for studying group differences among physicians.

Intra- and intercultural comparisons of the personality profiles of medical students in Argentina and the United States.

This study was designed to compare the personality profiles of medical students in Argentina and the United States. The ultimate purpose of the research was to study the value of personality measures in predicting academic and professional performances. Participants were 421 medical students in Argentina (254 women, 167 men) and 623 medical students in the United States (207 women, 416 men). Eight personality measures were administered: Perception of Stressful Life Events, Test Anxiety, General Anxiety, Loneliness, Self-Esteem, Locus of Control, Extraversion, and Neuroticism. Intracultural comparisons showed some minor gender differences in personality profiles within each culture (e.g., in the United States, women scored higher than men on the Perception of Stressful Life Events and General Anxiety scales, and in Argentina, women scored higher on the Test Anxiety scale). Intercultural comparisons of personality profiles showed that Argentine medical students obtained higher average scores than did their American counterparts on the Perception of Stressful Life Events, Test Anxiety, General Anxiety, External Locus of Control, Extraversion, and Neuroticism scales. Argentine students scored lower on the Loneliness scale than did their American counterparts. Psychometric findings supported the measurement properties of the personality measures in the two cultures (e.g., construct validity, and internal consistency aspect of reliability). Further study of the implications of the findings in predicting academic attainment in medical school and to physician performance is recommended.

Conceptualization and measurement of clinical competence of residents: a brief rating form and its psychometric properties.

Conceptualization and measurement of clinical competence of residents are of interest to medical educators. Yet there is a scarcity of operational tools with satisfactory psychometric support for measuring clinical competence. In this study, we investigated the underlying structure, criterion-related validity and alpha reliability of a brief rating form (20 items) developed to assess clinical competence of residents. The study sample consisted of 882 physicians (654 men, 228 women) in postgraduate training at Thomas Jefferson University Hospital between 1998 and 2000. Construct validity of the form was supported by factor analysis. Two relevant factors emerged: 'Knowledge, Data-Gathering and Processing Skills', and 'Interpersonal Skills and Attitudes'. Criterion-related validity was supported by significant linear associations between factor scores and performance on the medical licensing examinations. Alpha reliability coefficients for the two factors were 0.98 and 0.97, respectively. This brief rating form can be employed as one measure to evaluate clinical competence of residents with reasonable confidence in its measurement properties.