How learners learn: A new microanalytic assessment method to map decision-making.

BACKGROUND: Microanalytic techniques have shown considerable potential as avenues for understanding learning in a range of learning contexts. If a microanalytic approach is to be tested for utility, a suitable learning context is required. We chose problem-based learning (PBL) tutorials as our context. AIMS: We sought to determine if a new microanalytic approach is suitable for investigating the learning decisions made by students during PBL and what this form of microanalysis reveals. METHODS: Stimulated recall interviews were used to question 17 first year graduate-entry medical students regarding the conscious decisions behind their actions during one PBL case. Responses were categorized and used to construct process maps to illustrate the students' decision-making. These maps and the decisions within them were analyzed focusing on how learners learn. RESULTS: Stimulated recall interviewing (SRI) was conducted, during which students could articulate the conscious decisions they made during PBL. The data collected were used to construct 191 process maps and 802 categorized decisions for analysis. Students' decisions became increasingly self-centered as the case progressed while maintaining an awareness of group dynamics. CONCLUSIONS: The microanalytic approach employed in this study is a suitable tool for understanding the nature of learning in this, and other environments.

Variation in personality traits of medical students between schools of medicine.

INTRODUCTION: While there have been studies exploring the impact of personality on medical student selection and performance there has not been an investigation of the personality of students at different schools. METHOD: Demographic data and responses to the NEO measure of personality traits were collected from medical students in the first two weeks of their enrolment (2011) in seven medical schools in Australia. Personality traits were analysed by school features, gender and age using logistic regression. RESULTS: Differences were detected between schools in the personality traits of Agreeableness and Conscientiousness. Higher Agreeableness and Conscientiousness were associated with attending an Undergraduate school (OR = 1.07 and 1.03, respectively) and a rural or community focussed school (1.06 and 1.03). Students attending a school that used interviews for selection had higher levels of Agreeableness (1.04) and lower levels of Neuroticism (0.96). DISCUSSION: This is the first study to demonstrate that personality traits differ between students entering different medical schools. While there seems to be logic behind some differences, others are perplexing. Further research should expand on these findings and the implications to schools in regards to attracting students through selection processes, mission statements and their broader social focus.

Role of personality in medical students' initial intention to become rural doctors.

OBJECTIVE: Recent efforts to redress the deficit of rural medical practitioners have considered the problem of recruitment and retention of rural doctors as one of influencing individuals' career choices. Exposure to rural medical environments during basic medical training is one long-standing example of an initiative aimed in this direction and there is some evidence that it is effective. This study sought to determine whether or not various domains of personality are related to medical students' attitude to practising as rural doctors after graduation. DESIGN: The sample comprised 914 students commencing medical studies in Australian universities. They were recruited as part of the Medical Schools Outcomes Database project and indicated intended location of future medical practice. SETTING: Seven Australian basic medical training programs. MAIN OUTCOME MEASURES: All students completed the NEO five-factor index (NEO-FFI) and Adjective Checklist (ACL) personality instruments. RESULTS: A preference for a rural practice location was associated with a combination of six domains of personality. The probability of rural preference was greater with higher scores on openness to experience, agreeableness and self-confidence but lower with higher scores on extraversion, autonomy and intraception. Taken together these six domains of personality provide useful although imperfect discrimination between students with a rural versus urban location preference. After controlling for student age the associations with extraversion and agreeableness failed to reach statistical significance. CONCLUSIONS: While personality does not fully explain medical students' attitude towards practicing as a rural doctor, the data suggest it is an important factor and that some individuals may be better suited to a rural medical career than others. Considering personality along with other characteristics of the individual might allow targeted 'marketing' of rural practice.

Intern culture, internal resistance: uptake of peer review in two Australian hospital internship programs.

OBJECTIVE: To compare the uptake of peer review among interns in mandatory and voluntary peer-review programs. POPULATION: All first and second year graduates (n=105) in two Australian hospitals. MAIN OUTCOME MEASURES: Completion of peer review, and reported responses by doctors to peer review. RESULTS: Eight of sixty interns undertaking the mandated program completed all steps. In the voluntary program, none of 45 interns did so. Resistance to peer review occurred at all stages of the trial, from the initial briefing sessions to the provision of peer-review reports. DISCUSSION; Hospital internship is a critical period for the development of professional identity among doctors. We hypothesise that resistance to peer review among novice doctors reflects a complex tension between the processes underpinning the development of a group professional identity in hospital, and a managerial drive for personal reflection and accountability. Peer review may be found threatening by interns because it appears to run counter to collegiality or 'team culture'. In this study, resistance to peer review represented a low-cost strategy in which the interns' will could be asserted against management. CONCLUSION: To enhance uptake, peer review should be structured as key to clinical development, and modelled as a professional behaviour by higher-status colleagues.

Assessment of a peer review process among interns at an Australian hospital.

PURPOSE: This study considered how a peer review process could work in an Australian public hospital setting. METHOD: Up to 229 medical personnel completed an online performance assessment of 52 Junior Medical Officers (JMOs) during the last quarter of 2008. RESULTS: Results indicated that the registrar was the most suitable person to assess interns, although other professionals, including interns themselves, were identified as capable of playing a role in a more holistic appraisal system. Significant sex differences were also found, which may be worthy of further study. Also, the affirmative rather than the formative aspect of the assessment results suggested that the criteria and questions posed in peer review be re-examined. CONCLUSION: A peer review process was able to be readily implemented in a large institution, and respondents were positive towards peer review generally as a valuable tool in the development of junior medical staff.