Self-rated preparedness of Australian prevocational hospital doctors for emergencies.

OBJECTIVE: To determine perceived preparedness of Australian hospital-based prevocational doctors for resuscitation skills and management of emergencies, and to identify differences between doctors who perceive themselves well prepared and those who perceive themselves poorly prepared for emergencies, in demographics and exposure to desired learning methods. METHODS: Questionnaire consisting of a mix of graded Likert scales and free-text answers distributed to 36 Australian hospitals for secondary distribution to hospital medical officers. RESULTS: From 2607 questionnaires posted, 470 (18.1%) were returned. Thirty-one per cent (95% confidence interval [CI] 26-35%) felt well prepared for resuscitation and management of emergencies, 41% (CI 37-45%) felt adequately prepared and 28% (CI 24-32%) felt they were not well prepared. Those who felt well prepared reported that they had experienced more exposure to a range of educational methods, including consultant contact, supervisor feedback, clinical skills, high fidelity simulator sessions and unit meetings. Well-prepared and poorly prepared doctors had similar opinions of the usefulness of various learning methods, but the poorly prepared group more frequently expressed a desire for increased exposure to contact with registrars and consultants, clinical skills sessions and hospital and unit meetings. There were no differences in gender, age or country of origin (Australia vs international medical graduates) between those who felt well or poorly prepared. CONCLUSIONS: Many prevocational hospital doctors feel inadequately prepared for the management of emergencies. Perceived preparedness is associated with more exposure to particular educational activities. Increasing exposure to learning of emergencies in undergraduate and prevocational years could reduce the number of junior doctors who feel poorly prepared for emergencies.

Learning opportunities for Australian prevocational hospital doctors: exposure, perceived quality and desired methods of learning.

OBJECTIVE: To survey prevocational doctors working in Australian hospitals on aspects of postgraduate learning. PARTICIPANTS AND SETTING: 470 prevocational doctors in 36 health services in Australia, August 2003 to October 2004. DESIGN: Cross-sectional cohort survey with a mix of ordinal multicategory questions and free text. MAIN OUTCOME MEASURES: Perceived preparedness for aspects of clinical practice; perceptions of the quantity and usefulness of current teaching and learning methods and desired future exposure to learning methods. RESULTS: 64% (299/467) of responding doctors felt generally prepared for their job, 91% (425/469) felt prepared for dealing with patients, and 70% (325/467) for dealing with relatives. A minority felt prepared for medicolegal problems (23%, 106/468), clinical emergencies (31%, 146/469), choosing a career (40%, 188/468), or performing procedures (45%, 213/469). Adequate contact with registrars was reported by 90% (418/465) and adequate contact with consultants by 56% (257/466); 20% (94/467) reported exposure to clinical skills training and 11% (38/356) to high-fidelity simulation. Informal registrar contact was described as useful or very useful by 94% (433/463), and high-fidelity simulation by 83% (179/216). Most prevocational doctors would prefer more formal instruction from their registrars (84%, 383/456) and consultants (81%, 362/447); 84% (265/316) want increased exposure to high-fidelity simulation and 81% (283/350) to professional college tutorials. CONCLUSION: Our findings should assist planning and development of training programs for prevocational doctors in Australian hospitals.

BEME systematic review: predictive values of measurements obtained in medical schools and future performance in medical practice.

BACKGROUND: Effectiveness of medical education programs is most meaningfully measured as performance of its graduates. OBJECTIVES: To assess the value of measurements obtained in medical schools in predicting future performance in medical practice. SEARCH STRATEGY: The English literature from 1955 to 2004 was searched using MEDLINE, Embase, Cochrane's EPOC (Effective Practice and Organization of Care Group), Controlled Trial databases, ERIC, British Education Index, Psych Info, Timelit, Web of Science and hand searching of medical education journals. INCLUSION & EXCLUSIONS: Selected studies included students assessed or followed up to internship, residency and/or practice after postgraduate training. Assessment systems and instruments studied (Predictors) were the National Board Medical Examinations (NBME) I and II, preclinical and clerkship grade-point average, Observed Standardized Clinical Examination scores and Undergraduate Dean's rankings and honors society. Outcome measures were residency supervisor ratings, NBME III, residency in-training examinations, American Specialty Board examination scores, and on-the-job practice performance. DATA EXTRACTION: Data were extracted by using a modification of the BEME data extraction form study objectives, design, sample variables, statistical analysis and results. All included studies are summarized in a tabular form. DATA ANALYSIS AND SYNTHESIS: Quantitative meta-analysis and qualitative approaches were used for data analysis and synthesis including the methodological quality of the studies included. RESULTS: Of 569 studies retrieved with our search strategy, 175 full text studies were reviewed. A total of 38 studies met our inclusion criteria and 19 had sufficient data to be included in a meta-analysis of correlation coefficients. The highest correlation between predictor and outcome was NBME Part II and NBME Part III, r = 0.72, 95% CI 0.30-0.49 and the lowest between NBME I and supervisor rating during residency, r = 0.22, 95% CI 0.13-0.30. The approach to studying the predictive value of assessment tools varied widely between studies and no consistent approach could be identified. Overall, undergraduate grades and rankings were moderately correlated with internship and residency performance. Performance on similar instruments was more closely correlated. Studies assessing practice performance beyond postgraduate training programs were few. CONCLUSIONS: There is a need for a more consistent and systematic approach to studies of the effectiveness of undergraduate assessment systems and tools and their predictive value. Although existing tools do appear to have low to moderate correlation with postgraduate training performance, little is known about their relationship to longer-term practice patterns and outcomes.