International Journal of Medical Science and Current Research (IJMSCR)
Available online at: www.ijmscr.com
Volume2, Issue 3,Page No: 343-348
May-June 2019
343
Medicine ID-101739732
IJMSCR
Graduate Medical Students’ Preparedness to Practice: Self-Assessment
Eyad Altamimi, MD1* Ahmad Z Mahadeen, MBBS2, Amal Mashali3 MD,PhD 1 Associate Professor of Pediatrics, Jordan University of Science and Technology,Irbid-Jordan
2
Neurology Resident, Cleveland Clinic, Cleveland,OH
3 Professors of Forensic Medicine, Alexandria University, Alexandria-Egypt
*Corresponding Author:
Eyad Altamimi
Pediatric Gastroenterologist,Associate Professor of Pediatrics, Pediatric Department-Faculty of Medicine Jordan University of Science and Technology, P.O.Box 3030 – Postal Code: 22110
Type of Publication: Original Research Paper Conflicts of Interest: Nil
ABSTRACT BACKGROUND:
Medical schools are responsible for equipping the future physicians with sufficient knowledge and skills required to practice. We investigated the views of graduate students at Faculty of Medicine, Mutah University, Alkarak-Jordan on their preparedness for career post-graduation and what clinical competency deficits they may have as assessed by them.
METHODS:
Sixth-year medical students’ were asked to fill an online, self-administered questionnaire inquiring about six skill domains: (1) Communication, (2) Biomedical Knowledge Application, (3) History Taking, (4) Patient Examination, (5) Interpretation of Common Investigations, and (6) Procedures, rating their perception on a Likert scale from 1–5 (very poor to excellent). Results presented as averages and standard deviation. Each item was compared according to gender and level of preparedness. A p-value < 0.05 was considered significant.
RESULTS:
Of the 151 students in the graduating class, 63 students filled out the questionnaire (41.7%). The average age of responders was 23.7± 0.72 years. 41 (65.1%) were males and 33 (52.4%) were studying in their hometown .Only 10 (15.9%) of the students felt fully prepared. The skill domain with the highest average was ‘Gathering Patient History’ with Avg. ± SD of 3.53±.873, while the lowest was ‘Performing Procedures’ 2.72 ± 1.122. Students who felt ‘Fully Prepared’ rated themselves as more competent compared to the ‘Partially’ and ‘Unprepared’ students.
CONCLUSION:
It was evident that the majority of our students did not feel fully prepared to carry out their roles as health care providers as they don’t feel competent in doing physical examination and performing procedures. In addition to using such form of feedback by medical schools for curricula reforms and restructure clinical teaching to attain specific goals and competencies, using unconventional methods such as; teaching by simulation will contribute in mending this gap and increase students’ competency.
Keywords: Self-assessment, medical education, clinical skills, evaluate, graduate students, Medical school.
INTRODUCTION
Producing competent physicians who are well-trained, properly qualified, and capable is the ultimate goal of the teaching process. Medical schools are responsible for equipping future physicians with the sufficient knowledge and skills required to practice and at the same time, ensure the competence of using these skills.
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graduating physician is prepared to practice medicine.
Many studies have demonstrated that exam results do not correlate with an incoming resident’s level of confidence or feeling of preparedness to practice. [1, 2, 3, 4, 5, 6, 7] An individual’s perception of competency is of paramount importance because it influences career choice, accomplishments, and
self-directed lifelong learning. [8] However,
overestimation of competence can lead to
misdiagnosis, inadequate performance, and
premature closure of cases. In contrast,
underestimation of competence may lead to over-reliance on diagnostic tests, excessive uncertainty, and unnecessary referrals. Both situations are likely to affect the care delivered.
One study reported that only one-third of the graduates from seven German universities perceived themselves as well prepared or very well prepared for practicing medicine upon completing medical school. [3] Many of the graduates criticized the lack of practical relevance of the curriculum with regards to their upcoming career. [3] Another study showed that only 17% of newly graduated physicians from among all of the medical schools in Japan felt sufficiently prepared in general clinical skills for their postgraduate clinical training. [2]
The purpose of this study was to assess how graduate physicians from the Faculty of Medicine, Mutah University, Alkarak-Jordan perceived their clinical competency and preparedness for entering practice.
METHODS:
Study Design:
A cross-sectional observational study was conducted using an on-line self-administered questionnaire. Sixth-year medical students (in the last semester prior to graduation between February 26 and May 26, 2015) were asked to report their perceptions regarding competence in various clinical skills. The questionnaire was developed following a thorough review of the relevant literature, particularly the
minimum essential requirements for medical
education as defined by the American Association of Medical Colleges (AAMC) [9, 10] and the Institute for International Medical Education (IIME). [11] The questionnaire comprised 146 items consisting of Likert-scale-type questions measuring students’
self-assessment of their competency. Along with demographic questions, the questionnaire inquired about six skill domains: 1) Communication, 2) Biomedical Knowledge Application, 3) History-Taking, 4) Patient Examination, 5) Interpretation of Common Investigations, and 6) Procedures. Students were asked to rate their competency level for each item as 1 - very poor, 2 - poor, 3 - good, 4 - very good, or 5 - excellent. Students also were asked whether they felt prepared to practice medicine.
Between February 26, 2015 and May 26, 2015, the Facebook page of the sixth-year medical student group (all students were members of this group) carried an announcement of the study and all students were asked to participate. The first author (AM) was the administrator of this group. The questionnaire was posted online and an access link was made available to the group. No identifiable information was collected and data were collected anonymously. Students could complete the questionnaire only once; however, it was possible to save and continue in different sessions. Reminder messages were posted regularly to the group. A letter from the investigators was posted with the questionnaire explaining the purpose of the study and asking the students to complete the questionnaire accurately. The study was approved by the Ethics Committee of the Faculty of Medicine at our university.
Statistical Analysis:
Statistical analysis consisted of average and standard deviation for each variable and for each domain. Data analysis was performed using SPSS 14.0 (SPSS Inc., Chicago, IL, USA).
Each item was compared between males vs. females and according to the level of preparedness as perceived by the students (fully vs. partially vs. unprepared). These were tested using Paired Students t-test for significant differences. A p-value < 0.05 was considered significant. The graded Likert scale was designated as follows: 5 - excellent, 4 - very good, 3 - good, 2 - poor and 1 - very poor. Arithmetic mean values of the Likert scale were calculated and stratified as follows: ≥3.67 = high, 2.34-3.66 = medium, and ≤2.33 = low.
RESULTS:
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The average age of respondents was 23.7± 0.7 years. Forty-one students (65.1%) were male; 33 students (52.4%) completed their medical studies in their hometowns (Table 1). Only 10 (15.9%) students who completed the questionnaire felt fully prepared to practice medicine; there was no difference with respect to gender (Table 2).
The skill domain with the highest average was ‘Gathering Patient History’ (3.53±.873, mean ± S.D.) while the lowest was ‘Performing Procedures’ (2.72 ± 1.122, mean ± S.D.). All other domains were perceived as medium on average (Table 3). Students who felt ‘Fully Prepared’ rated themselves as more competent compared to the ‘Partially’ and ‘Unprepared’ students in all skill domains. However, this was only statistically significant for the domains of Communication and Patient Examination (p-values = 0.005 and 0.037, respectively). In the Procedure Domain, although ‘Fully Prepared’ students felt more competent compared to the others, this was not statistically significant (p-value = .075). While the students’ perceived competency in the Physical Exam domain was significantly different between groups at different levels of preparation, there were specific parts of the Physical Exam domain that showed a large amount of variability (specifically, genital
examinations and identification of abnormal
findings). Detailed responses are not shown.
DISCUSSION:
Perceived Lack of Competency is Part of a Widespread Phenomenon:
This was the first study of the self-assessed level of competency of medical students in our country. It was evident that the majority of students did not feel fully prepared to carry out their roles as healthcare providers. This finding was demonstrated previously [4] where 66% of junior doctors questioned felt unprepared. Another study demonstrated [3] that two-thirds of questioned alumni of seven medical universities in Germany stated they felt poorly prepared for medical practice. Furthermore, a study of Irish interns [6] found that 61% felt insufficiently or poorly prepared. Mohammad Jalili [5] found 28.4% of medical students were satisfied with their clinical training and only 33.3% felt they were ready to start residency programs. Only 19% of Japanese medical graduates felt well prepared for their new jobs. [2]
Gender Differences:
It was previously reported [7] that there was a slight difference between males and females in the perception of feeling prepared: male students reported feeling more prepared. This result was not found in our study in general. However, the biggest
gender difference was found in the
physical/emotional/mental demands of working as a physician. In our cohort, only the sub-category of
Physical Examination competency showed a
significant difference between males and females. Females rated themselves as more competent than males in ‘Perform Pelvic and Breast Exam and Describe Examination Process and Findings’. One other item in which a difference was detected was ‘Establish Proper Communication and Collaboration with Others in all Professional Settings’, where female graduates perceived themselves to be less competent than their male counterparts; we believe this result may be more of a cultural issue.
Specific Areas of Weakness:
The majority of students perceived themselves to be less competent in performing physical examination of
specific systems – Urogenital and Rectal
Examination – which may reflect inadequate exposure to these types of examinations during clinical rotations. This result also could be influenced by how clinical rounds were conducted in our hospital where the large number of students creates an environment that does not permit such sensitive
examinations to be observed or repeated.
Furthermore, this finding was in concordance with the results of Jalili et al. concerning Iranian medical students who rated their least satisfying rotation as Obstetrics and Gynecology. [5] Japanese medical graduates in the study of Tokuda et al. [2] perceived they were not well prepared clinically; however, the authors did not report which specific areas had the worst ratings.
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which consistently focuses on how to perform the examination rather than detecting abnormal findings. The issue is compounded by the fact that most of our simulated patients during assessments are healthy individuals with normal physical findings.
It was surprising to find that students rated the Performing Procedures domain at such a low level. Even simple procedures such as nasogastric tube placement were rated as the lowest competent procedure in the domain. We understand that we are not able to allow each of our students to perform the technique a sufficient number of times to attain mastery, but we felt that the use of the skills lab would bridge any gap in experience and increase students’ capability in this, as well as other procedures.
Confidence or Competence, and are they related?
It has been demonstrated that the accuracy of the self-assessment method is mixed [12]. Among all the domains, students who felt well-prepared believed themselves to be more competent in their skills. Although this finding might have reflected the actual degree of preparedness, it also could have reflected the degree of self-confidence [13]. Our study design did not allow us to discern between the two. To interpret these results properly, an objective measure of preparedness should be coupled with respondent’s perception of preparation. Future work in this area could correlate students’ perceptions of their preparedness and competence with that of their supervising physicians to provide another measure of comparison.
Mutah medical school graduates do not sit for a standardized national medical licensing examination; therefore it is not feasible to compare student perceptions to objective measurements such as from an examination. The variability among grading scales
between medical schools and the lack of
homogeneity renders medical school grades a less than ideal measure for such studies.
We suggest that this type of study should be repeated on a national scale to include graduates of all Mutah medical schools to provide a larger cohort and increase the power of future studies. This also would allow us to detect possible variation among graduates of medical schools. Further studies could be administered at the end of each rotation rather than at
a single time point to permit students and faculty to benefit from the results as a learning tool as well as an assessment of competency.
Studies such as the present study can be used to inform in curriculum changes and tailor teaching according to the students’ needs. In the UK for example, in a matter of 15 years, the percentage of junior doctors who either ‘Agreed’ or ‘Strongly Agreed’ that they were well prepared by their medical schools doubled from 35% in 1999 to 70% in 2012. This result was obtained by the exhaustive efforts of UK medical schools toward restructuring clinical courses to better deliver the directives for learning and competencies outlined by the General Medicine Council (GMC). [14]
Although we had several important findings, this study had several weaknesses. First, the results cannot be generalized to all medical schools in our country, especially those with different curricula and different types of teaching facilities (number of students, number of staff, university hospitals, etc.). Second, although the results of this study may appear to criticize the curriculum indirectly, there was no direct correlation between the curriculum at our institute, the method of exam, and the results of our questionnaires. The students were not asked to express their opinion in the curriculum and exam methodology. Third, the relationship between the perception of preparedness and performance during medical school (GPA) was not explored.
Future Perspectives and Conclusions:
We plan to expand this study to the four medical schools in our country and include additional aspects to our methods. We will request the students’ opinions about each clinical rotation and the basic science curriculum, and at the same time, correlate the data with the students` performance in medical school. It is vital that the teaching curricula of medical schools address these issues and integrate the findings into the students’ daily lives. Student feedback is essential for recognizing deficits in the teaching process and is integral for bridging the gap between studentship and readiness for medical practice.
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continuing professional development, and informing better decision-making by administrators.
Tables:
Table 1: Graduate Students` Demographics
Respondents Demographics
Age 23.7 ± 0.72 years
M:F 41:22
Studying at home town 21 (33%)
M: Male, F: Female
Table 2: Level of Preparedness According To Gender
Males N (%) Females N (%) Total N (%)
Don`t feel prepared 7(17.1) 3(13.6) 9(14.3)
Partially prepared 28(68.3) 16(72.7) 44(69.8)
Fully prepared 6(14.6) 3(13.6) 10(15.9)
Table 3: Skill Domain According To Gender And Level Of Preparedness Skill Domain Female
Avg. ± SD
Male
Avg. ± SD
p-value
Not prepared
Avg. ± SD
Partially Prepared
Avg. ± SD
Fully prepared
Avg. ± SD
p-value
Communication 3.34 ± .68
3.29 ± .86
.814 3.27±0.7
39
3.15±.74 2
4.04±.767 .005*
Biomedical Knowledge Application
3.06 ± .733
3.26± .807
.337 3.09±.79
7
3.11±.76 8
3.62±.788 .166
Gather a relevant patient history systematically
3.48 ± .82
3.55± .875
.758 3.36±.74
7
3.48±.88 4
3.93±.818 .269
Patient Examination
3.13± .869
3.11± .992
.937 2.67±.86
1
3.07±.90 8
3.74±.973 .037*
Interpretation of common
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investigations .813 .888 1
Procedures 2.63±
.914
2.69± 1.098
.823 2.17±.89
2
2.67±.95 6
3.21±.1.1 86
.079
*Statistically significant
ACKNOWLEDGEMENT:
The authors want to acknowledge that this project was done while the authors were working/ studying at Mutah University, Alkarak-Jordan.
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