Sample attrition analysis in a prospective cohort study of medical graduates in China

Background A major challenge of prospective cohort studies is attrition in follow-up surveys. This study investigated attrition in a prospective cohort comprised of medical graduates in China. We described status of attrition, identified participants with higher possibility of attrition, and examined if attrition affect the estimation of the key outcome measures. Methods The cohort study recruited 3,620 new medical graduates from four medical universities in central and western China between 2015 and 2019. Online follow-up surveys were conducted on an annual basis. Follow-up status was defined as complete (meaning that the participant completed all the follow-up surveys) and incomplete, while incomplete follow-up was further divided into ‘always-out’, ‘rejoin’ and ‘other’. Multivariable logistic and linear regressions were used to examine factors predicting attrition and the influence on the outcome measures of career development. Results 2364 (65.3%) participants completed all follow-up surveys. For those with incomplete follow-up, 520 (14.4%) were ‘always-out’, 276 (7.6%) rejoined in the 2020 survey. Willingness to participate in residency training (OR=0.80, 95%CI[0.66 - 0.98]) and willingness to provide sensitive information in the baseline survey predicted a lower rate of attrition (providing scores for university entrance exam OR=0.82, 95%CI[0.69 - 0.97]]; providing contact information (OR=0.46, 95%CI[0.32 - 0.66]); providing household income (OR=0.60, 95%CI[0.43 - 0.84]). Participants with compulsory rural service (OR=1.52, 95%CI[1.05 - 2.19]) and those providing university entrance scores (OR=1.64, 95%CI[1.15-2.33)) were more likely to rejoin in the follow-up survey. These factors associated with follow-up status did not have significant impact on key outcome measures of career development. Conclusions Graduates who were unwilling to participate in residency training or not providing sensitive information should be targeted early in the cohort study to reduce attrition. More information about the study should be provided to those graduates early to facilitate their understanding of the meaning in participation. On the contrary, medical graduates with compulsory rural service and those who provided university entrance scores were more likely to rejoin in the cohort. The research team should invest more effort in contacting those graduates and returned them to the cohort.

The Impression of ICT in Medical Education throughout COVID-19 Pandemic: A Survey among Medical Graduates of Bangladesh

In COVID-19 pandemic, the importance of ICT in Medical education is amplified. The purpose of the study was to assess and estimate the role and impact of ICT in relation to learning on medical education and changing behavior of the students in the period of pandemic. A questionnaire survey approach was applied amid of the Bangladeshi medical undergraduates during the period of August, 2020 to November, 2020. A Google linked structured questionnaire was used and distributed to the study population via email, messenger and WhatsApp. The questionnaire was completed by 201 medical students, with 65% were female and 35% were male students. Almost all respondents (98%) owned an android smartphone and used it to access the internet. Two-thirds (69%) of respondents have medical and health related apps in their device, with Medscape being the most widely utilized app. Respondents (49%) encountered bandwidth trouble during online class. For collaborative learning with classmates, 76% respondents favored messenger and whatsApp group. ICT knowledge should be included in the curriculum, according to 57% respondents. Over one-third participants, 37.3%, were neither satisfied nor dissatisfied. 30.8% respondents were satisfied while 19.4% were dissatisfied. The long-term benefits and problems of reforming the medical education system and utilizing ICT technologies should be considered. In this pandemic circumstance, digitalization of learning can give essential foundations for future medical education, aided by ICT tools. Our study may be used as a foundation for future research into developing digital teaching models in medical education. Bangladesh Journal of Medical Education Vol.13(1) January 2022: 58-68

Knowledge of recent medical graduates and views of stakeholders and teachers regarding medical ethics and professionalism in Bangladesh

Medical education aims to produce competent medical professionals and gives emphasis on competency-based learning in Bangladesh. Medical ethics and professionalism are considered as a core competency. A competent physician can ensure patient-centered health care system. This was an effort to obtain data regarding the knowledge of recent medical graduates and the opinion of medical educational stakeholders and teachers about medical ethics and professionalism at undergraduate medical education in Bangladesh. This mixed-method study was conducted in two rounds. The Round I was conducted from January 2018 to June 2019 for assessing the knowledge of 308 recent medical graduates towards medical ethics and professionalism. In Round II, key informant interviews were conducted among 30 medical educational stakeholders and teachers from July 2020 to December 2020. Data were collected by pre-tested self administered semi-structured questionnaire and interview guidelines. The percentages of recent medical graduates who could give correct answers regarding autonomy, justice, presenting a subject to visual social media, breaching of confidentiality, organ donation and medical certificate were 19.8%, 54.9%, 73.1%, 37.3%, 91.6% and 74.4% respectively. Most of the medical educational stakeholders and teachers (80%) expressed their opinion related to curriculum. They also suggested for practicing ethics (20.0%) and training (20.0%). A gap was observed in the knowledge regarding medical ethics and professionalism of recent medical graduates. To improve practice of ethics and professionalism, enhancement of the knowledge by incorporating “medical ethics and professionalism” in curriculum might be considered. A separate compulsory module for training on medical ethics and professionalism can be added at pre-internship period for the recent medical graduates. Bangladesh Journal of Medical Education Vol.13(1) January 2022: 40-48

Self-Perceived Skills of Pre Intern Doctors in Sri Lanka

IntroductionThe transition from medical student to intern is a significant and challenging time in a doctor’s training. It can be stressful for the young doctor and there can be varying expectations from employers and supervisors on their capabilities. There is a time gap between graduation and internship for medical graduates in Sri Lanka. Also, there was no proper orientation prior the internship. Thus, the Good Intern Programme was developed as a skills training programme for pre interns who are awaiting internship, and this was conducted in collaboration with Ministry of Health (MOH), Government Medical Officers’ Association (GMOA), Society for Health Research and Innovation (SHRI). This study aimed to explore self-perceived competency of selected skills of pre-interns who were awaiting for internship. Methods Study populationSri Lankan medical Faculties (University of Colombo, Peradeniya, Sri Jayewardenapura, Jaffna, Kelaniya, Ruhuna, Eastern University- Batticaloa, Rajarata University and General Sir John Kotelawala Defence University -KDU), and foreign universities produce approximately 1000 medical graduates per year. In 2020, all pre- interns who joined the Good Intern Programme, Sri Lanka were invited to participate in this questionnaire survey. Statistical analyses were performed using SPSS 23.0 software. Descriptive data were presented as proportions.Results Mean age was 27.6 (+ SD 1.4). Majority of the pre-interns were females (66.5%). Majority of pre-interns perceived that they were able to performs suturing, cannulation, catheterization, setting up an Intravenous (IV) drip, infusion pump setup, blood and blood products transfusion, venipuncture, venipuncture for blood culture, injections-Subcutaneous (SC)/Intramuscular (IM), Glasgow Coma Scale (GCS) monitoring, Cardiopulmonary resuscitation (CPR), arterial puncture for Arterial Blood Gases (ABG), wound dressing, suture removal, bandaging, glucometer use, nebulization, connecting to an ECG (electrocardiogram) monitor competently with or without supervision respectively. Lack of competency perceived on the following skills. Nasogastric tube (NG) insertion, pleural tap, peritoneal tap, removal of an Intercostal tube, lumbar puncture, defibrillation, venous cut down, intubation, CVP (central venous catheter) line insertion, Intercostal (IC) tube insertion were rated by the majority of pre-interns as skills that could be performed competently with supervision or not able to perform the skill but has observed skill. ConclusionAlthough most of the skills were rated by majority of the pre-interns as skills that could be competently performed with or without supervision respectively, there were some skills which needed some improvement. This study suggests that Good Intern Programme in pre-intern period can help to prepare students for the intern role.

Does performance at the intercollegiate Membership of the Royal Colleges of Surgeons (MRCS) examination vary according to UK medical school and course type? A retrospective cohort study

ObjectivesThe knowledge, skills and behaviours required of new UK medical graduates are the same but how these are achieved differs given medical schools vary in their mission, curricula and pedagogy. Medical school differences seem to influence performance on postgraduate assessments. To date, the relationship between medical schools, course types and performance at the Membership of the Royal Colleges of Surgeons examination (MRCS) has not been investigated. Understanding this relationship is vital to achieving alignment across undergraduate and postgraduate training, learning and assessment values.Design and participantsA retrospective longitudinal cohort study of UK medical graduates who attempted MRCS Part A (n=9730) and MRCS Part B (n=4645) between 2007 and 2017, using individual-level linked sociodemographic and prior academic attainment data from the UK Medical Education Database.MethodsWe studied MRCS performance across all UK medical schools and examined relationships between potential predictors and MRCS performance using χ2 analysis. Multivariate logistic regression models identified independent predictors of MRCS success at first attempt.ResultsMRCS pass rates differed significantly between individual medical schools (p<0.001) but not after adjusting for prior A-Level performance. Candidates from courses other than those described as problem-based learning (PBL) were 53% more likely to pass MRCS Part A (OR 1.53 (95% CI 1.25 to 1.87) and 54% more likely to pass Part B (OR 1.54 (1.05 to 2.25)) at first attempt after adjusting for prior academic performance. Attending a Standard-Entry 5-year medicine programme, having no prior degree and attending a Russell Group university were independent predictors of MRCS success in regression models (p<0.05).ConclusionsThere are significant differences in MRCS performance between medical schools. However, this variation is largely due to individual factors such as academic ability, rather than medical school factors. This study also highlights group level attainment differences that warrant further investigation to ensure equity within medical training.

Audit on Clinical Competency of Fresh Medical Graduates in a Malaysian Private University Using Kirkpatrick Level-1 Evaluation Model

Clinical competency is the core of the medical curriculum. Careful ongoing evaluation of clinical competency is required to ensure continuous reviewing for curriculum development. The objective of this study was to investigate self-perceptions of clinical competency of fresh medical graduates using the Kirkpatrick framework – the most convenient and widely used model for measuring clinical competency. A cross-sectional study was conducted among 50 fresh medical graduates of Widad University College, Malaysia in 2019 using a standardised questionnaire containing 43-items of competency. Respondents were asked to rate self-perceptions of his/her competency in these attributes using a five-point Likert scale against each attribute, where 5 = always competent and 1 = never competent. The response rate was 92%. Out of 43 items, graduates were always competent in taking clinical history and examining a patient thoroughly; frequently competent in eight attributes; sometimes competent in 29; and occasionally competent in four. The graduates have not yet started their houseman-training; and thus, got fewer chances to practice all the procedures. It is expected that graduates’ competency will improve during their houseman training. There is scope for improvement, as faculty need to pay more attention to improving student competency by arranging additional training. The teaching of clinical competency also needs integration with the pre-clinical phase for early exposure. The findings have direct implications for faculty development towards competency-based education that would bridge the gap between education and practice. This study offers other medical schools a window towards comprehensive use of competency tools to assess the competency of their graduates.

Security and Violence Perception of Medical Interns during Social Service Practice in Mexico

The increase of insecurity levels in Mexico, as well as the fact that violence is a frequent experience among health personnel, motivated this study whose purpose was to evaluate the perception of security and violence that social service medical interns (SSMI) had on the institutions and localities where they carried out their social work and make visible the main types of violence to which they were exposed. This was a cross-sectional study, based on a perception survey self-administered to 157 SSMI from Zacatecas, in Mexico. A high proportion of the participants (75.8%) stated that they were victims of violence, describing 134 incidents; however, only 33.6% of SSMI made an official report. The reported incidents were related to organized crime (31.9%), verbal violence (20.6%), violence by the authorities (14.7%) and sexual harassment (11.8%). One hundred percent of the victims of sexual harassment were women (p = 0.039). According to the above, it is a priority to generate strategies to prevent and reduce the risk of exposure to the violence generated in the medical units and communities where SSMI carry out their activities as medical graduates, as well as, to efficiently process formal violence reports to promote a safe environment that favors the fulfillment of the practice of SSMIs in Mexico.