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O'Neill, L, Norberg, K, Thomsen, M, Jensen, R D, Gjedde Brøndt, S, Charles, P, Mortensen, L S & Christensen, M K 2014, ' Struggling doctors in specialist training: a case control study. ', ICED 2014, Stockholm, Sverige, 16/06/2014-18/06/2014 . |
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summaryThe aim of this cummulative incidence case-control study was to examine: if struggling trainees in medical specialist training (cases) tended to struggle already in medical school or not compared to non-struggling controls, and which performance indicators during medical school seemed to predict struggling in postgraduate education if any. The study design is rooted in epidemiological methodology.Struggling doctors in specialist training: a case-control study.It has been reported in the international literature, that around 3-10% of doctors in post-garduate specialist training are struggling to comply with educational requirements.1-3 A struggling doctor risks being a liability to patients health care. In the medical education literature, early identification and support of strugglers has been proposed as an important investment in the development and training of future health professionals, and as the gold standard for educational supervision.2,4-6 Therefore, the aim of this study was to examine: if strugglers in specialist training (cases) tended to struggle already in medical school or not compared to controls (non-strugglers), and which performance indicators during medical school seemed to predict struggling in postgraduate education if any. The study design is that of a cummulative incidence case-control study, which is rooted in epidemiological methodology, but this method is also used by the research community in medical education.4,7-8 The source population was all active regional specialist trainees in 2010-June 2013 who were graduates from Aarhus University. Cases were defined as doctors in specialist training who either: decelerated (i.e. had long or repeated episodes of leave of absence, unknown absence, illness, or inadequate development of competences), or transferred (i.e. had unplanned changes in place of training/ward due to failure to thrive or due to inadequate development of competences), or dropped out (i.e. were dismissed from, had resigned from, or changed their speciality). Controls were a random sample of doctors in the source population, who were not identified as cases in the case extraction period. We aimed at a case-control ratio of 1:4 and intend to match on graduation year. Ten different performance measures relating to medical school admission, first year performance and overall program performances will be examined, such as: pre-university exam type, pre-university grade-point averages, program priority on the application form, number of resits in year 1, number of dispensation applications during year 1, causes given for seeking dispensations to progress, total number of resits, total number of dispensation applications, average grades in medical school, and program completion time. At the present we have identified 90 cases and 343 controls. We expect the study to be completed in the spring of 2014. To the best of our knowledge, nobody has examined this particular question before, though a few studies have examined the relationships between medical student behaviours and performances and subsequent professional misconduct or disciplinary action with the same study design and found positive associations.4,7 Our results (positive or negative) is of importance in the general discussion of the transition and handing-over of medical students from pre- to postgraduate education, as well as in a needed discussion of Danish Laws and rules on university student progression and its effect in a workplace, in this case hospital wards.Tabby DS, Majeed MH, Schwartzman RJ. Problem neurology residents. Neorology 2011;76:2119-2123.Steinert Y. The “problem learner”: whose problem is it? AMEE Guide No. 76. Med Teach 2013, e1-11.Zbieranowski I, Takahashi SG, Verma S, Spadafora SM. Remediation of residents in difficulty: A retrospective 10-year review of the experience of a postgraduate board of examiners. Academic Medicine 2013;88:111-116.Yates J, James D. Risk factors at medical school for subsequent professional misconduct: multicenter retrospective case-control study. BMJ 2010;340:c2040.Evans DE, Alstead EM, Brown J. Applying your clinical skills to students and trainees in academic difficulty. Clin Teach 2010;7(4):230-235.Yao DC, Wright SM. The challenge of problem residents. J Gen Intern Med 2001;16:486-492.Papadakis MA, Hodgson CS, Theherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med 2004;79:244-249. Ringsted C, Hodges B, Scherpbier A. ‘The research compass’: an introduction to research in medical education: AMEE Guide no. 56. Med Teach 2011;39(9):695-709. |
