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1.  Medicine or Science—A Study of Career Decisions 
Canadian Medical Association Journal  1967;96(14):1009-1018.
A study of the career decisions of all students in a single matriculation cohort was undertaken in 1965 at the University of British Columbia. Studied were 64 premedical students, 112 ex-premedical students and 87 science students who had completed at least their second year. It was found by means of a questionnaire that medicine remained the career of high prestige for the three groups of students. In general the values and needs of the ex-premedical student were more similar to those of the science student than the premedical student. The loyalists to medicine were found to be more committed, self-assured, and orientated towards people and service. In addition, the premedical student was more concerned about his academic achievement but was also more confident of his progress. He emerged at the end of his training as the committed student who had chosen medicine at an early age and had remained loyal to his chosen career goal.
PMCID: PMC1922737  PMID: 6020547
2.  The Premedical Education of the First-Year Class in Canadian Medical Schools: 1965-66 
Canadian Medical Association Journal  1967;96(14):1019-1026.
The premedical academic records of the 1965-66 entering class of Canadian medical students were analysed. Ninety-six per cent of the class had taken their preparation in a Canadian institution, while 80% had taken it in the same university as the medical school in which they enrolled. Forty per cent entered without a degree, the remainder having at least a bachelor's degree in arts or science.
Thirty-six per cent of all courses taken by these students in their premedical education were in the physical sciences, 22% in the biological sciences and 41% in the social sciences and humanities. One-third of the students had taken no course in the behavioural sciences and another third had taken only one course.
Analysis of the level of performance of the entering class showed that 10% had obtained an A average, 49% a B average, 41% a C average and 3% a D average. The grades of these students were higher generally in the natural sciences than in the social sciences or humanities.
It was concluded that it could be questioned whether medical students received a premedical preparation which met the philosophy of a “broad, liberal education”.
PMCID: PMC1922740  PMID: 6020548
3.  Chemistry courses as the turning point for premedical students 
Previous research has documented that negative experiences in chemistry courses are a major factor that discourages many students from continuing in premedical studies. This adverse impact affects women and students from under-represented minority (URM) groups disproportionately. To determine if chemistry courses have a similar effect at a large public university, we surveyed 1,036 students from three entering cohorts at the University of California, Berkeley. We surveyed students at the beginning of their first year at the university and again at the end of their second year. All subjects had indicated an interest in premedical studies at the time they entered the university. We conducted follow-up interviews with a stratified sub-set of 63 survey respondents to explore the factors that affected their level of interest in premedical studies. Using a 10-point scale, we found that the strength of interest in premedical studies declined for all racial/ethnic groups. In the follow-up interviews, students identified chemistry courses as the principal factor contributing to their reported loss of interest. URM students especially often stated that chemistry courses caused them to abandon their hopes of becoming a physician. Consistent with reports over more than 50 years, it appears that undergraduate courses in chemistry have the effect of discouraging otherwise qualified students, as reflected in their admission to one of the most highly selective public universities in the US, from continuing in premedical studies, especially in the case of URM students. Reassessment of this role for chemistry courses may be overdue.
doi:10.1007/s10459-009-9165-3
PMCID: PMC2814029  PMID: 19504170
Chemistry; Diversity; Ethnicity; Medical education; Minorities; Premedical education; Science education; Race
4.  The Premedical Student: His Progress 
Since September 1961, a prospective study of premedical and science students has been conducted at the University of British Columbia. On completion of their sophomore year, after a year of changes from one group to another or withdrawal from either group, only 82 students existed in the diminished Premedical cohort while 137 students existed in the augmented Science cohort. These two groups have now become similar demographically, and their academic potential, as indicated by achievement and ability tests, has also become similar in terms of their mean test scores. In academic performance the present Premedical cohort has displayed some superiority over the Science cohort in high school, freshman and sophomore years. The sophomore premedical mean grade was 66.0% compared with 63.7% for the Science cohort. The hypothesis is developed that these findings reflect a difference in motivation, and therefore that perception of ultimate career goals will motivate and affect academic performance of students in their undergraduate years.
PMCID: PMC1928565  PMID: 14278022
5.  Health-promoting factors in medical students and students of science, technology, engineering, and mathematics: design and baseline results of a comparative longitudinal study 
BMC Medical Education  2014;14:134.
Background
The negative impact of medical school on students' general and mental health has often been reported. Compared to students of other subjects, or employed peers, medical students face an increased risk of developing depression, anxiety and burnout. While pathogenetic factors have been studied extensively, less is known about health-promoting factors for medical students' health. This longitudinal study aims to identify predictors for maintaining good general and mental health during medical education. We report here the design of the study and its baseline results.
Methods
We initiated a prospective longitudinal cohort study at the University of Lübeck, Germany. Two consecutive classes of students, entering the university in 2011 and 2012, were recruited. Participants will be assessed annually for the duration of their course. We use validated psychometric instruments covering health outcomes (general and mental health) and personality traits, as well as self-developed, pre-tested items covering leisure activities and sociodemographic data.
Results
At baseline, compared to students of STEM (science, technology, engineering, and mathematics) subjects (n = 531; 60.8% response rate), a larger proportion of medical students (n = 350; 93.0% response rate) showed good general health (90.9% vs. 79.7%) and a similar proportion was in good mental health (88.3% vs. 86.3%). Medical students scored significantly higher in the personality traits of extraversion, conscientiousness, openness to experience and agreeableness. Neuroticism proved to be a statistically significant negative predictor for mental health in the logistic regression analyses. Satisfaction with life as a dimension of study-related behaviour and experience predicted general health at baseline. Physical activity was a statistically significant predictor for general health in medical students.
Conclusions
Baseline data revealed that medical students reported better general and similar mental health compared to STEM students. The annual follow-up questionnaires, combined with qualitative approaches, should clarify wether these differences reflect a higher resilience, a tendency to neglect personal health problems - as has been described for physicians - before entering medical school, or both. The final results may aid decision-makers in developing health-promotion programmes for medical students.
doi:10.1186/1472-6920-14-134
PMCID: PMC4096732  PMID: 24996637
Medical students; Medical education; Mental health; Health promotion; Prevention; Personality assessment
6.  Medical Students' Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review 
PLoS Medicine  2011;8(5):e1001037.
A systematic review of published studies reveals that undergraduate medical students may experience substantial exposure to pharmaceutical marketing, and that this contact may be associated with positive attitudes about marketing.
Background
The relationship between health professionals and the pharmaceutical industry has become a source of controversy. Physicians' attitudes towards the industry can form early in their careers, but little is known about this key stage of development.
Methods and Findings
We performed a systematic review reported according to PRISMA guidelines to determine the frequency and nature of medical students' exposure to the drug industry, as well as students' attitudes concerning pharmaceutical policy issues. We searched MEDLINE, EMBASE, Web of Science, and ERIC from the earliest available dates through May 2010, as well as bibliographies of selected studies. We sought original studies that reported quantitative or qualitative data about medical students' exposure to pharmaceutical marketing, their attitudes about marketing practices, relationships with industry, and related pharmaceutical policy issues. Studies were separated, where possible, into those that addressed preclinical versus clinical training, and were quality rated using a standard methodology. Thirty-two studies met inclusion criteria. We found that 40%–100% of medical students reported interacting with the pharmaceutical industry. A substantial proportion of students (13%–69%) were reported as believing that gifts from industry influence prescribing. Eight studies reported a correlation between frequency of contact and favorable attitudes toward industry interactions. Students were more approving of gifts to physicians or medical students than to government officials. Certain attitudes appeared to change during medical school, though a time trend was not performed; for example, clinical students (53%–71%) were more likely than preclinical students (29%–62%) to report that promotional information helps educate about new drugs.
Conclusions
Undergraduate medical education provides substantial contact with pharmaceutical marketing, and the extent of such contact is associated with positive attitudes about marketing and skepticism about negative implications of these interactions. These results support future research into the association between exposure and attitudes, as well as any modifiable factors that contribute to attitudinal changes during medical education.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
The complex relationship between health professionals and the pharmaceutical industry has long been a subject of discussion among physicians and policymakers. There is a growing body of evidence that suggests that physicians' interactions with pharmaceutical sales representatives may influence clinical decision making in a way that is not always in the best interests of individual patients, for example, encouraging the use of expensive treatments that have no therapeutic advantage over less costly alternatives. The pharmaceutical industry often uses physician education as a marketing tool, as in the case of Continuing Medical Education courses that are designed to drive prescribing practices.
One reason that physicians may be particularly susceptible to pharmaceutical industry marketing messages is that doctors' attitudes towards the pharmaceutical industry may form early in their careers. The socialization effect of professional schooling is strong, and plays a lasting role in shaping views and behaviors.
Why Was This Study Done?
Recently, particularly in the US, some medical schools have limited students' and faculties' contact with industry, but some have argued that these restrictions are detrimental to students' education. Given the controversy over the pharmaceutical industry's role in undergraduate medical training, consolidating current knowledge in this area may be useful for setting priorities for changes to educational practices. In this study, the researchers systematically examined studies of pharmaceutical industry interactions with medical students and whether such interactions influenced students' views on related topics.
What Did the Researchers Do and Find?
The researchers did a comprehensive literature search using appropriate search terms for all relevant quantitative and qualitative studies published before June 2010. Using strict inclusion criteria, the researchers then selected 48 articles (from 1,603 abstracts) for full review and identified 32 eligible for analysis—giving a total of approximately 9,850 medical students studying at 76 medical schools or hospitals.
Most students had some form of interaction with the pharmaceutical industry but contact increased in the clinical years, with up to 90% of all clinical students receiving some form of educational material. The highest level of exposure occurred in the US. In most studies, the majority of students in their clinical training years found it ethically permissible for medical students to accept gifts from drug manufacturers, while a smaller percentage of preclinical students reported such attitudes. Students justified their entitlement to gifts by citing financial hardship or by asserting that most other students accepted gifts. In addition, although most students believed that education from industry sources is biased, students variably reported that information obtained from industry sources was useful and a valuable part of their education.
Almost two-thirds of students reported that they were immune to bias induced by promotion, gifts, or interactions with sales representatives but also reported that fellow medical students or doctors are influenced by such encounters. Eight studies reported a relationship between exposure to the pharmaceutical industry and positive attitudes about industry interactions and marketing strategies (although not all included supportive statistical data). Finally, student opinions were split on whether physician–industry interactions should be regulated by medical schools or the government.
What Do These Findings Mean?
This analysis shows that students are frequently exposed to pharmaceutical marketing, even in the preclinical years, and that the extent of students' contact with industry is generally associated with positive attitudes about marketing and skepticism towards any negative implications of interactions with industry. Therefore, strategies to educate students about interactions with the pharmaceutical industry should directly address widely held misconceptions about the effects of marketing and other biases that can emerge from industry interactions. But education alone may be insufficient. Institutional policies, such as rules regulating industry interactions, can play an important role in shaping students' attitudes, and interventions that decrease students' contact with industry and eliminate gifts may have a positive effect on building the skills that evidence-based medical practice requires. These changes can help cultivate strong professional values and instill in students a respect for scientific principles and critical evidence review that will later inform clinical decision-making and prescribing practices.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001037.
Further information about the influence of the pharmaceutical industry on doctors and medical students can be found at the American Medical Students Association PharmFree campaign and PharmFree Scorecard, Medsin-UKs PharmAware campaign, the nonprofit organization Healthy Skepticism, and the Web site of No Free Lunch.
doi:10.1371/journal.pmed.1001037
PMCID: PMC3101205  PMID: 21629685
7.  Characteristics of medical-school matriculants who participated in postbaccalaureate-premedical programs 
Background
The authors sought to identify factors associated with U.S. medical-school matriculants’ postbaccalaureate-premedical-program participation and to determine if participation was associated with plans at medical-school graduation to practice in underserved areas.
Method
Using multivariable logistic regression, de-identified, individualized records of Medical College Admission Test (MCAT) scores and AAMC Matriculating Student Questionnaire responses for the 1996-2000 national cohort of U.S. medical-school matriculants were analyzed for associations with postbaccalaureate-premedical-program participation; postbaccalaureate-premedical-program participation was analyzed for associations with graduates’ plans to practice in underserved areas, based on AAMC Graduation Questionnaire responses. Adjusted odds ratios (ORs) significant at P<.05 are reported for independent predictors of postbaccalaureate-program participation among matriculants and of graduates’ plans to practice in underserved areas.
Results
The study sample of 57,276 matriculants included 3,561 (6.2%) academic-record-enhancer-program, 3,931 (6.9%) career-changer-program, and 1,354 (2.4%) career-changer/academic-record-enhancer-program participants. Matriculants with lower MCAT scores (<18: OR=6.16; 18-20: OR=4.26; 21-23: OR=3.22; 24-26: OR=2.30; 27-29: OR=1.76, each vs. MCAT>29), who participated in college summer academic-enrichment programs (OR=1.35), had premedical debt (OR=1.25) and were underrepresented minority race/ethnicity (OR=1.21) were more likely to report academic-record-enhancer-program participation. Students who decided after college to study medicine (OR=15.94) and women (OR=1.46) were more likely to report career-changer-program participation. Compared to non-participants, each of academic-record-enhancer, career-changer, and academic-record-enhancer/career-changer program participants were more likely to plan, at medical-school graduation, to practice in underserved areas (OR = 1.14; 1.48 and 1.47, respectively).
Conclusions
Among medical-school matriculants, postbaccalaureate-premedical-program participants were demographically diverse and were more likely than non-participants to plan to practice in underserved areas.
doi:10.1097/ACM.0b013e3182045076
PMCID: PMC3213404  PMID: 21169786
8.  Developing the Inner Scientist: Book Club Participation and The Nature of Science 
CBE Life Sciences Education  2013;12(1):80-91.
First-year premedical students' understanding of Nature of Science (NOS) improved over one academic year. Those who participated in a nonfiction book club as a curricular option showed better understanding of NOS than students who did not participate. Pre- and postcourse surveys and course documents suggest that book club may attract students with higher NOS status and further improve it.
The leap from science student to scientist involves recognizing that science is a tentative, evolving body of knowledge that is socially constructed and culturally influenced; this is known as The Nature of Science (NOS). The aim of this study was to document NOS growth in first-year premedical students who participated in a science book club as a curricular option. The club read three acclaimed nonfiction works that connect biology to medicine via the history of scientific ideas. Students’ NOS status was assessed as informed, transitional, or naïve at the beginning and end of the academic year using the Views of Nature of Science Questionnaire–Form C (VNOS-C). Focus group interviews and document analysis of assignments and exams provided qualitative evidence. VNOS-C scores improved over the academic year regardless of book club participation. Students who participated in book club had marginally better NOS status at the end of the year but also at the beginning, suggesting that book club may have attracted rather than produced students with higher NOS status. It is notable that an improvement in NOS understanding could be detected at all, as there have been few reports of NOS growth in the literature in which NOS was not an explicit topic of instruction.
doi:10.1187/cbe.12-02-0020
PMCID: PMC3587859  PMID: 23463231
9.  The undergraduate premedical experience in the United States: a critical review 
Objectives
To better understand the consequences of the premedical years for the character of (future) physicians by critically reviewing the empirical research done on the undergraduate premedical experience in the United States.
Methods
We searched ERIC, JSTOR, PubMed, Scopus, ISI Web of Science, and PsycINFO from the earliest available date for empirical, peer-reviewed studies of premedical students in the United States. We then used qualitative methods to uncover overall themes present in this literature.
Results
The initial literature search identified 1,168 articles, 19 of which were included for review. Reviewed articles were published between 1976 and 2010 with the majority published prior to 1990. Articles covered two broad topics: explaining attrition from the premedical track, and investigating the personality traits and stereotypes of premedical students. Self-selection bias and high attrition rates were among the limitations of the reviewed articles.
Conclusions
There is very little current research on the premedical experience. Given the importance of the premedical years on the process of becoming a medical professional, it is imperative that we do more and better research on how the premedical experience shapes future physicians.
doi:10.5116/ijme.5103.a8d3
PMCID: PMC3742104  PMID: 23951400
Premedical education; premedical syndrome; attrition from premedical track; hidden curriculum; professionalization
10.  An Assessment of a Premedical Program in Terms of its Ability to Serve Black Americans 
If special programs to increase the number of blacks gaining entry into health professional schools can identify whom they best serve, changes in either the selection process or the curriculum can increase their effectiveness. As one part of an evaluation of the effectiveness of the various components of the prehealth professions program at Xavier University of Louisiana (XU), black freshmen entering the university from 1981 to 1983 in the university's premedical program were tracked to determine who gained entry into medical and related mainline health professional schools upon graduation.
The analyses indicate that high-ability black freshmen entering Xavier are more than twice as likely to gain admission into medical school than are their black counterparts nationally, and that this difference is statistically significant beyond the 99 percent level. Fifty-seven percent of high-ability black freshmen (those with American College Testing [ACT] composite scores of 24 or above, the top 2 percent of blacks nationally) who entered XU's biology or chemistry programs during the period under study gained entry into medical school upon graduation, whereas a study by the Educational Testing Service indicates that only 24 percent of similar blacks nationally gain entry into any graduate or professional school.
The present study suggests that XU's premedical program serves those blacks who are not in the high-ability group (those whose ACT scores are below 24) at least as well (relative to the national average) as it does the top students. It therefore seems reasonable to assume that XU's premedical program is successful because it increases the probability that students gain admission into health professional schools rather than because of any preselection of students. These results are similar to those obtained from a comparable analysis of XU's prepharmacy program, the other component of prehealth at Xavier.
PMCID: PMC2625875  PMID: 3249314
11.  The Academic Backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors 
BMC Medicine  2013;11:242.
Background
Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude). Sex and ethnic differences were also analyzed in light of the changing demographics of medical students over the past decades.
Methods
Data from five cohort studies were available: the Westminster Study (began clinical studies from 1975 to 1982), the 1980, 1985, and 1990 cohort studies (entered medical school in 1981, 1986, and 1991), and the University College London Medical School (UCLMS) Cohort Study (entered clinical studies in 2005 and 2006). Different studies had different outcome measures, but most had performance on basic medical sciences and clinical examinations at medical school, performance in Membership of the Royal Colleges of Physicians (MRCP(UK)) examinations, and being on the General Medical Council Specialist Register.
Results
Correlation matrices and path analyses are presented. There were robust correlations across different years at medical school, and medical school performance also predicted MRCP(UK) performance and being on the GMC Specialist Register. A-levels correlated somewhat less with undergraduate and post-graduate performance, but there was restriction of range in entrants. General Certificate of Secondary Education (GCSE)/O-level results also predicted undergraduate and post-graduate outcomes, but less so than did A-level results, but there may be incremental validity for clinical and post-graduate performance. The AH5 had some significant correlations with outcome, but they were inconsistent. Sex and ethnicity also had predictive effects on measures of educational attainment, undergraduate, and post-graduate performance. Women performed better in assessments but were less likely to be on the Specialist Register. Non-white participants generally underperformed in undergraduate and post-graduate assessments, but were equally likely to be on the Specialist Register. There was a suggestion of smaller ethnicity effects in earlier studies.
Conclusions
The existence of the Academic Backbone concept is strongly supported, with attainment at secondary school predicting performance in undergraduate and post-graduate medical assessments, and the effects spanning many years. The Academic Backbone is conceptualized in terms of the development of more sophisticated underlying structures of knowledge ('cognitive capital’ and 'medical capital’). The Academic Backbone provides strong support for using measures of educational attainment, particularly A-levels, in student selection.
doi:10.1186/1741-7015-11-242
PMCID: PMC3827330  PMID: 24229333
Academic Backbone; Secondary school attainment; Undergraduate medical education; Post-graduate medical education; Longitudinal analyses; Continuities; Medical student selection; Cognitive capital; Medical capital; Aptitude tests
12.  A holistic review of the medical school admission process: examining correlates of academic underperformance 
Medical Education Online  2014;19:10.3402/meo.v19.22919.
Background
Despite medical school admission committees’ best efforts, a handful of seemingly capable students invariably struggle during their first year of study. Yet, even as entrance criteria continue to broaden beyond cognitive qualifications, attention inevitably reverts back to such factors when seeking to understand these phenomena. Using a host of applicant, admission, and post-admission variables, the purpose of this inductive study, then, was to identify a constellation of student characteristics that, taken collectively, would be predictive of students at-risk of underperforming during the first year of medical school. In it, we hypothesize that a wider range of factors than previously recognized could conceivably play roles in understanding why students experience academic problems early in the medical educational continuum.
Methods
The study sample consisted of the five most recent matriculant cohorts from a large, southeastern medical school (n=537). Independent variables reflected: 1) the personal demographics of applicants (e.g., age, gender); 2) academic criteria (e.g., undergraduate grade point averages [GPA], medical college admission test); 3) selection processes (e.g., entrance track, interview scores, committee votes); and 4) other indicators of personality and professionalism (e.g., Mayer-Salovey-Caruso Emotional Intelligence Test™ emotional intelligence scores, NEO PI-R™ personality profiles, and appearances before the Professional Code Committee [PCC]). The dependent variable, first-year underperformance, was defined as ANY action (repeat, conditionally advance, or dismiss) by the college's Student Progress and Promotions Committee (SPPC) in response to predefined academic criteria. This study protocol was approved by the local medical institutional review board (IRB).
Results
Of the 537 students comprising the study sample, 61 (11.4%) met the specified criterion for academic underperformance. Significantly increased academic risks were identified among students who 1) had lower mean undergraduate science GPAs (OR=0.24, p=0.001); 2) entered medical school via an accelerated BS/MD track (OR=16.15, p=0.002); 3) were 31 years of age or older (OR=14.76, p=0.005); and 4) were non-unanimous admission committee admits (OR=0.53, p=0.042). Two dimensions of the NEO PI-R™ personality inventory, openness (+) and conscientiousness (−), were modestly but significantly correlated with academic underperformance. Only for the latter, however, were mean scores found to differ significantly between academic performers and underperformers. Finally, appearing before the college's PCC (OR=4.21, p=0.056) fell just short of statistical significance.
Conclusions
Our review of various correlates across the matriculation process highlights the heterogeneity of factors underlying students’ underperformance during the first year of medical school and challenges medical educators to understand the complexity of predicting who, among admitted matriculants, may be at future academic risk.
doi:10.3402/meo.v19.22919
PMCID: PMC3974177  PMID: 24695362
admissions; underperformance; selection; at-risk students
13.  Retention of traditional premedical students in a medical career pathway compared with students in a combined baccalaureate-medical degree program. 
This study compared the retention in medical career pathways of students enrolled in a combined baccalaureate-medical degree program to traditional premedical students at Brown University. Whereas 84% of the combined-degree students went on to medical school, only 36% of the traditional premedical students did. Among underrepresented minority students, the proportions were 74% and 39%, respectively. Scholastic Aptitude Test (SAT) scores accounted for some of the difference, yet even when SAT scores were controlled using a multiple logistic regression model, students enrolled in the combined-degree program were more than eight times as likely to continue in a medical career pathway.
PMCID: PMC2568156  PMID: 8350374
14.  Medical students' achievement on the Bachelor of Medicine, Bachelor of Surgery/Chirurgery Final Part I and II licensing examination: a comparison of students in problem-based learning, community-based education and service, and conventional curricula in Ghana 
Purpose:
Problem-based learning is an established method of teaching and learning in medical education. However, its impact on students’ achievement on examinations is varied and inconsistent. We compared the levels of achievement on the Bachelor of Medicine, Bachelor of Surgery/Chirurgery (MB ChB) Part I and II licensing examination of students in problem-based learning, community-based education and service (PBL/COBES), and conventional curricula.
Methods:
In 2014, we analyzed the MB ChB Final Part I and II licensing examination results of students in three classes (2004, 2005, and 2006) of the School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana. Ninety-three students in the 2004 and 2005 cohorts followed a conventional curriculum, and 82 students in the 2006 cohort followed a PBL/COBES curriculum. Using appropriate statistical tools, the analysis compared individual discipline scores and the proportions of students who received distinction/credit/pass grades among the classes.
Results:
The PBL students had significantly higher mean and median scores than the conventional students in Obstetrics and Gynecology, Internal Medicine, Community Health and Family Medicine, Surgery, and Psychiatry, but not in Child Health and Pediatrics. Also, a significantly (P=0.0010) higher percentage, 95.1% (n=78), of the PBL students passed all the disciplines, compared to 79.6% (n=74) of the conventional students.
Conclusion:
The PBL students significantly performed better in all the disciplines except child health and pediatrics, where the conventional students scored higher. These findings demonstrate that the benefits of the PBL/COBES curriculum are tangible and should be fostered.
doi:10.3352/jeehp.2014.11.10
PMCID: PMC4026852  PMID: 24798425
Achievement; Educational status; Educational measurement; Licensure; Problem-based learning; Ghana
15.  Why medical students switch careers 
Canadian Family Physician  2007;53(1):94-95.
OBJECTIVE
To determine why students switch their career choices during the preclinical years of medical school.
DESIGN
Two questionnaires were administered: the first at the beginning of medical school and the second about 3 years later just before students entered clinical clerkship.
SETTING
University of British Columbia, University of Alberta, University of Toronto, University of Ottawa, Queen’s University, University of Western Ontario, University of Calgary, and McMaster University.
PARTICIPANTS
Entering cohorts from 10 medical school classes at 8 Canadian medical schools.
MAIN OUTCOME MEASURES
Proportion of students who switched career choices and factors that influenced students to switch.
RESULTS
Among the 845 eligible respondents to the second survey, 19.6% (166 students) had switched between categories of family medicine and specialties, with a net increase of 1.2% (10 students) to family medicine. Most students who switched career choices had already considered their new careers as options when they entered medical school. Seven factors influenced switching career choices; 6 of these (medical lifestyle, encouragement, positive clinical exposure, economics or politics, competence or skills, and ease of residency entry) had significantly different effects on students who switched to family medicine than on students who switched out of family medicine. The seventh factor was discouragement by a physician.
CONCLUSION
Seven factors appear to affect students who switch careers. Two of these factors, economics or politics and ease of residency entry, have not been previously described in the literature. This study provides specific information on why students change their minds about careers before they get to the clinical years of medical training.
PMCID: PMC1952562  PMID: 17872616
16.  Providing premedical students with quality clinical and research experience 
Undergraduate premedical students face a prodigious decision as they work to determine whether to pursue a profession in medicine. Experience in clinical medicine and research is essential to inform students what it might be like to be a physician. Undergraduates, however, face a number of obstacles to obtaining the kind of quality clinical and research experience needed to best inform them on this decision. Growing regulations designed to protect patient confidentiality, though undeniably important, pose a barrier to students seeking patient contact. Traditional passive physician shadowing often does not provide ample opportunities for one-on-one patient interaction or problem solving. Finally, research opportunities available to students typically are not associated with clinical work and therefore do not provide an experiential model of how empirical evidence informs medical practice. This report provides a description of the University of Wisconsin Tobacco Science Scholars Program, a pilot program designed to grapple with some of these barriers. The program provides supervision for students so that they might fulfill institutional requirements required for patient contact, provides an active model of clinical patient interaction and problem solving, and provides access to research that is integrated into the student’s clinical experience so the student might better understand the nature of research-based evidence in medicine. Program details and limitations are discussed.
PMCID: PMC4023636  PMID: 24734413
Premed students; clinical experience; research experience; tobacco
17.  Comparative Difficulties with Non-Scientific General Vocabulary and Scientific/Medical Terminology in English as a Second Language (ESL) Medical Students 
Objectives:
Medical education requires student comprehension of both technical (scientific/medical) and non-technical (general) vocabulary. Our experience with “English as a second language” (ESL) Arab students suggested they often have problems comprehending scientific statements because of weaknesses in their understanding of non-scientific vocabulary. This study aimed to determine whether ESL students have difficulties with general vocabulary that could hinder their understanding of scientific/medical texts.
Methods:
A survey containing English text was given to ESL students in the premedical years of an English-medium medical school in an Arabic country. The survey consisted of sample questions from the Medical College Admission Test (USA). Students were instructed to identify all unknown words in the text.
Results:
ESL students commenced premedical studies with substantial deficiencies in English vocabulary. Students from English-medium secondary schools had a selective deficiency in scientific/medical terminology which disappeared with time. Students from Arabic-medium secondary schools had equal difficulty with general and scientific/medical vocabulary. Deficiencies in both areas diminished with time but remained even after three years of English-medium higher education.
Conclusion:
Typically, when teaching technical subjects to ESL students, attention is focused on subject-unique vocabulary and associated modifiers. This study highlights that ESL students also face difficulties with the general vocabulary used to construct statements employing technical words. Such students would benefit from increases in general vocabulary knowledge.
PMCID: PMC3523999  PMID: 23275846
Medical education; Premedical education; Language; English; Medical students; Teaching; Oman
18.  The educational background and qualifications of UK medical students from ethnic minorities 
Background
UK medical students and doctors from ethnic minorities underperform in undergraduate and postgraduate examinations. Although it is assumed that white (W) and non-white (NW) students enter medical school with similar qualifications, neither the qualifications of NW students, nor their educational background have been looked at in detail. This study uses two large-scale databases to examine the educational attainment of W and NW students.
Methods
Attainment at GCSE and A level, and selection for medical school in relation to ethnicity, were analysed in two separate databases. The 10th cohort of the Youth Cohort Study provided data on 13,698 students taking GCSEs in 1999 in England and Wales, and their subsequent progression to A level. UCAS provided data for 1,484,650 applicants applying for admission to UK universities and colleges in 2003, 2004 and 2005, of whom 52,557 applied to medical school, and 23,443 were accepted.
Results
NW students achieve lower grades at GCSE overall, although achievement at the highest grades was similar to that of W students. NW students have higher educational aspirations, being more likely to go on to take A levels, especially in science and particularly chemistry, despite relatively lower achievement at GCSE. As a result, NW students perform less well at A level than W students, and hence NW students applying to university also have lower A-level grades than W students, both generally, and for medical school applicants. NW medical school entrants have lower A level grades than W entrants, with an effect size of about -0.10.
Conclusion
The effect size for the difference between white and non-white medical school entrants is about B0.10, which would mean that for a typical medical school examination there might be about 5 NW failures for each 4 W failures. However, this effect can only explain a portion of the overall effect size found in undergraduate and postgraduate examinations of about -0.32.
doi:10.1186/1472-6920-8-21
PMCID: PMC2359745  PMID: 18416818
19.  Association between course of study at university and cause-specific mortality 
Although socioeconomic position is clearly related to mortality and one measure of this is length of education, it is not known whether the choice of course at university determines future health. We therefore investigated the association between faculty of study and all-cause and cause-specific mortality in a prospective follow-up of male students who underwent health examinations while attending Glasgow University from 1948 to 1968.
Among the 9887 (84%) alumni traced by means of the NHS Central Register, 8367 (85%) had full data on important potential confounding variables; 939 of these men had died. Physiological variables differed little between students from the various faculties. Medical students were most likely to come from affluent social backgrounds and, after law students, were most likely to be smokers. Compared with former medical students, former arts and law students had excess all-cause and cardiovascular disease mortality, while science and engineering alumni had similar risks. Former medical students had lower lung cancer mortality than other alumni but higher mortality from alcohol-related causes including accidents, suicide and violence.
The lower mortality risks observed among former medical and engineering students may be due to their better employment prospects and healthier lifestyle behaviours, although the high mortality from alcohol-related causes among former medical students underscores the complexity of choice of health behaviour. The findings point to the potential for disease prevention among the large proportion of the population who now have third-level education.
PMCID: PMC539566  PMID: 12893853
20.  Cultural Intelligence and Social Adaptability: A Comparison between Iranian and Non-Iranian Dormitory Students of Isfahan University of Medical Sciences 
Materia Socio-Medica  2013;25(1):40-43.
Introduction:
At the modern age, to acquire knowledge and experience, the individuals with their own specific culture have to enter contexts with cultural diversity, adapt to different cultures and have social interactions to be able to have effective inter-cultural relationships.To have such intercultural associations and satisfy individual needs in the society, cultural intelligence and social adaptability are deemed as inevitable requirements, in particular for those who enter a quite different culture. Hence, the present study tries to compare the cultural intelligence and its aspects and social adaptability in Iranian and non-Iranian dormitory students of Isfahan University of Medical Sciences in 2012.
Methodology:
The study was of descriptiveanalytical nature. The research population consisted of Iranian and non-Iranian students resided in the dormitories of Isfahan University of Medical Sciences which are 2500, totally. For Iranian students, two-stage sampling method was adopted. At the first stage, classified sampling and at the second stage, systematic random sampling was conducted. In this way, 441 students were selected. To form non-Iranian students’ sample, consensus sampling method was applied and a sample of 37 students were obtained. The research data was collected by using Earley & Ang’s Cultural Intelligence Questionnaire with the Cronbach’s coefficient α of 76% and California Social Adaptability Standard Questionnaire with the Cronbach’s coefficient α of over 70%. Then, the data were put into SPSS software to be analyzed. Finally, the results were presented by descriptive and inferential statistics methods.
Results:
The study findings revealed that there was no statistically significant difference between cultural intelligence and cognitive aspect of cultural intelligence in Iranian and non-Iranian students (P≥0/05). However, Iranian and non-Iranian students statistically differed in terms of the following aspects of cultural intelligence: meta-cognitive aspect (61.8% for Iranian students vs. 47.6% for non-Iranians), motivational aspect (59.0% vs. 42.6%), behavioral aspect (31.8% vs. 41.2%) as well as social adaptability as the other variable in question ( 68.9% vs. 56.2%) (p<0.001).
Conclusion:
The comparison of the mean scores gained for meta-cognitive and motivational aspects of cultural intelligence as well as social adaptability in Iranian and non-Iranian students resided in the dormitories of Isfahan University of Medical Sciences revealed that the Iranian students had the higher rank. On the other hand, the mean score acquired for the behavioral aspect in Iranian and non-Iranian students were comparable, with non-Iranian students having the higher mean scores. Therefore, it can be said that the meta-cognitive and motivational aspects of cultural intelligence and social adaptability of non-Iranian students and the behavioral aspect of Iranian students’ cultural intelligence may be promoted by educational planning, thereby, taking effective steps towards their achievement in contexts with inter-cultural interaction . In this way, their mental health will be enhanced, as well.
doi:10.5455/msm.2013.25.40-43
PMCID: PMC3633545  PMID: 23678339
culture; intelligence; cultural intelligence; social adaptability.
21.  Factors Relating to Academic Performance of Medical Students at the University of British Columbia 
The performance of medical students enrolled at the University of British Columbia from 1952 to 1961 is reviewed and related to certain descriptive factors available to the screening committee at the time of application. Almost 40% of enrolled students had academic difficulty in medical school; 16.4% failed a complete year. Since 91% of students who failed out, did so after freshman medicine examinations, these grades were examined for significant association with certain intellectual and non-intellectural factors. Sex and year of registration were not significantly associated with freshman performance, but permanent home address was: students from other Commonwealth countries did not perform as well as Canadians. Significant correlations were observed between both pre-medical grades and Medical College Admission Test scores and first-year medicine marks. By multiple regression analysis four factors were found to be predictive: age, number of pre-medical years completed at the time of application, overall pre-medical grade average and “Science” M.C.A.T. score. From the resulting equation, 77.4% of the grades of medical students who completed their freshman year in 1962 were predicted within one standard error. Students on the whole were noted to perform consistently in pre-medicine and medicine.
PMCID: PMC1921932  PMID: 14069612
22.  USSTRIDE program is associated with competitive Black and Latino student applicants to medical school 
Medical Education Online  2014;19:10.3402/meo.v19.24200.
Purpose
We compared MCAT scores, grade point averages (GPAs), and medical school acceptance rates of Black and Latino students in an outreach program called Undergraduate Science Students Together Reaching Instructional Diversity and Excellence (USSTRIDE) to non-USSTRIDE students. We hypothesized that Black and Latino participants in USSTRIDE had higher acceptance rates to medical school, higher MCAT scores, and college GPAs when compared to other Black and Latino medical school applicants from our institution.
Methods
The academic performance (GPAs and MCAT scores) and acceptance and matriculation rate data on all Black and Latino Florida State University applicants to any medical school from 2008 to 2012 were collected from the AIS/AMCAS database and separated into two comparison groups (USSTRIDE vs. Non-USSTRIDE). Independent sample T-tests and chi-square analysis, Cohen's D test, and odds ratios were determined.
Results
Average science GPA was 3.47 for USSTRIDE students (n=55) and 3.45 for non-USSTRIDE students (n=137, p=0.68, d=0.0652). Average cumulative GPA was 3.57 for USSTRIDE students and 3.54 for non-USSTRIDE students (p=0.45, d=0.121). Average MCAT score was 23 for USSTRIDE students and 25 for non-USSTRIDE students (p=0.02, d=0.378). Twenty-three percent of accepted USSTRIDE students and 29% of accepted non-USSTRIDE students had multiple acceptances (p=0.483, OR 1.38, 95% CI 0.52–3.88). Forty-nine percent of non-USSTRIDE students and 75% of USSTRIDE students matriculated in medical school (p=0.001, OR 3.13 95% CI 1.51–6.74). About 78.6% of USSTRIDE students matriculated at FSU's medical school compared to 36.2% of non-USSTRIDE students (p<0.01).
Conclusions
USSTRIDE and non-USSTRIDE students had similar science and cumulative GPAs. USSTRIDE students' MCAT scores were lower but acceptance rates to medical school were higher. Participation in USSTRIDE is associated with increased acceptance rates for Black and Latino students to our medical school. This finding is true for other medical schools as USSTRIDE students are as likely as non-USSTRIDE students to have multiple acceptances.
doi:10.3402/meo.v19.24200
PMCID: PMC4033323  PMID: 24861543
minority health; medical education; pipeline; healthcare workforce; minorities in medicine; medical school admission
23.  A study assessing the impact of different teaching modalities for pharmacy students in a Cardio-Pulmonary Resuscitation (CPR) course 
The current study aims to assess the effectiveness of different teaching methods adopted for the practical session of Cardio-Pulmonary Resuscitation (CPR). CPR training is one of the compulsory modules of the Public Health Pharmacy (PHP) course at Universiti Sains Malaysia. CPR training comprises of 10% of total marks of the PHP course. To test the effectiveness of the different teaching strategies, three groups were defined using a two-stage cohort distribution—i.e. based on grade point average (GPA) and different teaching modalities. Group One was instructed using images and PowerPoint lecture slides. Group Two was instructed using videos and PowerPoint lecture slides. Group Three was instructed using PowerPoint slides with white boards and videos. Students in Group Three were not provided with a hard/soft copy of the PowerPoint slides and were encouraged to write down all the information on their personal notebooks. A 20-item questionnaire was used to assess the students’ understanding toward the CPR session. Data were analyzed using the Statistical Package for Social Science Students, SPSS version 13®. Based on the response attained, the comparison of the final score among the groups was undertaken using one way ANOVA. Twenty-seven students have participated in this study. Final evaluation using the questionnaire revealed that student’s in Group Three had a better understanding of CPR (18.1 ± 1.5, p <0.001) than the other two. Students’ note taking during the lecture and use of traditional chalkboard teaching were found significant to improve the students’ understanding and learning in the CPR session.
doi:10.1016/j.jsps.2012.11.002
PMCID: PMC3824940  PMID: 24227957
Teaching strategies; Chalkboard; Cardio-Pulmonary Resuscitation (CPR)
24.  Involving students in real-world research: a pilot study for teaching public health and research skills 
Background
There is some evidence that medical students consider population health issues less important than other domains in the health sciences and attitudes to this field may become more negative as training progresses. A need to improve research skills among medical students has also been suggested. Therefore we piloted an integrative teaching exercise that combined teaching of research skills and public health, with real-world research.
Methods
Third year medical students at the University of Otago (Dunedin, New Zealand) filled in a questionnaire on their housing conditions and health. The students were given the results of the survey to discuss in a subsequent class. Student response to this teaching exercise was assessed using a Course Evaluation Questionnaire.
Results
Of the 210 students in the class, 136 completed the Course Evaluation Questionnaire (65%). A majority of those who responded (77%) greatly supported or supported the use of the survey and seminar discussion for future third year classes. Most (70%) thought that the session had made them more aware and concerned about societal problems, and 72% felt that they now had an improved understanding of the environmental determinants of health. Students liked the relevance and interaction of the session, but thought it could be improved by the inclusion of small group discussion. The findings of the students' housing and health were considered by the tutors to be of sufficient value to submit to a scientific journal and are now contributing to community action to improve student housing in the city.
Conclusion
In this pilot study it was feasible to integrate medical student teaching with real-world research. A large majority of the students responded favourably to the teaching exercise and this was generally successful in raising the profile of public health and research. This approach to integrated teaching/research should be considered further in health sciences training and continue to be evaluated and refined.
doi:10.1186/1472-6920-9-45
PMCID: PMC2717069  PMID: 19607675
25.  Medical students’ experience of personal loss: incidence and implications 
BMC Medical Education  2013;13:36.
Background
Medical students are generally young people, often away from home for the first time and undertaking a course in which they are learning to care for people at all stages of life, including those approaching death. Existing research indicates that their experiences of personal bereavement may have significant implications for their pastoral welfare and medical learning. No previous studies have tracked medical student experience of bereavement longitudinally and no recent data are available from the UK.
Aims
The study aims to identify medical students’ experience of personal bereavement: the prevalence prior to and during the course and their relationship with those who died.
Method
Paper and online questionnaire including questions about recent personal loss. Setting / Participants: Four cohorts of core science and clinical medical students at the University of Cambridge, 1021 participants in total.
Results
Mean response rate was 65.2% for core science students and 72.8% for clinical students. On entry to the core science course, 23.1% of all students had experienced a loss at some point. Between 13.0% and 22.5% experienced bereavement during years 1 – 5 of the course: some (1.3% - 6.3%) experienced multiple or repeated losses. Close deaths reported were most commonly those of grandparents followed by friends.
Conclusions
Medical students commonly experience close personal bereavement, both before and during their course. Educators need to be aware of the range of personal and educational implications of bereavement for medical students, and ensure that appropriate help is available. Further research could explore incidence of loss at other medical schools and investigate the impact and depth of experience of loss.
doi:10.1186/1472-6920-13-36
PMCID: PMC3600365  PMID: 23497189
Undergraduate education; Bereavement; Student wellbeing; Pastoral care

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