A survey of medical school aspirant perceptions of an unexpected lottery-facilitated admissions adaptation.

INTRODUCTION: Due to the COVID-19 pandemic, the Undergraduate Medical Doctor (MD) Programme at McMaster University (Hamilton, Canada) was unable to run in-person medical school interviews in March 2020, prompting an alternate solution that maximised admission opportunities for Indigenous applicants, prioritised admission for those rated most highly in the interview determination process, and allocated subsequent offers via lottery. METHODS: A short survey was administered to applicants who had been offered an admissions interview and were subsequently impacted by the admissions adaptations. The survey elicited perceptions of the adaptation through Likert scale ratings and free-text responses. Survey data were analysed via a sequential (quantitative to qualitative) mixed-methods design. RESULTS: 196 of 552 potential participants completed the survey. Across quantitative and qualitative analyses, respondents reported that the adaptation had a negative impact on their professional development and personal life. Ratings of negative perception were greater for those who did not receive an offer than for those who accepted or declined an offer. Free text responses emphasised considerable criticism for the lottery portion of the adaptation and displeasure that efforts made in constructing applications were less relevant than anticipated. DISCUSSION: The negative responses to this unexpected change highlight the profound upstream impact admission policies have on the preapplication behaviours of aspiring medical students. The outcomes support a refined understanding of the value candidates place on the interview in appraising their own suitability for a career as a physician.

Associations between education policies and the geographic disposition of family physicians: a retrospective observational study of McMaster University education data.

The maldistribution of family physicians challenges equitable primary care access in Canada. The Theory of Social Attachment suggests that preferential selection and distributed training interventions have potential in influencing physician disposition. However, evaluations of these approaches have focused predominantly on rural underservedness, with little research considering physician disposition in other underserved communities. Accordingly, this study investigated the association between the locations from which medical graduates apply to medical school, their undergraduate preclerkship, clerkship, residency experiences, and practice as indexed across an array of markers of underservedness. We built association models concerning the practice location of 347 family physicians who graduated from McMaster University's MD Program between 2010 and 2015. Postal code data of medical graduates' residence during secondary school, pre-clerkship, clerkship, residency and eventual practice locations were coded according to five Statistics Canada indices related to primary care underservedness: relative rurality, employment rate, proportion of visible minorities, proportion of Indigenous peoples, and neighbourhood socioeconomic status. Univariate and multivariable logistic regression models were then developed for each dependent variable (i.e., practice location expressed in terms of each index). Residency training locations were significantly associated with practice locations across all indices. The place of secondary school education also yielded significant relationships to practice location when indexed by employment rate and relative rurality. Education interventions that leverage residency training locations may be particularly influential in promoting family physician practice location. The findings are interpreted with respect to how investment in education policies can promote physician practice in underserved communities.

Spiralling Pre-clerkship Concepts into the Clinical Phase: Augmenting Knowledge Transfer Using Innovative Technology-Enhanced Curriculum Activities.

Background: Clerkship is a challenging transition for medical students where they learn to apply functional knowledge and diagnostic reasoning skills learned in the pre-clinical phase into the clinical environment. Rather than a smooth continuum to facilitate application of knowledge, clerkship blocks are discrete, fragmented structures with little integration. Developments in cognitive psychology and increasing attention to the student learning environment are driving more purposeful integration in medical education. We sought to enhance knowledge transfer in the Family Medicine clerkship by developing an e-learning pathway with both asynchronous and synchronous components to integrate pre-clerkship problem-based learning (PBL) cases into more complex clinical scenarios. Methods: A parallel-convergent mixed methods evaluation was conducted, which included comparison of learning outcomes (exit exams) relative to the prior class, knowledge check quiz performance, and qualitative analysis of student and faculty perceptions. Results: Analyses revealed no significant difference between exit exam scores of the intervention and pre-intervention clerks (p = 0.30). There were statistically significant differences in mean quiz scores over the rotation (p = 0.0001). Moreover, learners and faculty each perceived the integration components as facilitating the transfer of pre-clinical learning into clerkship activities. Conclusion: The novel e-learning pathway firmly anchored FM clerkship learning and will continue to ensure learners are ideally primed to optimize their direct clinical learning opportunities.