Commentary on robust, defensible, and fair: The AMEE guide to selection into medical school: AMEE Guide No. 153.

The AMEE Guide to Selection for medical school is a welcome addition that provides much sound advice and guidance. It employs a comprehensive framework and a number of innovations, international case studies, for instance. There are also some omissions that a future revision could usefully address. The key ones concern the evidence base for assessment of personal attributes by questionnaire or interview; conflation of two separable stages in selection, meeting minimum requirements for suitability, and discriminating between suitable candidates; how best to provide feedback to candidates; and the question of what counts as a fair, equitable approach to selection. Nevertheless, the new AMEE Guide (No 153) is well-aligned with the most recent Ottawa consensus statement on selection, and will make a good contribution to the development or revision of selection systems in medical schools.

Impact of accelerated, graduate-entry medicine courses: a comparison of profile, success, and specialty destination between graduate entrants to accelerated or standard medicine courses in UK.

BACKGROUND: Little research has compared the profile, success, or specialty destinations of graduates entering UK medical schools via accelerated, 4-yr, standard 5-yr and 6-yr programmes. Four research questions directed this investigation:- What are the success rates for graduates entering graduate-entry vs. undergraduate medicine courses? How does the sociodemographic and educational profile differ between these two groups? Is success - in medical school and foundation training - dependent on prior degree, demographic factors, or aptitude test performance at selection? What specialty do graduate entry medicine students subsequently enter? METHODS: The data from two cohorts of graduates entering medical school in 2007 and 2008 (n = 2761) in the UKMED (UK Medical Education Database) database were studied: 1445 taking 4-yr and 1150 taking 5-yr medicine courses, with smaller numbers following other programmes. RESULTS: Completion rates for degree programmes were high at 95%, with no significant difference between programme types. 4-yr entrants were older, less likely to be from Asian communities, had lower HESA (Higher Education Statistics Agency) tariff scores, but higher UKCAT (UK Clinical Aptitude Test) and GAMSAT (Graduate Medical School Admissions Test) scores, than 5-yr entrants. Higher GAMSAT scores, black or minority ethnicity (BME), and younger age were independent predictors of successful completion of medical school. Foundation Programme (FPAS) selection measures (EPM - educational performance measure; SJT - situational judgment test) were positively associated with female sex, but negatively with black or minority ethnicity. Higher aptitude test scores were associated with EPM and SJT, GAMSAT with EPM, UKCAT with SJT. Prior degree subject, class of degree, HESA tariff, and type of medicine programme were not related to success. CONCLUSIONS: The type of medicine programme has little effect on graduate entrant completion, or EPM or SJT scores, despite differences in student profile. Aptitude test score has some predictive validity, as do sex, age and BME, but not prior degree subject or class. Further research is needed to disentangle the influences of BME.

"I'm a Medic" - a web-based, social capital approach to health careers.

This article was migrated. The article was marked as recommended. Widening access to medicine in U.K. requires outreach that engages schools in remote areas, schools with below average attainment, and schools serving disadvantaged communities in order to develop a more representative profession and meet serious workforce shortages. The approach reported here embodies ideas about how to develop social and educational capital by facilitating live web chats between school children (13-17 years) and teams of health practitioners. "I'm a Medic" comprised three 2-week events over a 10-month period with circa 900 school students and 22 health professionals from general (family) practices participating. A high proportion (78%) of the students was actively engaged in live chats, asking questions, and voting for the most valuable health practitioner. Questions covered education and training, the nature of the practitioners' work, political and ethical aspects of healthcare, and a variety of scientific and personal aspects. Evaluation showed a positive increase in career interest and aspiration for science, healthcare and medicine. Teachers would all recommend "I'm a Medic" to colleagues and all bar one would take part again. They reported it was effective in engaging students, improving their confidence in asking questions, and their awareness of general practice and the NHS. Practitioners reported improvements in their understanding of how school students view healthcare professions, their interest in public engagement, and their confidence in communicating their work. Logistic challenges included conflict between scheduled web chats in normal school time and practitioners' clinical commitments. Nevertheless, the project demonstrated effective engagement across geographic and social/educational barriers, and can provide a valuable mode of outreach, particularly about careers in healthcare.

Profiling strugglers in a graduate-entry medicine course at Nottingham: a retrospective case study.

BACKGROUND: 10-15% of students struggle at some point in their medicine course. Risk factors include weaker academic qualifications, male gender, mental illness, UK ethnic minority status, and poor study skills. Recent research on an undergraduate medicine course provided a toolkit to aid early identification of students likely to struggle, who can be targeted by established support and study interventions. The present study sought to extend this work by investigating the number and characteristics of strugglers on a graduate-entry medicine (GEM) programme. METHODS: A retrospective study of four GEM entry cohorts (2003-6) was carried out. All students who had demonstrated unsatisfactory progress or left prematurely were included. Any information about academic, administrative, personal, or social difficulties, were extracted from their course progress files into a customised database and examined. RESULTS: 362 students were admitted to the course, and 53 (14.6%) were identified for the study, of whom 15 (4.1%) did not complete the course. Students in the study group differed from the others in having a higher proportion of 2ii first degrees, and scoring less well on GAMSAT, an aptitude test used for admission. Within the study group, it proved possible to categorise students into the same groups previously reported (struggler throughout, pre-clinical struggler, clinical struggler, health-related struggler, borderline struggler) and to identify the majority using a number of flags for early difficulties. These flags included: missed attendance, unsatisfactory attitude or behaviour, health problems, social/family problems, failure to complete immunity status checks, and attendance at academic progress committee. CONCLUSIONS: Problems encountered in a graduate-entry medicine course were comparable to those reported in a corresponding undergraduate programme. A toolkit of academic and non-academic flags of difficulty can be used for early identification of many who will struggle, and could be used to target appropriate support and interventions.

Who applies and who gets admitted to UK graduate entry medicine? - An analysis of UK admission statistics.

BACKGROUND: Graduate-entry medicine is a recent development in the UK, intended to expand and broaden access to medical training. After eight years, it is time to evaluate its success in recruitment. OBJECTIVES: This study aimed to compare the applications and admissions profiles of graduate-entry programmes in the UK to traditional 5 and 6-year courses. METHODS: Aggregate data on applications and admissions were obtained from the Universities and Colleges Admission Service covering 2003 to 2009. Data were extracted, grouped as appropriate and analysed with the Statistical Package for the Social Sciences. RESULTS: Graduate-entry attracts 10,000 applications a year. Women form the majority of applicants and admissions to graduate-entry and traditional medicine programmes. Graduate-entry age profile is older, typically 20's or 30's compared to 18 or 19 years in traditional programmes. Graduate-entry applications and admissions were higher from white and black UK ethnic communities than traditional programmes, and lower from southern and Chinese Asian groups. Graduate-entry has few applications or admissions from Scotland or Northern Ireland. Secondary educational achievement is poorer amongst graduate-entry applicants and admissions than traditional programmes. CONCLUSIONS: Graduate-entry has succeeded in recruiting substantial additional numbers of older applicants to medicine, in which white and black groups are better represented and Asian groups more poorly represented than in traditional undergraduate programmes.

Adaptation after facial surgery: using the diary as a research tool.

We conducted a small-scale qualitative diary study to gather accounts from five facial cancer surgery patients. Participants were asked to record their experiences, thoughts, and feelings for up to 1 year, as they underwent and recovered from their surgery and adapted to living with alterations in their appearance. In this article, we consider evidence relating to the diary as a research tool and discuss our experiences of issues arising with the qualitative diary method employed in this study.These include comparability with interview data, factors affecting the quantity and quality of data (novelty, personal significance, and individual writing styles), chronological storytelling, and barriers to writing (visual difficulties and depression).

Comparative attainment of 5-year undergraduate and 4-year graduate entry medical students moving into foundation training.

BACKGROUND: Graduate entry medicine is a recent innovation in UK medical training. Evidence is sparse at present as to progress and attainment on these programmes. Shared clinical rotations, between an established 5-year and a new graduate entry course, provide the opportunity to compare achievement on clinical assessments. To compare completion and attainment on clinical phase assessments between students on a 4-year graduate entry course and an established 5-year undergraduate medicine course. METHODS: Overall completion rates for the 4 and 5 year courses, fails at first attempt, and scores on 14 clinical assessments, were compared between 171 graduate-entry and 450 undergraduate medical students at the University of Nottingham, comprising two graduating cohorts. Percentage assessment marks were converted to z-scores separately for each graduating year and the normalised marks then combined into a single dataset. Z-score transformed percentage marks were analysed by multivariate analysis of variance and univariate analyses of variance for each summative assessment. Numbers of fails at first attempt were analysed aggregated across all assessments initially, then separately for each assessment using chi2. RESULTS: Completion rates were around 90% overall and significantly higher in the graduate entry course. Failures of assessments overall were similar, but a higher proportion of graduate entry students failed the final OSLER. Mean performance on clinical assessments showed a significant overall difference, made up of lower performance on 4 of 5 knowledge-based exams (as well as higher performance on the first exam) by the graduate entry group, but similar levels of performance on all the skills-based and attitudinal assessments. CONCLUSIONS: High completion rates are encouraging. The lower performance in some knowledge-based exams may reflect lower prior educational attainment, a substantially different demographic profile (age, gender), or an artefact of the first 2 years of a new graduate entry programme.

Coming to terms: a grounded theory of adaptation to facial surgery in adulthood.

Facial surgery is associated with both functional difficulties and disfigurement, and there is evidence to show that psychosocial outcomes vary widely between individuals. This article reports the findings of a grounded theory study of the predictors and process of adaptation to facial surgery in adulthood. Interviews and focus groups were conducted with 29 facial surgery survivors. Four super-ordinate data categories were generated, namely 'Demands','Resources', 'Responding and managing' and 'Consequences'. A model of adaptation was developed which reflected the inter-relationships apparent between these categories. Data extracts are presented to illustrate the grounding of the model in participants' accounts, and the model is discussed with reference to previous theory and research.

Impact of a multimedia intervention "Skinsafe" on patients' knowledge and protective behaviors.

BACKGROUND: Rates of malignant melanoma are rising, with those people with sun-sensitive skin most at risk. Health education interventions are needed to help people protect themselves by detecting early signs of melanoma and by protecting their skin from sunburn. This study aimed to evaluate the impact of an interactive multimedia intervention "Skinsafe" on patients' knowledge about melanoma and on their skin protective behaviors. METHODS: In this cluster-randomized, controlled trial conducted in Nottinghamshire, UK, doctors and nurses in 5 family practices prescribed Skinsafe to patients with higher risk skin characteristics. Measures of melanoma knowledge, perceived risk of melanoma and reported skin protective behaviors were obtained at baseline and at 6-month follow-up from 259 patients receiving the intervention and 330 patients with higher risk skin characteristics in 5 matched control practices. RESULTS AND DISCUSSION: Participants had low levels of melanoma knowledge at baseline. At follow-up, the intervention group had higher knowledge scores than control (3.71 vs. 3.03, P < or = 0.001), reported more protective skin behaviors (5.36 vs. 5.06, P = 0.007) and were more likely to report mole checking (odds ratio 1.67, 95% CI 1.04 to 2.70, P = 0.035). The Skinsafe intervention was evaluated positively by patients and could be used to support melanoma health education within clinical settings.

Evaluation of generic patient information: effects on health outcomes, knowledge and satisfaction.

OBJECTIVE: To establish whether the provision of commercially produced written information in addition to routine hospital information can improve patients' knowledge and satisfaction and affect their health-related quality of life. METHODS: Elective surgical patients were randomised into an experimental group (N = 54) who received three commercially produced information booklets at pre-assessment, before surgery and at discharge, and a control group (N = 55) who received standard hospital information only. RESULTS: The experimental group were significantly less anxious immediately before their operation, and reported greater perceived control compared to controls post-operatively. Two weeks after discharge, health status for the two groups was similar except the experimental group reported significantly less pain. Overall satisfaction was fairly high and similar in both groups. The experimental group demonstrated greater knowledge at pre-admission, but not at discharge or follow-up. DISCUSSION: Patients increasingly expect written information; however amount, quality and timeliness vary considerably. Combining commercially produced information with standard hospital information may be to the patient's benefit. PRACTICE IMPLICATIONS: Providing patients with commercially produced standardised information in addition to internally produced hospital information could have an additional, though limited, benefit to patients' health outcomes. This could be a way of incorporating the expertise of both providers to the patient's benefit.