Student assistantship programme: an evaluation of impact on readiness to transit from medical student to junior doctor.

BACKGROUND: Studies report that medical graduates are not prepared for practice as expected, and interventions have been developed to prepare them for practice. One such intervention is the assistantship, which provides hands-on opportunities to hone clinical skills and undertake responsibilities under supervision. The Lee Kong Chian School of Medicine (LKCMed) is Singapore's newest medical school, and students undergo a Student Assistantship Programme (SAP) to prepare for practice as junior doctors (PGY1). This study evaluated the SAP from the students' and clinical supervisors' perspectives. METHODS: Students completed online questionnaires to assess readiness for practice before and after SAP, and a subsample were interviewed about their experiences of SAP and its impact on their preparedness for PGY1. In addition, after our graduates had begun work as PGY1 doctors, their clinical supervisors completed an online questionnaire and were interviewed about the perceived benefits of SAP and the attributes of our graduates as junior doctors. RESULTS: Fifty (96%) students completed the pre-SAP questionnaire and 46 (92%) completed the post-SAP questionnaire. Levels of preparedness increased post-SAP (mean scores range pre-SAP: 2.38 to 4.32 vs post-SAP: 3.08 to 4.48); so did opportunities to undertake PGY1 duties (pre-SAP: 56% vs post-SAP: 96%), and hands-on experience in medical emergencies (pre-SAP: 76% vs post-SAP: 89%).Experience of acute care situations increased except "paracetamol overdose". Readiness to be first respondents in ten acute situations improved (statistically significant for asthma, chronic obstructive pulmonary disease exacerbation, gastrointestinal bleed, sepsis, and adverse drug reactions). Three themes emerged from twenty-five student interviews: learning about the work environment, opportunities to learn in a safe environment, and enhancing SAP for future students. Thirty-three supervisors completed the questionnaire, and 70% rated SAP positively in preparing students for PGY1. Eight supervisors interviewed shared positively about the content, timing, and duration of SAP; and suggested future SAPs help students to develop coping and reflective skills. CONCLUSIONS: The SAP improved students' preparedness and experience across clinical areas, and students felt the SAP helped bridge undergraduate curriculum and work, provided opportunities to hone their skills and learn from junior doctors. Most clinical supervisors rated the SAP effective in preparing students for PGY1. This is the first formal evaluation of an assistantship in Singapore, and the findings are encouraging from the perspective of students and PGY1 supervisors.

Role of social comparison in preparedness for practice as a junior doctor in Singapore: a longitudinal qualitative study.

OBJECTIVES: To date, most research on medical graduates' preparedness for practice has conceptualised preparedness as something possessed by the individual. However, new doctors work within social settings with other people and, given this, we argue that preparedness has a social and comparative dimension. The aim of this paper is to explore medical students'/graduates' self-assessments of their preparedness for practice using the lens of social comparison theory. SETTING: We invited medical students from one of Singapore's three medical schools who were in their final-year Student Assistantship Programme to participate in semi-structured interviews, and follow-up interviews 6 months later when they were working as junior doctors. Data was collected from two cohorts, in 2018 and 2019. Initial analysis of interview transcripts was inductive and thematic. Social comparison theory was used for subsequent theory-driven analysis. PARTICIPANTS: 31 participants took part, of whom 21 also engaged in follow-up interviews. RESULTS: We identified three uses of social comparison: as coping strategy to manage uncertainties in transitions where there was no formal, objective testing of their performance; as a means to confirm their self-perceived preparedness (upwards or downwards, eg, being better or worse prepared than comparator others); and as the basis for decision-making (eg, changing career choices). CONCLUSIONS: Senior medical students and newly-graduated doctors compare themselves with peers and near-peers in terms of prior learning and current performance to evaluate and understand their own performance at work. Future studies need to examine further how the feeling of preparedness or unpreparedness generated from social comparisons may affect subsequent clinical performance and professional development.

Promotion of knowledge transfer and retention in year 2 medical students using an online training exercise.

It was recently shown that novice medical students could be trained to demonstrate the speed-to-diagnosis and diagnostic accuracy typical of System-1-type reasoning. However, the effectiveness of this training can only be fully evaluated when considering the extent to which knowledge transfer and long-term retention occur as a result, the former of which is known to be notoriously difficult to achieve. This study aimed to investigate whether knowledge learned during an online training exercise for chest X-ray diagnosis promoted either knowledge transfer or retention, or both. Second year medical students were presented with, and trained to recognise the features of four chest X-ray conditions. Subsequently, they were shown the four trained-for cases again as well as different representations of the same conditions varying in the number of common elements and asked to provide a diagnosis, to test for near-transfer (four cases) and far-transfer (four cases) of knowledge. They were also shown four completely new conditions to diagnose. Two weeks later they were asked to diagnose the 16 aforementioned cases again to assess for knowledge retention. Dependent variables were diagnostic accuracy and time-to-diagnosis. Thirty-six students volunteered. Trained-for cases were diagnosed most accurately and with most speed (mean score = 3.75/4, mean time = 4.95 s). When assessing knowledge transfer, participants were able to diagnose near-transfer cases more accurately (mean score = 2.08/4, mean time = 15.77 s) than far-transfer cases (mean score = 1.31/4, mean time = 18.80 s), which showed similar results to those conditions previously unseen (mean score = 0.72/4, mean time = 19.46 s). Retention tests showed a similar pattern but accuracy scores were lower overall. This study demonstrates that it is possible to successfully promote knowledge transfer and retention in Year 2 medical students, using an online training exercise involving diagnosis of chest X-rays, and is one of the few studies to provide evidence of actual knowledge transfer.

Summative and Formative Style Anatomy Practical Examinations: Do They Have Impact on Students' Performance and Drive for Learning?

Anatomical knowledge is commonly assessed by practical examinations that are often administered in summative format. The format of anatomy practical examination was changed at the Lee Kong Chian School of Medicine in Singapore from summative (graded; must pass) to formative (ungraded; no pass/fail) in academic year (AY) 2017-2018. Both assessment formats were undertaken online, but the formative mode used a team-based learning activity comprising individual and team assessments. This gave an unique opportunity to investigate: (1) the impact of two different online assessment formats on student performance in practical examination; (2) the impact of new formative practical examination on students' performance in summative examinations; and (3) students' opinions of these two practical examination formats. The class of 2021 perceptions was obtained as they experienced both formats. A retrospective cohort study was also conducted to analyze the Year 2 students' performance in anatomy practical and year-end summative examinations of cohorts AY 2015-2016, AY 2016-2017 (summative format), and AY 2017-2018 (formative format). There were no significant differences in students' performance between two practical examination formats. The cohort who experienced the formative format, performed significantly better in summative examinations (mean ± SD: 82.32 ± 10.22%) compared with the cohort who experienced the summative format (73.77 ± 11.09%) (P < 0.001). Students highlighted positive features of the formative practical examination, including team reinforcement of learning, instant feedback, and enhanced learning. These findings indicate that students continue to study for anatomy practical examination without the need for external drivers. The team-based learning style practical examination enhances students' performance in summative examinations.

Evidence supporting dual-process theory of medical diagnosis: a functional near-infrared spectroscopy study.

PURPOSE: The objective of this study was to determine the extent to which the dual-process theory of medical diagnosis enjoys neuroscientific support. To that end, the study explored whether neurological correlates of system-2 thinking could be located in the brain. It was hypothesised that system-2 thinking could be observed as the activation of the prefrontal cortex. METHOD: An experimental paradigm was applied that consisted of a learning and a test phase. During the learning phase, 22 medical students were trained in diagnosing chest X-rays. Four of these eight cases were presented repeatedly, to develop a high level of expertise for these cases. During the test phase, all eight cases were presented and the participants' prefrontal cortex was scanned using functional near-infrared spectroscopy. Response time and diagnostic accuracy were recorded as behavioural indicators. RESULTS: The results revealed that participants' diagnostic accuracy in the test phase was significantly higher for the trained cases as compared with the untrained cases (F[1, 21] = 138.80, p < 0.001, η2  = 0.87). Also, their response time was significantly shorter for these cases (F[1, 21] = 18.12, p < 0.001, η2  = 0.46). Finally, the results revealed that only for the untrained cases, could a significant activation of the anterolateral prefrontal cortex be observed (F[1, 21] = 21.00, p < 0.01, η2  = 0.34). CONCLUSION: The fact that only untrained cases triggered higher levels of blood oxygenation in the prefrontal cortex is an indication that system-2 thinking is a cognitive process distinct from system 1. Implications of these findings for the validity of the dual-process theory are discussed.

Inducing System-1-type diagnostic reasoning in second-year medical students within 15 minutes.

Purpose: Diagnostic reasoning literature debates the significance of "dual-process theory" and the importance of its constituent types of thinking: System-1and System-2. This experimental study aimed to determine whether novice medical students could be trained to utilize System-1 thinking when making diagnoses based on chest X-rays. Method: Second-year medical students were recruited and presented with a series of eight online chest X-rays cases. Participants were shown half of the cases repeatedly during a training phase and the other half only twice. During the final test phase, they were shown all eight cases, providing a diagnosis as a free text answer. Dependent variables were diagnostic accuracy and response time. Results: Thirty-two students participated. During the test phase, students responses were significantly more accurate and faster for cases which had been seen repeatedly during the training phase (mean score = 3.56/4, mean time = 2.34 s) compared with cases which had been seen only twice (mean score = 1.59/4, mean time = 7.50 s). Conclusion: This study demonstrates that it is possible to induce in novice students the speed-to-diagnosis and diagnostic accuracy typical of System-1-type reasoning. The full experimental design and the chest X-rays used may provide new opportunities to explore some of the issues surrounding dual-process theory.

Register based study of anorectal anomalies over 26 years: Associated anomalies, prevalence, and trends.

BACKGROUND: Anorectal anomalies are atresias or stenoses of the anal canal and rectum with or without fistulous connections with the bladder, urethra, perineum, or vestibule. The aim of this study was to describe the epidemiology of anorectal anomalies, including associated anomalies, prevalence, and temporal trends. METHODS: Anorectal anomalies occurring in late miscarriages (>20 gestation weeks), terminations of pregnancy for fetal anomaly (any gestation), stillbirths (≥24 gestation weeks) and live births, delivered from 1985 to 2010, notified to the Northern Congenital Abnormality Survey (NorCAS) were included in this population-based case series. RESULTS: There were 278 cases among 892,194 live births. Twenty (7.2%) cases occurred in twin pregnancies and 24 (8.7%) with chromosomal anomalies/genetic syndromes were excluded. There were 234 cases (total prevalence = 2.7, 95% confidence interval [CI]: 2.4, 3.1 per 10,000 live and stillbirths). There was no evidence of a trend in prevalence over time (Chi(2) test for trend: p = 0.789). There was a male predominance (70.9%). Of the 234 cases, 167 (71.4%) were live born, two (0.9%) were late miscarriages, seven (3.0%) were stillbirths, and 58 (24.8%) were terminations of pregnancy for fetal anomaly. There was no significant association with maternal age at delivery (p = 0.095). 7.2% of isolated cases (cases with no other congenital anomalies) were diagnosed prenatally. CONCLUSION: The prevalence of anorectal anomalies in this study is comparable to other case series. There was no evidence of a temporal increase in prevalence. We confirmed a male predominance of anorectal anomalies and no significant association with maternal age. Birth Defects Research (Part A) 103:597-602, 2015. © 2015 Wiley Periodicals, Inc.