The recognition that medical practitioners require more than simply a high level of academic ability to function successfully in their profession, together with a sharp increase in the number of academically qualified applicants to medical courses, has led to new ways of selecting medical students. Consequently the selection of students into the high-stakes course of medicine has become an area of considerable interest and research activity. The issues involved in selection are now prominent in the medical and medical education literature published in the UK, the USA, Australia, New Zealand and Canada, and in some European countries. At the same time as the introduction of new selection procedures, and independently of it, due to advances in pedagogy the nature of the medical curriculum has also changed. Changes have been characterised by the use of problem-based learning, and an emphasis on self-directed learning, as well as an increase in interaction between the students in classes and between students and their teachers. The recognition that problemsolving, communication and interaction skills in the courses, in addition to the requisite intellectual capacity, would enhance performance as practitioners, has reinforced the need for students to be selected on a different set of attributes from those used previously. In Australia, changes in the way in which medical students are selected were initiated by the University of Newcastle in the early 1990s, with the introduction of some tests of cognitive skills and an interview. Over the following ten years, the other Australian undergraduate medical schools followed suit and a three-component selection process developed in an attempt to differentiate among the high calibre applicants to medical courses, by identifying additional important skills and attributes. The three components are the academic score, results on an aptitude test and results on a selection interview. Two of the nine undergraduate medical schools chose not to use a selection interview. The focus of this thesis is on evaluating the new selection processes and investigating the consequences of the admission of school-leaver applicants into undergraduate medical courses, where the Tertiary Entrance Rank (TER) is the academic criterion for determining suitability to undertake tertiary studies. Each undergraduate medical school has developed its own unique way to operationalise the selection of its students. However, the use of the Undergraduate Medicine and Health Sciences Admissions Test (UMAT), which developed out of the University of Newcastle’s test of cognitive skills, and the conduct of an interview for a select group of applicants are common to these practices. The implementation of the new selection processes has not been without its critics, mainly from within the medical profession. This thesis studies the issues which underlie the three components of selection (the TER, the UMAT and a selection interview) and uses as a case study the particular process used to select students into the six year undergraduate medical course at The University of Western Australia (UWA). The UWA selection process involves applicants passing a threshold score on each of the three components and then being ranked by a mechanism which combines the three scores with equal weight. This is a compensatory system in which applicants can compensate for a score near the threshold on one component by high scores on the other two components. This study showed that the resultant cohort is eclectic in its characteristics, with the full range of scores (above the threshold) in each component being represented. Both qualitative and quantitative methods of data collection were used to address the issues surrounding the way in which medical students are selected and the outcomes of such processes. First, semi-structured interviews were held with different groups of stakeholders, including the staff at secondary schools which prepare the students for tertiary entrance; academic and administrative staff at The University of Western Australia (UWA); academic and administrative staff at other Australian universities; and senior staff at the major teaching hospitals in Western Australia. Secondly, quantitative studies on UWA data addressed the predictive validity of the components of selection; inter-rater reliability and the internal consistency of the data sets from the selection interview; and the attrition rate in the course. Outcomes from the research showed that in general, the reactions from stakeholders have been positive. Importantly, academic levels amongst medical students and recent graduates do not appear to have been eroded by the new process, in which the academic threshold has been lowered. The UMAT is a contentious national test which has had its validity as a selection instrument questioned. A recent construct and content validity study on the UMAT (Mercer and Chiavaroli, 2006) has gone some way towards settling some of these issues, but the question of predictive validity has yet to be addressed adequately. The existence of commercially available preparation courses has been controversial because of the equity issues involved for those applicants who for some reason do not have access to such courses. The selection interview, one of the three components of selection, conducted by the Faculty of Medicine, Dentistry and Health Sciences at UWA, whilst attracting criticism from some for appearing stilted and overly prescriptive, was judged to be robust and rigorous by many of those directly involved in its implementation. Furthermore a high proportion of medical students were judged by their teachers to have good communication skills, which is a positive outcome for future members of the profession. A study to quantify reliability indices for the UWA selection interviews indicated high levels of inter-rater reliability and internal consistency of the ratings data produced. The predictive validity study conducted as part of this study showed the two major predictors of course outcomes at UWA to be the TER and female gender. The TER predicts outcomes in the knowledge-based units across the course and in some clinically-based units in the later years. However, the interview score (in particular the Communication Skills component) and scores on the first section of UMAT (Logical reasoning and problem solving) also predict outcomes in some of the clinically-based units. The results of these studies are encouraging to those who believe that the new selection process, whilst imperfect, has gone some way towards solving the problems attached to selection based solely on academic merit. The question now becomes how to improve further on the selection of medical students and to do so in an evidence-based way. The characteristics to be included in selection remain controversial. The rigorous assessment of such characteristics needs to be addressed in the longer term and will be an evolving issue, as the medical curriculum and the nature of the profession also continue to change.

It is near universally accepted that empathy is a desirable trait for physicians and physicians in training. Empathy is not simply a desirable trait, it is part of the deontological duty of a physician. When physicians understand their patients they can offer them options which are best suited for them, thus giving patients autonomy. Empathy is especially important for patients in urban and undeserved environments as a weapon against conscious and unconscious bias. Interestingly, the data also suggest that empathy improves patient outcomes in multiple settings. Unfortunately the evidence would suggest that medical students become less emphatic over the course of their training. This paper argues that empathy should be emphasized in medical education and also gives suggestions as to how it can be better incorporated and nurtured in a curriculum. / Urban Bioethics

This article presents findings from my PhD study entitled Midwifery knowledge and the medical student experience. The research study sought to explore the question: 'What do medical students learn from midwives?' In the first part of this dual-phase project I conducted a Delphi study with an international panel of midwives to examine the concept of 'midwifery knowledge' (MacVane 2013a). Data from the Delphi survey were used to inform the second phase, which employed a longitudinal case study approach to explore medical students’ experiences of working with midwives during a specialist obstetric rotation. Thirteen medical students, who were recruited from a fourth-year cohort, participated in interviews at the start, middle and end of their specialist obstetric rotation. The students spent the majority of the rotation at their local teaching hospital (LTH), but also spent an interim two-week period at a variety of district general hospitals (DGH).

Background: Over 50% of Canadian medical students report experiencing mistreatment, yet only a small proportion of students report these concerns to administration. It is unknown how medical students make sense of their experiences of mistreatment and come to decide about formally reporting these experiences. Improved understanding of this phenomenon will facilitate changes at the administrative and institutional levels to better support students. Methods: This Constructivist Grounded Theory study interviewed 19 current and former medical students from one institution about their experiences with mistreatment and reporting. Anonymized transcripts were reviewed, coded and theory was developed. Results: Students undergo a journey surrounding experiences of mistreatment in five phases: Situating, Experiencing and Appraising, Reacting, Deciding, and Moving Forward. Students move through these phases as they come to understand their position as medical learners and their ability to trust and be safe within this institution. Each experience of mistreatment causes students to react to what has happened to them, decide if they will share their experiences and reach out for support. They choose if they are going to report the mistreatment, at what cost and for what outcomes. Students continue through their training while incorporating their experiences into their understanding of the culture in which they are learning and continually resituating themselves within the institution. Discussion: This study revealed institutional mistrust from students especially as it related to reporting mistreatment. Interventions designed to support students and decrease exposure to mistreatment may be best focused on increasing organizational trust and organizational compassion between students and the medical school. Students volunteered mechanisms of support and to improve the reporting process. Medical school administration should consider how they can increase trust with their learners while identifying areas of concern and procedures for intervening and providing more transparent resolutions. / Thesis / Master of Science (MSc) / More than half of all Canadian medical student experience mistreatment during their medical school but very few choose to formally report it. In this study we explored how students experienced mistreatment and their decisions about reporting it as well as what supports would be most helpful for them. To better understand this issue, 19 medical students were interviewed about their experiences. The interviews were analyzed through constructivist grounded theory and the identified themes were used to develop a theory of how students experience mistreatment and make decisions around reporting. Students go through five phases: Situating themselves in their learning environment, Experiencing and Appraising mistreatment, Reacting to that mistreatment, Deciding about reporting and the risks and benefits and Moving Forward within the same medical school as they continue. Students showed mistrust towards the medical school and suggested changes the medical school could make to better support them.

There are three interrelated concepts of what medical students learn, which include the formal, informal, and hidden curriculum. Several researchers who have investigated notions of the hidden curriculum have demonstrated how the experiences of medical training entrenched in the hidden curriculum can have a profound impact on medical student adaptation. The most influential transitional stage in undergraduate medical education is the third-year clinical clerkship, when medical students transition from classroom learners into clinicians. The Northern Ontario School of Medicine’s (NOSM) clinical clerkship year consists of a mandatory eightmonths of living and working in rural and northern communities throughout Northern Ontario, and learning in the context of rural family practice. Informed by a social constructivist research paradigm, I explored how 12 third-year students described the challenges they had to manage and, in response, the strategies they employed to adapt to their clerkship. I elicited their experiences and perspectives to contribute to a rich understanding of how students at the NOSM describe developing processes of adaptation during the Comprehensive Community Clerkship. Data were collected between August 2011 and April 2012, including: a) pre-clerkship interviews and a demographic questionnaire, b) mobile methods in the form of ‘guided walks’ in the communities, and c) post-clerkship interviews. The quality of the data collection and analysis were enhanced through processes of methodological and interpretive rigour, representativeness and authenticity, rich description and contextual relevance, audit trail, and reflexivity. Through an inductive thematic analysis of the data, the findings provide a rich description of events experienced such as medical training in one’s hometown or a familiar community, iv transitions including adaptation to the clinical setting and to the medical profession, and the influence of the clerkship on career path, personal well-being, and empathy for patients. The findings serve to advance our understanding of how medical students describe developing processes of adaptation throughout a longitudinal integrated clerkship. Implications are considered for medical students, the NOSM, the clerkship communities, and medical schools nationally and internationally. I propose recommendations regarding the suitability of authentic methods in medical education research, and discuss the implications for rural and northern health research.

Transgender individuals are defined as those whose gender does not match the sex they were assigned at birth. Healthcare providers receive inadequate training in transgender medicine, which could lead to provider stigma and lower health outcomes and higher health disparities. The purpose of our study was to assess the effect of an educational intervention on first and second year ETSU medical students’ knowledge and attitudes regarding transgender healthcare. A transgender healthcare-centered Integrated Grand Rounds (IGR) was used as a setting to conduct a 9-item survey regarding definitions, medical management, and attitudes/comfort levels with transgender care. First and second year medical students (n=140) who participated in the intervention had the option to complete pre and post surveys on paper before and after IGR. Of the 140 participants, 138 (98.6%) completed the pretest and posttest measures. The participants’ attitudes about transgender patients and their comfort in treating transgender patients significantly improved between pre and posttest surveys (p

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Background: The purpose of this study was to develop a preclerkship elective and assess its effectiveness in supplementing medical students' education. Methods: A group of medical students under the guidance of two faculty advisors developed an elective consisting of six sessions covering a variety of practical aspects of diabetes care/education taught by an interprofessional team. Following the course completion, a survey was emailed to the enrollees who attended at least one session. The results were analyzed using Wilcoxon signed-rank and descriptive analyses. Results: A total of 14 medical students were enrolled (nine first year and five second year). An average of 4.4 sessions/student was attended. Thirteen students attended at least one session and were surveyed. The survey response rate was similar to 62% (8/13). All eight students indicated that the course was valuable and would recommend it to their colleagues. A Wilcoxon signed-rank test revealed a statistically significant increase in students' confidence in all five areas assessed following participation in the course, P<0.05 with a large effect (r>0.5). Conclusion: This study suggests the feasibility of developing disease state-specific preclerkship elective courses and that such courses can be beneficial in supplementing medical student education with practical knowledge.

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Medical students are more susceptible to experiencing stress, anxiety, depression, and subsequent burnout relative to their peers in other professional fields. The Medical Student Well-Being Index (MSWBI) is a standardized and validated survey that represents the percentage of medical students “at risk” for adverse psychological outcomes, including but not limited to depression, anxiety, suicidal thoughts. At Quillen College of Medicine (QCOM), the MSWBI data has been collected annually in an attempt to better understand the factors that contribute to and mitigate medical student burnout. Through the use of the Medical Student Well-Being Index (MSWBI), we compared the changes in the percentage “at risk for adverse psychological outcomes” of first-year medical student responses at Quillen College of Medicine over several years. MSWBI is composed of a seven-item survey. Student responses were summed to total scores then categorized as “at risk” or not “at risk”. We used a two-sided Chi-square Fisher’s exact test analysis. Results demonstrated a statistically significant increase in “at risk” students of MS1s for the Classes of 2024 and 2025 relative to the prior Class of 2021 (MS1 ’21 vs ’24: p-value = 0.0191; MS1 ’21 vs ’25: p-value = 0.0103). The data demonstrate that during the COVID-19 pandemic, there has been an increasing percentage of M1 students found to be “at risk for adverse psychological outcomes” such as burnout, depression, and suicide. By finding those at risk, we can then start to determine the modifiable factors contributing to burnout to mitigate downstream consequences. With increasing rates of burnout among medical students and physicians during the COVID-19 pandemic, albeit for varying reasons, there is an urgency and demand for medical schools to foster competent, compassionate doctors to enter the workforce.