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The Survey
The Survey
In an effort to improve my understanding of the problem, I created a survey and sent it to several forums populated by individuals involved in medical education.
The four main goals of my survey were:
Establish that the problem is actually a problem from the perspective of stakeholders
Establish that clinical application of knowledge was actually important
Determine if stakeholders agree too and have an appetite for curriculum structure adjustments to address the problem
Suggest opportunities for activities beyond MCQ Exams to stakeholders, gauge their enthusiasm for the suggested options, and give space for stakeholders to suggest other ways to tackle the problem.
The Response
The Response
I received 67 responses. Fifty-nine of those were from medical education faculty, five were from medical education staff, one was a clinician, one a medical student currently in their clinical rotation, and one identified as "Other" and indicated that they were both a faculty member and a clinician.
For the first series of Likert questions (figure 1), all respondents agreed in some degree to the statement that when medical students start clinical rotations, they should be able to apply their foundational basic science (FBS) and systems knowledge to clinical scenarios (100% agreement - 79.1% strongly agreed, 19.4% agreed, 1.5% somewhat agreed).
There was also general, but less strong agreement that passing the first two years of medical school indicates a readiness to apply knowledge gained during that time to clinical scenarios (~89% agreement to these statements, though more than half of those in agreement only somewhat agreed). Additionally, there was general agreement that students who score higher in the first two years of medical school should show greater ability to apply their knowledge to clinical scenarios (~85% indicated some level of agreement). Notably, more than 34% of respondents expressed some level of disagreement that level 1 board exams sufficiently measure a student’s ability to apply science to clinical scenarios.
Then, in a list of skills/accomplishments a student may demonstrate (Figure 2), respondents rated the ability to apply science knowledge to clinical situations the second highest in importance. This was only below a student’s ability to demonstrate clinical skills (e.g. familiarity with processes and procedures in clinical practice).
Interpretation:
First, there is strong agreement in the medical education community that clinical knowledge application is important.
Second, there is some positivity toward the idea that students who pass their FBS/systems courses are prepared to apply said knowledge to clinical scenarios. In fact, many respondents seem to think that higher grades correlate with better preparation for clinical application. However, it is clear that there is at least some measurable consensus that simply because a student passes their step 1 boards does not necessarily mean they are prepared to apply the information from that exam to clinical scenarios.
Figure 1
Figure 2
Next, respondents were asked to rate a series of activity types that are meant to provide opportunities for knowledge application (figure 3). Most respondents showed general support toward the use of a variety of case-based scenarios to practice knowledge application and clinical reasoning, including individually assigned cases (93% support), small and large group review of case-based scenarios (98% support), self-directed learning activities (91% support), and early clinical experience (time spent in actual clinics, 95% support). Most also expressed general support of reducing the value of exams in the course grade (76% support) and increasing the value of participation of activities in the final grade (94% support). It is notable that reducing the value of exams also received 23% opposition.
Respondents were asked to rate what percentage of time (figure 4) and grade (figure 5) should be allocated to additional activities that promote application of FBS and systems knowledge. The mode response of both of these questions was 21-40 percent allocation (of grade value, 20 of 67 responses, and time allocation, 19 of 67 responses).
Interpretation: The responses to these questions indicate to me that firstly, medical educators are positive toward incorporating both a greater number and a variety of activities into their current curricula, dedicating valuable time to these activities. Secondly, there is at least an openness to increasing the value of these activities in the overall grade of the course.
Figure 3
Figure 4
Figure 5
Finally, respondents were asked for written feedback related to considerations missed in the survey or additional activity types to give students opportunities to apply knowledge to clinical scenarios. Most of the comments were useful; a sampling is listed on this page in a rotating slide deck. These responses were incredibly useful and contributed greatly to my proposal on the last page of this site.
Photo by fauxels: https://www.pexels.com/photo/top-view-photo-of-people-near-wooden-table-3183150/
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