“There's so much to study!” Medical students' perceptions of curriculum relevance and subject balance: results of a survey of three medical schools

Ewan Gray (MPH student)Paula Lorgelly (Senior Lecturer in Health Economics)

Section of Public Health and Health Policy

Curricular Dilemma

As early as 1876 Thomas Huxley, the famous biologist and educationalist, observed the medical student…

“risked breaking his intellectual back”

…due to the overloading of knowledge considered to be required.

Huxley advocated pre-clinical training in the basic sciences of his day.

The modern medical course

Tomorrow’s doctors

The Scottish Doctor

Students setting the curriculum?!

The decision process in setting the curriculum rarely has strong student involvement despite their obvious stakeholder interest and the evidence of potential benefit in promoting academic success

While students may not be able to comment on the professional/vocational relevance of the content they are uniquely aware of the academic relevance

Student feedback systems popular in many academic departments

Research Questions

Would students re-balance the curriculum teaching and learning time among different subject areas?Which areas would be prioritised more and

which less?Do differences exist in the expressed

preferences of students of:Different universities?Different year groups?

Research Methods

An online questionnaire of medical students Consisting of questions about:

1. Demographic information

2. Knowledge of health economics

3. Views/opinions of health economics and the medical curriculum.

Offered to all medical students at Glasgow, Newcastle and East Anglia via linked email Part of the ‘Medical Students and Health

Economics: What do they know? What do they need to know?’ study

Survey Monkey – Page 1

Specific Questions (1)

Which of these areas do you feel require more teaching/learning time? (please tick all that apply) Anatomy and Physiology Pathology Microbiology Pharmacology Clinical Medicine Clinical Skills (e.g. Examination Technique) Surgery Public Health Personal and Professional Development

Specific Questions (2)

In what areas would you be willing to sacrifice teaching/learning time in order to make room for new material in the course (not necessarily health economics)? (please tick all that apply) Anatomy and Physiology Pathology Microbiology Pharmacology Clinical Medicine Clinical Skills (e.g. Examination Technique) Surgery Public Health Personal and Professional Development

Do you feel that the inclusion of broader health topics places too great a strain or burden on medical students?Open-ended question

Qualitative data collection

Response Rates

578 students accessed the surveyGlasgow – 166 responses – 12.7%Newcastle – 268 responses – 17%East Anglia – 144 responses – 21.5%

423 completed the survey sufficiently for analysis (answered 5 or more multiple choice questions)

University by Year statistics

Glasgow Newcastle UEA Total

Year 1 23 27 32 82

Year 2 18 37 21 76

Year 3 17 44 23 84

Year 4 23 53 16 92

Year 5 18 40 18 76

Intercalated 11 0 2 13

Desire for more teaching

General preference for more teaching of:PharmacologyAnatomy & PhysiologyPathology Surgery

Limited support for more teaching of the non-clinical subjectsPersonal & professional developmentPublic Health

57%

42%

31%

58%

34%

33%

38%

17%

5%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Anatomy & Physiology

Pathology

Microbiology

Pharmacology

Clinical Medicine

Clinical Skills

Surgery

Public Health

Pers & Prof Develop

% respondents

Teaching desires by university

Considerable differences across universities Glasgow and UEA want more pharmacology,

more microbiology and more anatomy/physiology relative to Newcastle [pure science]

Glasgow and Newcastle more clinical medicine and clinical skills [clinical subjects]

Glasgow wants more public health UEA wants more pathology

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Anatomy & Physiology

Pathology

Microbiology

Pharmacology

Clinical Medicine

Clinical Skills

Surgery

Public Health

Pers & Prof Develop

% respondents

UEA

Newcastle

Glasgow

p<0.001

p<0.001

p<0.001

p<0.001

p<0.001

p=0.091

p=0.003

p=0.018

p=0.917

Teaching desires by year of study

Few differences across year of study (excluded intercalated year)Year 5 want more pharmacology, and

(marginally) more microbiology

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Anatomy & Physiology

Pathology

Microbiology

Pharmacology

Clinical Medicine

Clinical Skills

Surgery

Public Health

Pers & Prof Develop

% respondents

Year One

Year Two

Year Three

Year Four

Year Five

p=0.256

p<0.001

p=0.063

p=0.481

p=0.463

p=0.278

p=0.654

p=0.840

p=0.563

Teaching desires by year of study: Glasgow University only

Greater number of significant differences across year of study for Glasgow University studentsYear 5 students want more microbiologyYear 4 & 5 students want more

anatomy/physiologyYear 3 students want more public health

(marginal)Gradient with respect to pharmacology,

increases as year increases (marginal)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Anatomy & Physiology

Pathology

Microbiology

Pharmacology

Clinical Medicine

Clinical Skills

Surgery

Public Health

Pers & Prof Develop

% respondents

Year One

Year Two

Year Three

Year Four

Year Five

p=0.004

p=0.097

p=0.005

p=0.374

p=0.230

p=0.281

p=0.087

p=0.263

p=0.600

Willingness to sacrifice

More than half of all respondents are willing to sacrifice teaching of personal and professional development to make room for new material

While one third are willing to sacrifice public health teaching

5%

8%

18%

4%

4%

5%

9%

33%

55%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Anatomy & Physiology

Pathology

Microbiology

Pharmacology

Clinical Medicine

Clinical Skills

Surgery

Public Health

Pers & Prof Develop

% respondents

Sacrifice by university

UEA and Newcastle more willing than Glasgow to sacrifice public health teaching

UEA and Glasgow more willing than Newcastle to sacrifice surgery and clinical medicine

Newcastle and Glasgow more willing than UEA to sacrifice microbiology

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Anatomy & Physiology

Pathology

Microbiology

Pharmacology

Clinical Medicine

Clinical Skills

Surgery

Public Health

Pers & Prof Develop

% respondents

UEA

Newcastle

Glasgow

p=0.105

p=0.595

p=0.027

p=0.027

p=0.855

p=0.042

p=0.047

p=0.117

p=0.454

Sacrifice by year of study

Steep gradient with respect to personal and professional development, willingness to sacrifice increases with year of study

Year 2 students willing to sacrifice pharmacology, while year 5 students didn’t indicate this at all

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Anatomy & Physiology

Pathology

Microbiology

Pharmacology

Clinical Medicine

Clinical Skills

Surgery

Public Health

Pers & Prof Develop

% respondents

Year One

Year Two

Year Three

Year Four

Year Five

p=0.737

p=0.021

p=0.189

p=0.503

p=0.123

p=0.711

p=0.696

p=0.183

p=0.001

Sacrifice by year of study: Glasgow University only

No significant differences across the various years of study for the Glasgow sample

Year 1 students are (marginally) less willing to sacrifice personal and professional development compared to the more advanced students

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Anatomy & Physiology

Pathology

Microbiology

Pharmacology

Clinical Medicine

Clinical Skills

Surgery

Public Health

Pers & Prof Develop

% respondents

Year One

Year Two

Year Three

Year Four

Year Five

p=0.252

p=0.685

p=0.117

p=0.286

p=0.156

p=0.667

p=0.970

p=0.156

p=0.096

Measure of expression of preference

Asked to tick all that applied 12% expressed no desire for more teaching,

more than half (59%) wished for more teaching in 2 to 4 areas

Average amount of more teaching, 3.14 Differed significantly between years 1-3

(µ=2.98) and years 4-5 (µ=3.38), suggesting some experience effect

Little difference in aggregate willingness to sacrifice teaching across the two year groups

Qualitative responses

Do you feel that the inclusion of broader health topics places too great a strain or burden on medical students?252 (60%) commented64 said yes147 said no41 said maybe

Are broader aspects of health a burden? – YES

“Yes. It means that there is a lot to learn and it is very hard to see what should be sacrificed”

“Yes, it is difficult to tie all the interlinking ideas together and often comes at the expense of more 'core sciences' for which we are often criticised”

“I cannot deny that it will be a burden. But I think broader health topics are important, outweigh the fact that it will become a burden”

“Inclusion of any topic adds burden - but this is tolerable when it's relevant”

Are broader aspects of health a burden? – NO

“No, but I don't think that they should be treated as core subjects so students are able to prioritise”

“No, we get very little teaching anyway so a couple of hours lectures on this topic would be very interesting and beneficial”

“No. They should realise when they choose medicine that its a high stress/responsibility career path”

“No but it is pretty dull”

Discussion (1)

General preference for more teaching/learning time dedicated to science subjects But is this a reflection of enjoyment, need or

difficulty? Do students want more pharmacology, in terms of

greater coverage or more hours on the same topic?

Evidence of differences across universities and year groups To understand why necessary to review all course

documentation

Discussion (2)

Great willingness to sacrifice learning/teaching time on personal and professional development to make way for new material

Similar across universities and year groups, although year 5 students are especially willing to sacrifice personal and professional development

Discussion (3)

Aggregate found evidence of an experience effect, year 4 and 5 students may be better placed to give views of curriculum design

What would this mean for GlasgowMore anatomy/physiology, pharmacology,

microbiology and pathology at the expense of personal and professional development and possibly public health

More science less broader health issues