Bury G, Egan M, Vallely J
In the last decade, university medical education in Ireland has been increasingly challenged to move outside the traditional undergraduate education/postgraduate masters’ taught courses. The rapidly changing health service environment demands that medical education respond innovatively to new or changed forms of medical practice. We describe one such challenge and medical education response.
Adults entering the university for the first time face specific challenges ; this is particularly so for those whose career and promotional trajectories depend on their achievement or academic success. The Graduate Diploma in Emergency Medical Science (GradDipEMS) is offered jointly by SMMS, UCD and the HSE National Ambulance Service and trains Advanced Paramedics for Ireland’s statutory ambulance services. Advanced practice was established in 2005 by the statutory regulator, the Pre-Hospital Emergency Care Council.
The GradDip is a demanding full-time, one year, 80 ECTS credit, level 4 course. Key outcomes include the competencies required to make complex clinical decisions in emergencies, administer more than 50 drugs, carry out interventional procedures and practice with a high level of autonomy. Candidates are principally nominated by HSE, Dublin Fire Brigade and the Defence Forces, have at least three years Paramedic experience and are selected by intense internal competition.
Since its inception in 2006, 338 candidates have entered the programme (88% male, mean age 36 (range 24-56), 84.5% from HSE, 10% from DFB, 2.5% Defence Forces and 2.5% others). All have previously undertaken a Diploma level EMS course prior to the GradDip, but only 9% have a primary or higher degree. More than 90% of candidates have successfully completed the programme and 15% have entered Master’s level courses in UCD; several have entered Graduate Entry to Medicine courses and at least two candidates are undertaking PhD programmes.
This is a highly motivated candidate group with strong incentives to succeed. A high proportion hold vocational / volunteer qualifications prior to programme entry. The framework, teaching and assessment components of the course required to address the needs of this unique cohort are described. The potential lessons for mainstream health professional education are discussed.
Geoghegan SF(1), Stenke E(1), Nicholson AJ(2,3), Molloy EJ(1,2,4,5)
Worldwide over 6 million children under 5 die annually. The chance of a child surviving to 5 years of age in sub-Saharan Africa is 16.5 times lower than in a developed nation. Ongoing disparities in global child health emphasize the importance that future doctors in developed nations be informed on some of the major issues early in their training.
To survey final year medical students and their level of interest and knowledge of key topics in international child health. (ICH)
We surveyed final year medical students via a questionnaire given prior to and after an hour long interactive seminar on ICH. The seminar was given by a pediatric Registrar with recent experience of working in emergency medical projects in developing nations. Problem based learning with real case examples were used as a teaching tool as well as a question and answer session. The cases covered the major contributors to under 5 mortality; childhood pneumonia, neonatology, malaria, diarrheal disease and malnutrition. In the questionnaire students were asked demographic information, perceived relevance of ICH to their degree and future careers and their knowledge of core subjects in ICH. In the post seminar questionnaire they were asked additional questions on the impact of the session on their interest in ICH.
We included 93 medical students with equal gender distribution. 86% of students were aged 18-27 years. There were 18 nationalities and 59% were non-Irish. The majority of students perceived ICH to be relevant to both their degree (80%) and future Career (69%). A high proportion of students rated their knowledge in core topics as poor or fair prior to the seminar but this significantly improved post seminar. Interest in ICH was increased in 57% of students following the seminar.
This survey demonstrates the interest among final year medical students in international child health but also the gaps in knowledge of some of the major contributors to child mortality. The results suggest that problem based learning with real case examples from developing nations is an effective teaching tool. International child health should be formally integrated into undergraduate pediatric curricula.
The Basic Specialist Training applications open to first year doctors (interns) early in intern year and determine eventual career pathway. Interns’ experience of the medical profession is largely based on the six years spent as an undergraduate. We looked at the influence of undergraduate teaching on the career choice of junior doctors.
A questionnaire was distributed to interns in 3 major teaching hospitals within 6 months of graduation. Using a Likert scale, this assessed whether undergraduate teaching in their chosen speciality influenced their decision. Factors assessed included the structure and the timing of undergraduate modules and the impact of exposure to clinicians and university teachers during their undergraduate training.
95% of interns (n=45) approached completed the survey. 91.1% of interns had a working career plan. Popular career choices included Paediatrics (29.3%), Medicine (19.5%), General Practice (19.5%), medical subspecialities (9.8%) and Surgery (7.3%). 87.8% agreed that their choice was influenced by undergraduate teaching. All aspects of undergraduate teaching assessed were identified as influential. 53.7% felt that the timing of their exposure to a subject influenced their decision to choose it as a career, with 58.6% believing that the structure of the undergraduate module influenced their decision. 75.6% agreed that exposure to clinicians in their area of interest influenced their career choice, with 56.1% strongly agreeing. Teachers at university influenced career choice in 61.1%.
Most interns have chosen their career pathway by the first 6 months of internship, and this is influenced by undergraduate training in the majority. Teachers and clinicians were the most influential factors. They are therefore ideally placed to improve the quality of undergraduate medical education. The data is overall encouraging, with a positive undergraduate teaching experience in a subject correlating with a decision to pursue it as a career. These data are also relevant to the less popular specialities in this study, such as surgery, as ncreasing clinician-student interaction in these fields could increase undergraduate interest in pursuing these specialities as a career.