Cohort study of examination performance of undergraduate medical students learning in community settings

Abstract

Objectives To determine whether moving clinical medical education out of the tertiary hospital into a community setting compromises academic standards. Design Cohort study. Setting Flinders University four year graduate entry medical course. In their third year, students are able to choose to study at the tertiary teaching hospital in Adelaide, in rural general practices, or at Royal Darwin Hospital, a regional secondary referral hospital. Participants All 371 medical students who did their year 3 study from 1998-2002. Main outcome measures Mean student examination score (%) at the end of year 3. Results The unadjusted mean year 3 scores at each location differed significantly (P < 0.001); the mean score was 65.2 (SE = 0.43) for Adelaide students, 68.2 (0.83) for Darwin students, and 69.3 (0.97) for students on the rural programme. Mean year 2 scores were similar for each location. Post hoc tests of means adjusted for sex, age, year 2 score, and cohort year showed that the rural and Darwin groups had a significantly improved score in year 3 compared with the Adelaide group (adjusted mean difference = 3.08, 95% confidence interval 1.25 to 4.90, P < 0.001 for rural group; 1.91, 0.47 to 3.36, P = 0.001 for Darwin group). Conclusions These findings show that the concern that student academic performance in the tertiary hospital would be better than that of students in the regional hospital and community settings is not justified. This challenges the orthodoxy of a tertiary hospital education being the gold standard for undergraduate medical students.

The clinical skills experience of rural immersion medical students and traditional hospital placement students: A student perspective

“…Overall, endof-year scores of students in rural programmes have been similar or better than their urban-based peers (Schauer & Schieve 2006;Worley et al 2004a;Waters et al 2006).…”

“…The development of rural medical programmes has been an international trend in medical education over the past few decades (Worley et al 2004a;Lang et al 2005;Tesson et al 2005). This trend can be justified both in moving students away from often student dense urban learning areas and also to attract students to continue practice in rural areas (Maley et al 2009).…”

‘It's really, really good, but it could be a lot better’: Qualitative evaluation of a Rural Clinical School, four years on

“…Problems that were identified were addressed immediately by senior academic staff and where necessary sites were visited regularly and frequently over the remainder of the year. Much of the evaluation of the effectiveness of clinical longitudinal integrated clerkships has concentrated on quantitative methodologies which seek to compare the marks of students working in rural and remote locations as compared to those who study in tertiary teaching hospitals (Worley et al 2004;Halaas 2005;Oswald et al 2001;Waters et al 2006;Schauer & Schieve 2006). However less attention has been paid to the experience of students working in these situations using valid qualitative methods such as are described above.…”

The Best of Both Worlds: Resident Experiences of Urban and Regional Contexts in a Hybrid Pediatrics Residency Program

“…2 Community-based and AHSC-based training have been described as distinct, yet complementary, models of graduate medical education. 3 Distributed programs have typically been considered in the context of their outcomes, 4 social mission, 5 or workforce dimensions. 6,7 Rather than creating parallel community-only programs, most residency programs seem to have expanded to include both community and urban tertiary experiences, as indicated by descriptions of the introduction of community experiences to existing programs.…”