Medical School Attrition-Beyond the Statistics A Ten Year Retrospective Study

Abstract

BackgroundMedical school attrition is important - securing a place in medical school is difficult and a high attrition rate can affect the academic reputation of a medical school and staff morale. More important, however, are the personal consequences of dropout for the student. The aims of our study were to examine factors associated with attrition over a ten-year period (2001–2011) and to study the personal effects of dropout on individual students.MethodsThe study included quantitative analysis of completed cohorts and qualitative analysis of ten-year data. Data were collected from individual student files, examination and admission records, exit interviews and staff interviews. Statistical analysis was carried out on five successive completed cohorts. Qualitative data from student files was transcribed and independently analysed by three authors. Data was coded and categorized and key themes were identified.ResultsOverall attrition rate was 5.7% (45/779) in 6 completed cohorts when students who transferred to other medical courses were excluded. Students from Kuwait and United Arab Emirates had the highest dropout rate (RR = 5.70, 95% Confidence Intervals 2.65 to 12.27;p < 0.0001) compared to Irish and EU students combined. North American students had a higher dropout rate than Irish and EU students; RR = 2.68 (1.09 to 6.58;p = 0.027) but this was not significant when transfers were excluded (RR = 1.32(0.38, 4.62);p = 0.75). Male students were more likely to dropout than females (RR 1.70, .93 to 3.11) but this was not significant (p = 0.079).Absenteeism was documented in 30% of students, academic difficulty in 55.7%, social isolation in 20%, and psychological morbidity in 40% (higher than other studies). Qualitative analysis revealed recurrent themes of isolation, failure, and despair. Student Welfare services were only accessed by one-third of dropout students.ConclusionsWhile dropout is often multifactorial, certain red flag signals may alert us to risk of dropout including non-EU origin, academic struggling, absenteeism, social isolation, depression and leave of absence. Psychological morbidity amongst dropout students is high and Student Welfare services should be actively promoted. Absenteeism should prompt early intervention. Behind every dropout statistic lies a personal story. All medical schools have a duty of care to support students who leave the medical programme.

The influence of different curriculum designs on students’ dropout rate: a case study

“…Nevertheless, considering only the first three years of studies between both samples, which are comparable to each other in study duration, the difference in the average of dropout percentages between both curriculum designs is remarkable – which prompted us to show these data and discuss what might have caused the attrition reduction. The implication of this finding is that it corroborates similar findings in a few other studies that have shown that the curriculum design seems to influence students’ dropout rates [6,7,10,23–25]. However, little is known about the role curriculum designs play in dropping out [26].…”

“…Dropping out usually has negative consequences on social, personal, financial and educational aspects of students’ lives, constituting a reason of great concern in medical schools [10,18]. Since dropping out represents an important educational problem, plenty of information on calculating the percentage of admitted students that drop out of medical school without completing their studies exists in the available literature [4,19–22].…”

“…One interesting finding from this information is that the average percentages of dropping out varies among developed countries [3], which is only 11.1% normally, and for developing countries such as those in South America [17], dropout rates may range from 43 to 62%. As a high attrition rate may entail a loss of social impact and potential contribution on enhancing health workplaces [10], which in turn anchor the development in poor countries, understanding medical school dropout rates and their associated factors are therefore of key importance in medical education research. The insights derived from this research may lead to future interventions for students at risk of dropping out, thus, increasing graduation rates.…”

“…On the other hand, Strayhorn [9] found no significant differences. Because of this gap in knowledge and considering all the negative consequences of dropping out for society in general and health systems in particular [10], we believe it is necessary to understand how dissimilar curriculum designs influence the attrition rates in practice. Thus, curriculum designers (including teachers) may make informed decisions about which – and why – curriculum design is better to use to diminish students’ withdrawal when it comes to reforming the curriculum.…”

Continuing professional development and Irish hospital doctors: a survey of current use and future needs

“…6 Against the backdrop of a challenging economic environment, Ireland's health system has experienced significant budgetary pressure and this has produced a decrease in front-line staff morale and an increase in international migration. 7,8 Irish trainee doctors have referred to feeling undervalued by the system and have reported fatigue as well as heightened anxiety regarding clinical performance and decision-making skills. 8 These pressures are heightened by the recent shift in the role expectations of doctors, which has expanded beyond clinical knowledge and skills to include team management, administration and use of electronic records.…”