A comparative study of medical student perspectives on distributed medical education

1. A comparative study of medical student perspectives on distributed medical education M. Tenbergen, M. Holmes, S. Tellier, J. Coulson, J. Ernst, University of Western Ontario C. Leighton, Department of Oncology, University of Western Ontario ABSTRACT Background/Purpose: This student designed survey examines medical student perspectives on a distributed medical education (DME) model with focus on the learning environment (LE), community based learning (CL), and the quality of extracurricular social events (SE).Methodology: A focus group of year 1 and 2 medical students from both campuses of the Schulich School of Medicine developed a 29 item Likert scale (4 point + NA) survey of items felt relevant to their learning and social experiences. The survey was then distributed to year 1 and 2 students at three medical school programs: Western University, University of McMaster, and the University of British Columbia. A comparison of median response scores (Mann-Whitney, α = 0.05) from the students' respective campuses (main or distributed) was completed. Domain scores of (LE), (CL), and (SE) were tabulated. .Results: A total of 208 medical students completed the questionnaire, 66 from distributed campuses and 142 from main campuses; a 12.9 % overall response rate. Comparison of median scores suggested subtle but significant response differences by assigned campuses. LE: At the satellite campuses, resources for campus learning were deemed more satisfactory (p=0.0001) and stronger agreement was expressed for the statement that small group facilitators were experienced and knowledgeable (p=0.0004). Overall, students noted a subtle but greater satisfaction in the LE at the main campus (p<0.05)*. CL: Satellite campus students indicated greater satisfaction with feeling welcomed in their community of study (p=0.0001). SE: There was mutual disagreement with the statements that students felt as one large group rather than 2 isolated campuses, and that an equal number of social events were held at each campus. However, mean campus domain scores for CL and SE were very similar. .Conclusions/Discussions: Medical student perceptions on DME learning differ qualitatively, based on their assigned campus, primarily by the quality of the LE. Differences of the perceptions of CL and SE appear minimal, based on the students assigned campus. Keywords: Distributed Medical Education, Student Perspectives, Hidden Curriculum *errata – Note, corrected p value for LE is not significant at 0.181 BACKGROUND A primary goal of a distributed medical education (DME) program is to deliver equitable and positive learning experiences across campuses. Few studies have examined student perspectives of their unique learning and social experiences across main and distributed campuses. The purpose of this study is to compare and contrast student perspectives on their learning experiences (learning environment on campus and in the community – LE & CL) and their opportunity for social events (SE) at three DME programs across Canada: University of British Columbia, McMaster University and the University of Western Ontario (now Western University). This unique, student designed questionnaire includes those items identified as most important in the learning environment and social milieu of medical students. METHODS A focus group of year 1 & 2 medical students at Western University (main and distributed campuses) developed a questionnaire of items deemed relevant to the learning environment and social experience of medical students in their early studies. Possible constraints of learning in a distributed model of education were considered. Three Canadian medical schools with DME campuses agreed to participate, though at least one required the data be blinded as to school origin. Students were contacted by email to complete the online survey on two occasions. Median scores and composite domain scores of the 4-point Likert scale questions were tabulated. Responses by campus site, main or satellite, were compared for statistical significance (Mann-Whitney test, alpha=0.05, P < 0.05, Minitab 15). DISCUSSION This unique, qualitative survey contrasts the perceptions of medical students at distributed undergraduate medical education campuses across Canada, with the student perceptions of those assigned to their respective parent campuses. Inter-site (university) differences were not possible to calculate given at least one institution did not want identifiable data reported. Additional demographic data may have permitted an exploration of learning biases. The response rate was low, under 13%. Construct validity is supported by the student designed aspect of the questionnaire i.e. items relevant to students were chosen. Perceptions were most divergent regarding the learning environment (LE). Students at the DME campuses were more satisfied with the experience and knowledge of their small group facilitators, and with their campus resources. This may be a result of the newer, “state of the art” learning environments at most DME campuses. Students at DME programs felt somewhat disadvantaged with less opportunity for social events compared to their parent campuses (P=0.06). DME students also reported greater ease at arranging clinical observerships or obtaining rural medicine experience compared to students assigned to the parent campus. Overall, global domain scores demonstrate similar mean responses by assigned campuses. Veerapen and McAleer (2010) examined student perceptions of the learning environment at the central and distributed campuses of the University of British Columbia. They demonstrated a modest divergence in the perception of learning environment in the domains concerning local arrangements and social factors. As in our study, global scores suggested positive learning environments across campuses. CONCLUSIONS Qualitative differences in student perceptions of their learning environments and opportunity for social events at a distributed medical education program were noted, based on the assigned campus. DME students may be slightly advantaged, or more motivated at obtaining rural medicine and elective opportunities. However, global scores suggest uniform student satisfaction with their learning and social experiences, regardless of their assigned campus. This qualitative survey provides some insight into the hidden curriculum of Canadian DME programs. REFERENCES Veerapen, K and McAleer, S. Students’ perceptions of the learning environment in a distributed medical programme. Medical Education Online 2010, 15:5158. Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students’ perception of teaching. BMJ 2004;329:770-3. RESULTS Table 1. Mean Rating Scores by Domain and Campus Location A total of 208 medical students (years 1-2) participated from the satellite (66) and main (142) medical education campuses of the University of Western Ontario, McMaster University and the University of British Columbia. This was an English survey that took approximately 5 minutes to complete. Each survey was approved by the research ethics board of the respective university. The response rate was 12.9%. Sample question responses from the domains of Learning Environment (LE), Community Learning (CL) and Social Events (SE) with their associated distribution of responses are illustrated in Figures 1-3. Table 1 presents a comparison of mean ratings for each domain, with responses 3 and 4 favoring the DME model of education. Figure 1. Sample questions employed in the Learning Environment Domain. A 4-item Likert scale was employed (N/As or missing data excluded). P-values represent a comparison of medians with the non-parametric Mann-Whitney Test, (alpha=0.05), P < 0.05 level of significance. Figure 2. Sample questions employed in the Community Learning Domain. A 4-item Likert scale was employed (N/As or missing data excluded). P-values represent a comparison of medians with the non-parametric Mann-Whitney Test (alpha=0.05), P < 0.05 level of significance. Figure 3. Sample questions from the Social Events Domain. A 4-item Likert scale was employed (N/As or missing data excluded). P-values represent a comparison of medians with the non-parametric Mann-Whitney test (alpha=0.05), P < 0.05 level of significance.