Predicting medical students who will have difficulty during their clinical training

Abstract

Background: We aimed to classify the difficulties students had passing their clinical attachments, and explore factors which might predict these problems.

Methods: We analysed data from regular student progress meetings 2008-2012. Problem categories were: medical knowledge, professional behaviour and clinical skills. For each category we then undertook a predictive risk analysis.

Results: Out of 561 students, 203 were found to have one or more problem category and so were defined as having difficulties. Prevalences of the categories were: clinical skills (67%), knowledge (59%) and professional behaviour (29%). A higher risk for all categories was associated with: male gender, international entry and failure in the first half of the course, but not with any of the minority ethnic groups. Professional and clinical skills problems were associated with lower marks in the Undergraduate Medical Admissions Test paper 2. Clinical skills problems were less likely in graduate students.

Conclusions: In our students, difficulty with clinical skills was just as prevalent as medical knowledge deficit. International entry students were at highest risk for clinical skills problems probably because they were not selected by our usual criteria and had shorter time to become acculturated.

Fig. 1

Selection, medical training course and study interval. Timeline showing pathways leading to selection into medical school and progress through early and advanced learning courses [unfilled arrows]. Vertical arrows refer to end-of-run and end-of-year assessments; bold arrows refer to major examinations for selection and end-of-5^th year “finals”. GPA = grade point average, UMAT = Undergraduate Medical Admissions Test, OSCE = Objective Structured Clinical Examination, written = multi-choice and short answer examinations, HSFY = Health Sciences First Year, Other graduate refers to students with allied-health degrees. International refers to full-fee-paying students from overseas. Other graduates, Maori and Pacific students, and International students are exempt from the standard GPA- UMAT selection process