이공학계열 출신 학생과 비이공학계열출신 학생 혼합의 효과 탐색(Medical Education, 2014)
Exploring the consequences of combining medical students with and without a background in biomedical sciences
Rachel H Ellaway,1 Amanda Bates,2 Suzanne Girard,2 Deanna Buitenhuis,2 Kyle Lee,2 Aidan Warton,3 Steve Russell,3 Jill Caines,3 Eric Traficante3 & Lisa Graves1,4
CONTEXT:
의과대학에는 대체로 뛰어난 이공계열 출신 학생들이 입학한다. 기존의 연구에서 사회과학계열 출신 학생도 의과대학에서 비슷한 수준의 성취를 올릴 수 있음을 보여준 바 있지만, 오랜 기간동안 '비이공학계열 출신 학생'으로 지내는 것에 대해 연구된 바는 많지 않다.
Medical schools have tended to admit students with strong backgrounds in the biomedical sciences. Previous studies have shown that those with backgrounds in the social sciences can be as successful in medical school as those with science backgrounds. However, the experience of being a 'non-science' student over time has not been well described.
METHODS:
Mixed-methods 연구를 하였음. 개인 수준의 경험을 확인하고자 설문과 면담을 하였다. 스스로의 정체성, 스스로 느끼는 준비된 저도, 스트레스 등을 확인하였고 의과대학 기간 전반에 걸친 경험을 물었다. 설문 결과는 descriptive statistics를 활용하였고, 포커스그룹 결과와 unstructured data는 common theme을 찾았다. 모듈 종료 후, 학년 종료 후 시험성적을 분석하였다.
A mixed-methods study was developed and run with the aim of elucidating the personal experiences of science and non-science students at our institution. Data were generated from a student survey that focused on participants' self-identification as science or non-science students, and on their sense of preparedness and stress, and from a series of student focus groups exploring participants' experiences of science and non-science issues in all aspects of their training. Descriptive statistics were generated for structured survey data. Focus group data and unstructured survey data were analysed to identify common themes. End-of-module and end-of-year examination data for the four class cohorts in the programme were also analysed to compare science and non-science student performance over time.
RESULTS:
두 그룹간 확연한 차이가 있었다. 준비도와 스트레스 수준에 대해 차이가 있었으며, 시험성적에도 차이가 있었으나 이 차이는 3학년으로 올라가면서 거의 사라졌다. 같은 교실에 두 그룹의 학생이 모두 있는 것은 서로 다른 방향으로 서로 다른 수준의 차이를 만들었는데, 여기서 생기는 혼란(disruption)도 수행능력 차이가 줄어들면서 점차 사라졌다.
There were clear differences between the experiences and performance of science and non-science students. We found dichotomies in students' self-reported sense of preparedness and stress levels, and marked differences in their examination performance, which diminished over time to converge around the third year of their studies. Combining science and non-science students in the same class affected the students to different extents and in different ways. The potential disruption of mixing science and non-science students diminished as their levels of performance converged.
CONCLUSIONS:
비이공계출신 학생들이 겪는 정신사회적 스트레스는 학업적 부분과 개인적 부분에 모두 있었으며, 이는 이들 학생에 대한 지원이 어떠해야 하는지, 교육과정이 어떻게 모든 학생들에게 도움이 될 수 있게 적합하게 조정되어야 하는가에 대해 시사하는 바가 많다.
The psychosocial stress experienced by non-science students and the challenges it posed, in both their academic and their personal lives, have implications for how such students should be supported, and how curricula can be configured to afford quality learning for all medical students.
학생들의 분류 Categorising students according to their academic backgrounds is an essential part of studying this phenomenon with prior studies employing similar models. For instance, Yens and Stimmel categorised students as having a major in ‘traditional science’ (e.g. biology, chemistry, zoology), ‘other science’ (e.g. psychology, sociology) or ‘humanities’ (e.g. English, philosophy), noting that the performances of students in the ‘other science’ and ‘humanities’ categories were very similar.[2] Dickman et al.[3] defined a ‘non-science’ group based on students’ majors in subjects such as English, history, psychology and sociology (roughly 27% of the class); the remaining students were given the ‘science’ category and had backgrounds in subjects such as zoology, biology, chemistry and physics. We chose to adopt a similar dichotomised model using the terms ‘science’ and ‘non-science’. However, rather than defining the inclusion criteria for either category in advance, we allowed these definitions to emerge from our data.
수행능력에 대한 기존 연구 Many studies have compared the performance of science and non-science students.
- Gough observed that whereas student examination performance differed in Years 1 and 2, it had become indistinguishable by Year 4 of the programme.[1]
- Dickman et al.[3] found no significant differences between science and non-science students in examination performance, licensing examination performance, and residency selection.
- Craig et al.[10] grouped students into five categories based on their backgrounds (health professions, biomedical sciences, other biology, physical sciences, and non-science) and compared their performance on different kinds of science-based examination. They found differences between all groups, with non-science students performing less well than students in the other categories. The differences among all groups diminished over time.[10]
수행능력 차이가 사라진다는 점은 조심히 볼 필요가 있음. This issue of convergence should be considered with some caution. Although several studies found no significant difference in final performance, they also noted that both science and non-science students had comparable MCAT scores,[2, 12] indicating that non-science students in these studies had studied sufficient biomedical science material to pass the test, thereby reducing the differences between the two groups. Although the MCAT is a prerequisite for entry to many schools in the USA and Canada, some medical schools have opted not to use the MCAT (or an equivalent) that necessarily selects candidates with a science background over those with other backgrounds,[13] thereby removing any normalising effects it might have.
모든 연구가 시험점수에만 초점을 맞춘 것은 아님 Not all studies have concentrated on the examination performance of science and non-science students. Ferrier and Woodward looked at the attitudes of students at the then relatively new McMaster University medical school and reported: ‘…academic background has been found to be of little influence on graduates’ perceptions of the […] programme.’[14] However, a more recent study found that although non-science students were able to cope with the demands of medical school, ‘students who had a non-science background prior to entering medicine were significantly less positive than those students who had a science background’.[11] This suggests that, although non-science students are able to catch up with their science-educated colleagues, there are clear differences in the personal experiences and expectations of the two groups. Indeed, several papers have identified science students as having an intrinsic advantage in their studies,[4, 5, 15] which in turn raises equity of access issues.[16]
서로에 대한 영향이 어떤지에 대한 연구는 적음 Although these studies have compared the grades and performance of science and non-science students, relatively little attention has been focused on the impact of science and non-science students on each other, or on how their personal experiences differ. One study, that did look at how different students approached their studies, concluded that: ‘…liberal arts graduates favoured “discussing issues” over “memorising facts” and “problem solving”. These points likely reflect students' familiarity and comfort with different pedagogies in their undergraduate settings.'[17]
Analytical methods
All focus groups were audio-recorded and transcribed. Free-text responses were combined with the focus group transcripts. Thematic analysis involved seven reviewers (RHE, AB, JC, ET, KL, SG, and Boxhill). The six student reviewers independently generated a narrative interpretation of the transcripts and the faculty lead performed a line-by-line open coding thematic analysis. The analyses were shared among the review team for comment. These comments were assimilated into a single thematic framework that accommodated and linked the various concepts and themes identified in the earlier stages. This framework was further reviewed and adapted to accommodate the remaining differences between reviewer perspectives. Descriptive statistics were generated for structured responses from the survey. Examination data were analysed by Theme across all 4 years of the programme for each cohort (for which data were available) and descriptive statistics generated.
Science and non-science students' personal experiences were different
- Although science and non-science students did not necessarily represent two completely dichotomous groups, they did tend to self-identify as belonging to one or other category. Student perceptions of this difference in others seemed to diminish over time:
- However, the stigma of being ‘non-science’ may last longer:
- The difference between science and non-science students was emphasised in sessions in which non-science students were seeing material for the first time and science students were reviewing material they had previously been taught:
- This difference was amplified by the fact that non-science students had much less time to learn this material than their peers had originally had:
- Although students perceived the difference between science and non-science academic backgrounds in themselves and their peers, they did not necessarily see a non-science background as an intrinsic disadvantage:
Science and non-science students had different approaches to study
- Setting aside individual learning preferences, students from science and non-science backgrounds tended to approach their learning in different ways. In general, science students reported having been taught to study details within single concepts, whereas non-science students were trained to look for general themes crossing multiple concepts. Approaches to learning that were unfamiliar added to students' stress levels:
- Science and non-science students sometimes helped each other with unfamiliar material:
- Sometimes this division of labour led to a positive group dynamic:
- Unfamiliar language, terminology and presentation styles were more troubling for non-science students than unfamiliar content:
- Differences between science and non-science students changed the learning environment.
- Different approaches to learning were more apparent in small-group learning contexts, in which students were more dependent on one another:
- Differences in the needs and behaviours of science and non-science students sometimes led to a negative group dynamic:
- Different group dynamics determined students' ability to help others or to be helped:
Specific non-science student concerns
- Many non-science students were worried they were falling further behind their science peers:
- Non-science students' attention to learning biomedical science material could lead them to miss out on other aspects of medical school life:
- Some non-science students became increasingly solitary as they sought to catch up with their science peers:
- Non-science students sometimes voiced concerns about the impact they had on their science peers, for instance limiting in-depth discussion of biomedical science topics:
- Non-science students also described being particularly stressed in their first year:
- A number of non-science students had not known where to start to prepare for medical school:
- Several non-science students suggested that they might have prepared differently had they known what would be required of them once they started:
Specific science student concerns
- Some science students acknowledged their advantage:
- Others acknowledged that a science perspective could be both a strength and a weakness:
- Some science students expressed sympathy for the struggles of non-science students:
- Some science students reported helping their non-science colleagues:
- Other science students were not always well disposed to their non-science colleagues:
Examination data
의학교육에 시사하는 바
Although this was a single-institution study, its findings have broader implications for medical education.
Firstly, schools and programmes need to be more sensitive to the personal experiences of students from non-science backgrounds, particularly in the initial stages of their training. This is not to say that all non-science students will struggle to the same extent, but the hidden curriculum of non-science students who must stoically accept their additional workload and associated stress should be acknowledged and, where appropriate, addressed.
Secondly, group cohesiveness is an indicator of the quality of learning for members of that group.[24] Teachers need to be aware of the potential for disruption that the combining of science and non-science students in a single group can bring. Positive group dynamics should be encouraged, which should include the building of a shared recognition of the different strengths of those in the group, and students should be encouraged to help each other according to these strengths.
Thirdly, teachers should seek to address common learning challenges for their non-science students. For example, a recurring issue identified in this study was non-science students' struggle to understand how biomedical science material was spoken in terms of its style, syntax and underlying assumptions. Supporting non-science students' orientation to these unfamiliar discourses would go some way to making their journeys easier.
Fourthly, schools should consider their support for non-science students before they start school as the challenges of access to medical training clearly continue after their places are confirmed. Although this would probably fall short of classes or other face-to-face activities, support could be provided in the form of online study materials such as self-assessment quizzes linked to study materials and primers. We are planning a follow-up study to explore this area further.
We should note that we found little indication that significant changes to the curriculum as a whole were either necessary or desired. We identified issues around the accessibility of the programme rather than problems with the programme itself. We should also be clear that the issues we have identified are not about the shortcomings of either non-science or science students, but, rather, about the impact of combining them in a single class. A non-science background should not be a barrier to medical school admission, as others have noted.[11, 13]
Not all medical schools are alike. Some schools may concentrate on creating physician scientists, whereas others may have more of a community focus.[25] Community-focused and socially accountable schools often seek to open access to medicine to previously under-represented populations[26] and the findings of this study may therefore be more relevant to these institutions. However, any institution that admits non-science students should consider our findings from the perspectives of both student welfare and curriculum design and delivery.
Med Educ. 2014 Jul;48(7):674-86. doi: 10.1111/medu.12496.
Exploring the consequences of combining medical students with and without a background in biomedicalsciences.
Author information
- 1Undergraduate Medical Education, Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
Abstract
CONTEXT:
METHODS:
RESULTS:
CONCLUSIONS:
© 2014 John Wiley & Sons Ltd.
- PMID:
- 24909529
- [PubMed - indexed for MEDLINE]
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