May 2021

| 0

COMSEP Journal Club

May 2021

Editors: Karen Forbes, Jon Gold and Randy Rockney

 

The Emotional Rollercoaster of the Unmatched Student

Journey of candidates who were unmatched in the Canadian Residency Matching Service (CaRMS): A phenomenology study

Okoniewska B, Ladha MA, Ma IWY. Canadian Medical Education Journal 2020; 11(3): e82-e91. https://doi.org/10.36834/cmej.69318

Reviewed by: Karen Forbes

What was the study question?

What are the experiences of Canadian medical students who were unmatched in the first iteration of the residency matching process?

How was it done?

Using a phenomenology approach, telephone interviews were conducted with 15 participants from 7 universities who were unmatched between 2011 and 2017 in the Canadian Residency Matching Service. A semi-structured guide was used, exploring the overall unmatched experiences, perceived reasons leading to being unmatched, systemic challenges, resources available, recommendations and eventual career outcomes. Due to the sensitive nature of the topic, interviews were not recorded, and field notes were compiled from the interviews. Thematic analysis of data was used to identify major themes.

 

What were the results?

Negative outcomes were universally reported, including disbelief, grief, self-doubt, shame, isolation, uncertainty and bitterness. Further, students described concerns regarding privacy, confidentiality breaches and stigma. Perceived circumstances for not matching included the matching process itself, school factors and personal match strategies including ranking too few programs. Systemic challenges included lack of information, pressure from programs to apply to specialties they did not want in the second iteration, financial, licencing and scheduling issues. Peer support from other unmatched candidates differed, but when present was found to be beneficial

 

What are the implications?

The experiences and challenges faced by these unmatched students are significant. While this study has a Canadian context, the match process in the US through the NRMP is similar, and the results likely have generalizability to US medical students’ experiences. This study highlights the importance of transparency and clarity of information in the unmatched process and the need for immediate support of unmatched students. Medical schools should invest in strategies to prevent or reduce unmatched students, and there is a need for a cultural shift to reduce the stigma associated with being unmatched.

 

Editor’s Comments: Many of us have been in the unfortunate position of counseling an unmatched student, but this study allows us to see the commonalities across the experiences of many such students.  While we can never hope to eliminate the pain and struggle for unmatched students, sharing best practices can help us mitigate some of their difficulties.  (JG)

Students Writing SOAP-Education Notes

 

Evaluating Core Clerkships: Lessons Learned From Implementing a Student-Driven Feedback System for Clinical Curricula.  Russel SM et al. Academic Medicine 2021; Feb 1;96(2):232-235. https://dx.doi.org/10.1097/ACM.0000000000003760

Reviewed by: Margaret Huntwork

 

What was the study question?

What are preliminary successes and ongoing improvements from a highly structured, student-driven clerkship feedback model?

 

How was it done?

Third- and fourth-year students were invited to be Student Curricular Board (SCB) representatives and liaise between students and clerkship directors. Both students and administration agreed on end-of-block survey questions, and surveys were administered after each clerkship. Results were compiled by students in a novel format of a “SOAP-Education” note that was edited by faculty, shared with administration, and catalogued for future reference in clerkship reviews.

  • Subjective: Free responses that reviewed student perspective of the clerkship.
  • Objective: Multiple choice survey questions responses, included feedback on site-specific experiences, feedback on clerkship structure, student resources.
  • Assessment: Description of real-time changes to the clerkship, implementation of past recommendations, strengths, and areas of improvement in the clerkship.
  • Plan: Action items, long- and short-term goals.

 

What were the results?

Approximately 60% of students surveyed felt that their feedback was taken seriously; about the same number of students felt that faculty were responsive to feedback. Over 70% of students felt that faculty actively sought out student feedback in an effort to improve the clerkship curriculum.

 

What are the implications?

Bidirectional feedback can lead to meaningful changes in clinical clerkships. Students who were selected as representatives got great exposure to the challenges and limitations that clerkship directors face, and curriculum development. Perhaps these student representatives will be involved in medical education in their future careers. The SOAP-Education note described here is organized and iterations can be easily cataloged for future reference.

 

Editor’s Comments: One interesting aspect of this study is that there were two types of CSB representatives; third year students were representatives for students on their particular clerkship “track” and served in this role across all clerkships, whereas fourth year students were representatives for a specific clerkship (e.g. pediatrics) across the year. Given different contexts of each of these roles in terms of obtaining peer feedback, the combination of these two reps likely contributed to the success of this program. (KFo)

 

Ethnic minorities in the Netherlands

“What kind of support do I need to be successful as an ethnic minority medical student?” A qualitative study. Isik, U., Wouters, A., Croiset, G. et al. BMC Med Educ 21, 6 (2021). https://doi.org/10.1186/s12909-020-02423-8

Reviewed by: Jon Gold

 

What was the study question?

What barriers do ethnic minority students experience in the learning environment and how can support structures be organized for these students in the learning environment in order to sustain their motivation?

 

How was it done?

Semi-structured interviews were conducted with 18 medical students from an ethnic minority at a single medical school in Amsterdam.   The focus of the interviews was to explore the research question above.  Transcripts of the interviews were coded; codes were compared by investigators for two interviews and consensus was reached.  Themes were identified and discussed by the research team.  Quotes were chosen to illustrate the perceived lessons learned.

 

What were the results?

Of the 18 students, 7 were male and 7 were from the preclinical years.  Identified barriers included: (1) experiences of discrimination (2) lack of representation of ethnic minority role models, (3) lack of a sense of belonging, (4) lack of medical network, (5) cultural communication differences and language difficulties, and (6) and examiner bias in clinical assessments.

 

Subjects provided a range of suggestions for supporting ethnic minority students.  They included recruiting more ethnic minority faculty as role models, training and assisting minority students in networking, and more diversity training for majority students and faculty, among several other suggestions.  For all supports, subjects emphasized that they should be implemented from the first day of medical school and that they should be offered to all students so as not to inadvertently reinforce a separation between majority and minority students.

 

What are the implications?

Many of us who have heard the concerns of underrepresented minority students in the U.S. and Canada will find these themes very familiar.  Clearly these experiences are transnational.   Likewise, it is good to hear that the suggested solutions align with what many at our schools are working on.  That doesn’t mean that they will be quick or easy.

 

Editor’s comments: Students in this study suggested many ways that support could be implemented. In particular, this study reinforces the importance of role models and mentors for underrepresented minority students, a point that resonated clearly at our recent COMSEP Annual Meeting. (KFo)