An uninformed methodology

Dear Sir

We read with great interest the article by Farrokhi-Khajeh-Pasha et al. (2014), who conducted a cross-sectional survey of 220 Iranian medical students from six schools to assess whether they made an informed choice when applying to medicine. Only 32.5% of respondents had made an informed choice to study medicine. Students who did not do so were less satisfied and achieved lower scores in their final year.

We’re writing to raise our concerns with the article. Firstly, the authors’ decision of who made an informed decision was not robust. Students who chose ‘personal interest’ as the main reason for studying medicine and scored their determination in choosing medicine highly were informed, according to the authors. However, ‘personal interest’ is a vague term which encompasses an interest in science or caring for patients, among other things. Two questions on their survey have been used as the basis for this study; however, other aspects should have also been queried, such as prior medical experience and physician relatives, for example. Moreover, the authors state that the survey was assessed by “educational” experts for further feedback but they neglect to mention who these experts were, or their qualifications.

Secondly, all the respondents were at their internship stage but it is unclear when this survey was administered post-matriculation. Newly qualified interns in the United Kingdom report feeling unprepared by their medical school on transition to working life, with associated stress (Kellett et al. 2014). It’s plausible that this situation is similar in Iran too, resulting in a perceived dissatisfaction with their course. Furthermore, the authors’ conclusion that an ‘informed’ choice can play a major role in the job satisfaction of students is not supported by their results.

Thirdly, the schools surveyed were of different rankings, as decided by the Iranian Ministry. It would be useful to see any differences in results between the schools; whether higher-ranked schools received a higher proportion of ‘informed’ students or not – if we, reasonably, assume being ‘informed’ means a higher motivation and, therefore, desire to study at premier institutions. Moreover, lower-ranked schools may, consequently, have low student satisfaction which can introduce response bias into this study.

This article raises a point of interest regarding how informed prospective medical students are at the time of application. However, the authors’ categorisation of ‘informed student’ is flawed, resulting in a weak premise on which to base their findings.

Declaration of interest: The authors have no declarations of interest to report.