Student academic performance in rural clinical schools: The impact of cohort size and competition

Abstract

Objectives: The Deakin University School of Medicine commenced in 2008 as a rurally focused medical school in south-eastern Australia. This research was designed to examine the effectiveness of the school’s adoption of small regional clinical school settings.

Methods: A retrospective cohort study of the first two cohorts of students was employed to assess academic performance at each of five geographically dispersed clinical training sites, with varying student cohort sizes. The Dundee Ready Education Environment Measure (DREEM) questionnaire provided quantitative data regarding the students’ perception of their educational environment. The data were analyzed using univariate and multivariate analyses.

Results: The highest examination scores, and greatest satisfaction with educational environment, were associated with the clinical school that had a small-sized group of students and was not co-located with another medical school. These differences remained after adjusting for multiple potential confounding factors.

Conclusion: The smaller sites appear to have provided superior support for student learning in this new medical school. This advantage diminishes when smaller cohorts are co-located with students from other medical schools. Cohort size and co-location of medical school curricula may be important independent variables for researchers to consider when comparing the results of clinical education innovations in different settings.

Acknowledgements

I would like to thank my mentors, PSW, DJP, and JRC, for their invaluable guidance and support. I also wish to thank Mrs. Kelli-Jane Vertigan, Mr. Ashley Zanker, Dr. David Kramer, & Dr. Janet McLeod for their wonderful assistance in the execution, and presentation, of this study.

Disclosure statement

BPC is a clinical educator at the Rural2 site involved in this study.

Prior to the commencement of this study, DJP was seconded to Deakin University to advice on the development and implementation of the Deakin School of Medicine curriculum, which was adapted from the Flinders University School of Medicine curriculum.

PSW and JRC report no declaration of interest.

Glossary

Dundee Ready Educational Environment Measure (DREEM):

The DREEM questionnaire is a reliable, validated inventory of a student’s perception of his/her educational environment. It claims to be not culturally specific and to be applicable generically to the education of undergraduate health professionals.

The DREEM has been used to:

• identify particular institution’s strengths and weaknesses;

• compare students’ perceptions of education environments both within, and between, institutions or between student cohorts;

• assess correlation with academic results; and

• to identify students who are likely to be at risk of poor academic performance, as well as those likely to excel.

Roff, S. 2005. The Dundee Ready Educational Environment Measure (DREEM): A generic instrument for measuring students' perceptions of undergraduate health professions curricula. Med Teach., 27, doi: 10.1080/01421590500151054.

Rural Clinical School (Australia):

Australian Rural Clinical Schools are established by the federal government, and are charged with delivering significant components of the medical curriculum in a rural environment. They are an integral structure within the host university medical school, with students undertaking a year or more of their medical training in a rural location.

In broad terms, rural clinical schools exist to:

• encourage medical students (and medical professionals) to take up a career in rural practice, by delivering high-quality rural experiences to enhance the workforce;

• encourage, and support, rural health professionals to take up academic positions, and build training capacity;

• Enhance rural student recruitment, community engagement and collaboration

• improve the range of rural health care services in rural communities across Australia, including Aboriginal and Torres Strait Islander health; and

• progress the rural health agenda (research, curriculum and student support) and maintain and progress an evidence base.

Greenhill JA, Walker J, Playford D. Outcomes of Australian rural clinical schools: a decade of success building the rural medical workforce through the education and training continuum. Rural Remote Health (Internet). 2015; 15: 2991. Available from: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=2991 (Accessed 11 November 2016)

Notes on contributors

Brendan Condon, MClinEd, is a clinical senior lecturer in the Greater Green Triangle Clinical School within the Deakin University School of Medicine, and Director of Clinical Training at South West Healthcare, Warrnambool. He has a particular interest in clinical communication skills.

Prof. Paul Worley, PhD, is an academic rural doctor and Dean of Medicine at Flinders University. Much of his research focuses on rural community based medical education and its impact on addressing the maldistribution of doctors for underserved areas.

Prof. David Prideaux, PhD, is Emeritus Professor of Medical Education in the Prideaux Centre for Research in Health Professions Education, within the School of Medicine at Flinders University. He has been active in the establishment of new medical schools and new approaches to clinical education In Australia and elsewhere.

Prof. John Condon, PhD, is an epidemiologist who has extensive experience in primary health care in remote Indigenous communities, health policy and administration, and in development of clinical information, data management and statistical reporting systems