Transferable skills of incoming medical students and their development over the first academic year: The United Arab Emirates experience

Abstract

Increasingly, it is being recognised in higher and medical education that learners should be adequately prepared for the unpredictable nature of professional practice. Several generic or transferable skills or capabilities (e.g., communication, information handling) that will enable graduates to function in an ever-changing professional world have been identified. Using a validated inventory comprising six categories of transferable skills, three cohorts of incoming male and female medical students at a Gulf university documented their level of practice and confidence for 31 skills. The exercise was repeated a year later. New medical students identified computer and organisational skills and the ability to manage their learning as strengths, but scores for technical and numeracy, information handling and presentation and communication skills suggested that learners generally required guidance. A year later, despite considerable self-reported information handling and communication skills development, learners generally did not consider themselves self-sufficient. A significant gender difference emerged, with incoming males reporting less experience and confidence in many skills. This gap was reduced but did not disappear over the first academic year. An audit such as this may be useful for identifying individual skills levels as well as providing insight into shortcomings in the academic programme in terms of opportunities for transferable skills development.

Introduction

Bowden and colleagues (2000) have described graduate capabilities or transferable skills as the qualities, skills and understandings a university community agrees its students should develop while at the institution. These attributes include but go beyond the disciplinary expertise and technical knowledge that have traditionally formed the core of most university courses. More importantly, they are the capabilities that prepare graduates as ‘agents of social good in an unknown future’ (Bowden et al. 2000). With the speed at which information is currently being generated, a major underpinning of medical education should be to prepare students for independent learning throughout their professional life (General Medical Council 1993, 2003, 2009; Whittle & Murdoch-Eaton 2004). Medical educators have thus for some time acknowledged the need to shift the focus of medical training from content (which becomes outdated) to developing skills and abilities that will enable graduates to practice medicine in an ever-changing and unpredictable world (GMC 1993, 2003; Whittle & Murdoch-Eaton 2004). In 1993, the UK's General Medical Council in ‘Tomorrow's Doctors’ advocated a core curriculum comprising knowledge, skills and attitudes, which was supplemented by student selected components (SCCs) to allow learners to study areas of interest whilst developing a range of generic skills considered essential for practicing medicine in the 21st century. Using the SCCs as a framework for developing generic skills, consensus was reached amongst some UK higher education institutes in terms of educational outcomes, culminating in the identification of several categories of generic skills and the development of an inventory to evaluate these skills (Jha et al. 2002; Whittle & Murdoch-Eaton 2002, 2004; Murdoch-Eaton et al. 2004; Robley et al. 2005a,b). Much of the pioneering work on transferable skills in medical education has been conducted by Leeds medical educators (Whittle & Murdoch-Eaton 2002, 2004; Murdoch-Eaton et al. 2004; Whittle et al. 2010).

Bowden and colleagues (2000) view the achievement of the desired capability of a given skill as incremental, with development and application involving increasing complexity and sophistication from the time learners are introduced to the transferable skill to when it becomes part of professional practice. It should then follow that fostering skills such as problem solving, teamwork and the ability to manage learning, with ample opportunity to practice, early in the programme, should develop independent and self-directed learners who are able to meet the challenges of their medical studies and eventually the unpredictable demands of medical practice. With this in mind, the present study set out to ascertain the self-reported experience and confidence for a range of generic skills (some advertised course outcomes) of Emirati male and female medical students on entry into medical school and after their first academic year.

Table

Practice points

Transferable skills are those skills that provide students with the ability to become independent and self-directed learners. As learners enter medical school with different experience and confidence in these skills, it would be useful to ascertain individual student's skills level. Appropriate support can be offered to allow students to develop and improve deficient skills. Opportunities for practice of transferable skills should be identified in the curriculum. Transferable skills should be articulated as important for future practice and should be assessed.

Institutional setting

The Faculty of Medicine and Health Sciences (FMHS), United Arab Emirates University (UAEU), was established in 1986 to train Emirati doctors to service the health care needs of the country. All students at the college are UAE Nationals and native Arabic speakers. With English the medium of instruction, an IELTS score of 5 is required for admission. English proficiency, however, varies, generally reflecting the language of instruction at school (i.e. English at private schools, Arabic at public schools).

The six-year medical programme comprises three two-year courses: a medical sciences course (MSC, years 1 and 2), an organ systems course (OSC, years 3 and 4; problem-based learning (PBL); clinical skills) and a clinical sciences course (CSC, clerkships, years 5 and 6). After completing a year-long University General Requirements Unit (UGRU) foundation programme in which learners are coached in English, Mathematics and computer studies, successful students are admitted to study medicine. Instruction is gender-segregated, with identical resources, facilities and teachers for male and female students.

The MSC guide states that the aim of the two-year course is to provide a firm foundation for the OSC (i.e. PBL). The course objectives reflect the need for learners to acquire an understanding of the fundamental concepts in several biomedical content areas (e.g. molecular medicine, pharmacological agents and infectious agents) and disciplines (e.g. anatomy and physiology) as well as develop problem-solving and critical-thinking skills. The guide specifically states that in addition to content knowledge, learners will also develop the following abilities, most of which qualify as generic or transferable skills:

• Skills in the practical aspects of the biomedical sciences

• Information-gathering skills

• Self-directed learning and time management

• Oral and written presentation skills

• Medical communication skills in reading, writing and comprehension

• A sense of professionalism and an understanding of ethics

• First aid and basic life support skills

During the 2 years of MSC, learners progress through 10 thematic, integrated units (e.g. the cell, tissues and abdomen) before qualifying for a course examination. Each unit comprises three elements: biomedical sciences, medical practice and medical communication and study skills (MCSS), which are assessed continuously throughout the unit (e.g. in-unit test, health visit report, essay and oral presentation). While medical practice introduces learners to the medical profession (e.g. health care systems, professional behavior, ethics), the primary objective of the MCSS component is to initiate learners to the discourse of medicine through the medium of English by listening to, reading, writing and speaking about topics relevant to the biomedical content of the unit.

The aims of the present study were two-fold: To evaluate the self-reported experience and confidence of incoming male and female medical students for six categories of generic skills, and, a year later, to assess the development of these skills.

Methodology

Participants

Participants comprised three cohorts (2006–2008) of incoming Emirati medical students (n = 112 females; n = 47 males). The small annual intake (i.e. 35–50 females; 10–20 males) necessitated canvassing multiple cohorts to ensure representative data collection. The curriculum did not undergo any major revisions during the study period. Each cohort of incoming students completed a skills audit during the first few weeks of MSC1. A year later, they were followed up in the second or third week of MSC2. Students who had not progressed to year 2 were included in the follow-up. As the skills audit was a timetabled event completed under supervision, more than 95% of students completed the initial inventory, with ± 90% of learners followed up a year later. Attrition accounted for ± 3% of students.

Skills inventory

Using a validated inventory comprising 31 generic skills in six categories (information handling, technical and numeracy, computer/information technology (IT), organisational, managing learning, presentation and communication) (Whittle & Murdoch-Eaton 2004), students rated their frequency of practice (i.e. experience) on a scale between 1 (never) and 4 (every week). They also rated their confidence on a scale between 1 (little or no experience) and 4 (more than I need, I often help others). The scale was modified slightly from the original Whittle & Murdoch-Eaton (2004) version to accommodate the FMHS curriculum structure (i.e. year-long rather than semester courses). Scores of <3 for the practice/experience and confidence scales were deemed to reflect ‘inexperience’ and ‘lack of confidence’ (i.e. requiring assistance), respectively. Although not strictly comparable because of different scales, experience and confidence were compared to check for general trends, i.e. whether more practice led to increased confidence.

As English proficiency amongst students varied, one of the authors (McLean) explained the audit to the students, obtained individual signed consent and then proceeded item by item through the inventory, providing appropriate examples of each skill. The supervised audit took approximately 45 min to complete. A year later, now as new MSC2 students, the exercise was repeated with the same supervision.

Data analysis

Completed questionnaire sheets were optically scanned and the data imported into Excel for descriptive statistical analysis (mean, standard deviation, student's t-test). A p value of <0.05 was considered to be statistically significant. Students’ experience and confidence were compared in terms of:

• All incoming MSC1 students (Y1) versus the same students early in MSC2 (Y2) students

• Y1 versus Y2 males

• Y1 versus Y2 females

• Y1 males versus Y1 females, and

• Y2 males versus Y2 females

Results

Skills level of incoming students

Incoming medical students reported being most experienced and most confident in their organisational and computer skills. Scores >3 for confidence suggested that they considered themselves reasonably self-sufficient. They were least experienced in technical and numeracy skills, followed by presentation and communication skills (Table 1). In terms of individual skills, students reported being most experienced and confident in ‘taking responsibility for learning’ (managing learning) and ‘meeting deadlines’ (organisational skill) (Table 2). They were least practiced and confident in ‘designing their own experiments’ (technical and numeracy) and ‘writing laboratory reports’ (presentation and communication) (Tables 3 and 4).

Table 1.  Students’ (3 cohorts of males and females) perceived experience and confidence in six categories of generic skills as incoming learners and one year later

	Information-handling		Technical and numeracy		Computer skills		Organisational skills		Managing learning		Presentation skills		Total inventory
Students	Experience	Confidence	Experience	Confidence	Experience	Confidence	Experience	Confidence	Experience	Confidence	Experience	Confidence	Experience	Confidence
Y1 cohort	2.98 ± 0.57	2.79 ± 0.55	2.72 ± 0.47	2.74± 0.54	3.45 ± 0.38	3.36 ± 0.50	3.56 ± 0.57	3.11 ± 0.63	3.23 ± 0.40	3.04 ± 0.48	2.84 ± 0.51	2.72 ± 0.56	3.13 ± 0.32	2.96 ± 0.38
Y2 cohort	3.23 ± 0.50	3.02 ± 0.53	2.42 ± 0.53	2.46 ± 0.61	3.29 ± 0.40	3.37 ± 0.48	3.54 ± 0.54	3.07 ± 0.65	3.25 ± 0.43	3.07 ± 0.51	2.86 ± 0.48	2.80 ± 0.55	3.10 ± 0.31	2.96 ± 0.37
Y1 males	2.75± 0.66	2.66 ± 0.59	2.63 ± 0.52	2.58 ± 0.52	3.43 ± 0.46	3.29 ± 0.56	3.42 ± 0.73	3.06 ± 0.67	3.04 ± 0.44	2.96 ± 0.46	2.74 ± 0.52	2.59 ± 0.62	3.00 ± 0.38	2.86 ± 0.41
Y2 males	3.05± 0.49	3.00 ± 0.52	2.51 ± 0.43	2.54 ± 0.54	3.29 ± 0.47	3.28 ± 0.54	3.45 ± 0.52	2.94 ± 0.67	3.11 ± 0.46	3.00 ± 0.50	2.89 ± 0.46	2.84 ± 0.53	3.05 ± 0.30	2.93 ± 0.39
Y1 females	3.07 ± 0.50	2.84 ± 0.52	2.75 ± 0.45	2.81 ± 0.53	3.46 ± 0.34	3.39 ± 0.47	3.62 ± 0.48	3.13 ± 0.62	3.31 ± 0.36	3.07 ± 0.49	2.89 ± 0.49	2.78 ± 0.53	3.18 ± 0.28	3.00 ± 0.36
Y2 females	3.30 ± 0.48	3.03 ± 0.53	2.38 ± 0.57	2.42 ± 0.64	3.29 ± 0.38	3.40 ± 0.45	3.57 ± 0.55	3.12 ± 0.63	3.31 ± 0.41	3.10 ± 0.51	2.85 ± 0.48	2.78 ± 0.55	3.12 ± 0.32	2.98 ± 0.36
p: Y1:Y2	0.0001	0.0002	<0.0001	<0.0001	0.0005	NS	NS	NS	NS	NS	NS	NS	NS	NS
p: Y1M:Y2M	0.02	0.006	NS	NS	NS	NS	NS	NS	NS	NS	NS	0.05	NS	NS
p: Y1F:Y2F	0.0007	0.008	<0.0001	<0.0001	0.0008	NS	NS	NS	NS	NS	NS	NS	NS	NS
p: Y1M:Y1F	0.001	NS (0.06)	NS	0.01	NS	NS	0.05	NS	0.0001	NS	NS	0.05	0.0009	0.03
Y2M:Y2F	0.005	NS (0.08)	NS	NS	NS	NS	NS	NS	0.01	NS	NS	NS	NS	NS

Note: NS – not significant.

Bold – significant difference.

Table 2.  Students’ self-reported experience and confidence for selected skills in organizational and managing learning categories over a one-year period

	Organisational skills				Managing learning skills
	Planning		Meeting deadlines		Taking responsibility own learning		Teamwork
Students	Experience	Confidence	Experience	Confidence	Experience	Confidence	Experience	Confidence
Y1 cohort	3.56 ± 0.73	3.10 ± 0.77	3.67 ± 0.63	3.16 ± 0.75	3.80 ± 0.49	3.42 ± 0.64	3.14 ± 0.72	3.04 ± 0.84
Y2 cohort	3.56 ± 0.65	3.13 ± 0.82	3.68 ± 0.55	3.18 ± 0.72	3.79 ± 0.49	3.33 ± 0.67	3.06 ± 0.74	3.15 ± 0.75
Y1 males	3.47 ± 0.88	3.11 ± 0.81	3.51 ± 0.83	3.11 ± 0.79	3.70 ± 0.59	3.43 ± 0.65	2.72 ± 0.77	2.76 ± 0.82
Y2 males	3.44 ± 0.67	2.95 ± 0.89	3.71 ± 0.56	3.12 ± 0.68	3.73 ± 0.55	3.32 ± 0.69	2.85 ± 0.76	3.10 ± 0.77
Y1 females	3.60 ± 0.66	3.10 ± 0.76	3.73 ± 0.52	3.18 ± 0.74	3.85 ± 0.43	3.42 ± 0.64	3.31 ± 0.63	3.16 ± 0.82
Y2 females	3.60 ± 0.63	3.20 ± 0.78	3.67 ± 0.55	3.21 ± 0.74	3.81 ± 0.46	3.34 ± 0.67	3.14 ± 0.72	3.17 ± 0.74
p: Y1:Y2	NS	NS	NS	NS	NS	NS	NS	NS
p: Y1M:Y2M	NS	NS	NS	NS	NS	NS	NS	NS
p: Y1F:Y2F	NS	NS	NS	NS	NS	NS	NS	NS
p: Y1M:Y1F	NS	NS	0.04	NS	NS	NS	<0.0001	0.006
Y2M:Y2F	NS	NS	NS	NS	NS	NS	0.04	NS

Table 3.  Students’ self-reported experience and confidence for a range of technical and numeracy skills over a one-year period

	Performing laboratory experiments		Designing your own experiments		Analysing experimental data		Drawing conclusions from data		Calculations		Statistics
Students	Experience	Confidence	Experience	Confidence	Experience	Confidence	Experience	Confidence	Experience	Confidence	Experience	Confidence
Y1 cohort	3.12 ± 0.86	2.69 ± 0.84	1.63 ± 0.79	1.82 ± 0.93	2.66 ± 0.76	2.87 ± 0.82	2.74 ± 0.84	2.97 ± 0.80	3.53 ± 0.71	3.26 ± 0.81	2.63 ± 0.91	2.80 ± 0.93
Y2 cohort	2.89 ± 0.83	2.61± 0.88	1.64 ± 0.77	1.75 ± 0.78	2.49 ± 0.81	2.49 ± 0.91	2.46 ± 0.86	2.57 ± 0.92	2.81 ± 0.87	2.96 ± 0.89	2.23 ± 0.79	2.41 ± 1.00
Y1 males	2.98 ± 0.88	2.54 ± 0.86	1.61 ± 0.77	1.77 ± 0.96	2.49 ± 0.69	2.67 ± 0.74	2.70 ± 0.95	2.72 ± 0.74	3.33 ± 0.92	3.06 ± 0.89	2.70 ± 0.98	2.68 ± 0.84
Y2 males	2.90 ± 0.62	2.61 ± 0.86	1.78 ± 0.91	1.90 ± 0.80	2.56 ± 0.63	2.49 ± 0.78	2.60 ± 0.63	2.78 ± 0.79	2.85 ± 0.79	2.98 ± 0.85	2.37 ± 0.77	2.51 ± 0.93
Y1 females	3.17 ± 0.84	2.76 ± 0.83	1.64 ± 0.81	1.84 ± 0.92	2.73 ± 0.78	2.95 ± 0.85	2.76 ± 0.80	3.08 ± 0.81	3.61 ± 0.59	3.34 ± 0.75	2.60 ± 0.88	2.85 ± 0.96
Y2 females	2.89 ± 0.91	2.61 ± 0.89	1.58 ± 0.71	1.69 ± 0.77	2.46 ± 0.87	2.48 ± 0.96	2.41 ± 0.93	2.48 ± 0.96	2.79 ± 0.91	2.96 ± 0.91	2.17 ± 0.79	2.37 ± 1.03
p: Y1:Y2	0.03	NS	NS	NS	NS	0.0002	0.0046	0.0001	0.000001	0.0030	0.0001	0.0005
p: Y1M:Y2M	NS	NS	NS	NS	NS	NS	NS	NS	0.01	NS	NS	NS
p: Y1F:Y2F	0.02	NS	NS	NS	0.02	0.0002	0.0032	0.000002	0.0000001	0.001	0.0002	0.0005
p: Y1M:Y1F	NS	NS	NS	NS	NS	0.05	NS	0.01	0.02	0.05	NS	NS
Y2M:Y2F	NS	NS	NS	NS	NS	NS	NS	NS (0.07)	NS	NS	NS	NS

Table 4.  Students’ self-reported experience and confidence for a number of presentation and communication skills over a one-year period

	Presentation and communication skills
	Writing laboratory reports		Essay writing		Explaining ideas		Oral presentations
Students	Experience	Confidence	Experience	Confidence	Experience	Confidence	Experience	Confidence
Y1 cohort	1.95 ± 0.88	1.96 ± 0.64	3.04 ± 0.67	2.68 ± 0.76	3.24 ± 0.82	2.94 ± 0.81	2.61 ± 0.67	2.82 ± 0.82
Y2 cohort	2.00 ± 0.82	2.13 ± 0.95	3.01 ± 0.46	2.94 ± 0.71	3.28 ± 0.69	2.99 ± 0.72	2.51 ± 0.60	2.87 ± 0.70
Y1 males	1.98 ± 0.87	1.91 ± 0.83	2.96 ± 0.78	2.64 ± 0.87	3.09 ± 0.88	2.77 ± 0.87	2.38 ± 0.71	2.55 ± 0.88
Y2 males	2.22 ± 0.76	2.34 ± 0.82	3.05 ± 0.50	3.02 ± 0.72	3.15 ± 0.69	3.07 ± 0.72	2.54 ± 0.64	2.85 ± 0.79
Y1 females	1.94 ± 0.88	1.97 ± 0.87	3.07 ± 0.63	2.70 ± 0.71	3.30 ± 0.79	3.01 ± 0.78	2.71 ± 0.64	2.93 ± 0.77
Y2 females	1.91 ± 0.83	2.05 ± 0.99	3.00 ± 0.45	2.90 ± 0.70	3.34 ± 0.68	2.95 ± 0.73	2.50 ± 0.59	2.87 ± 0.60
p: Y1:Y2	NS	NS	NS	0.003	NS	NS	NS	NS
p: Y1M:Y2M	NS	0.02	NS	0.003	NS	NS (0.08)	NS	NS (0.1)
p: Y1F:Y2F	NS	NS	NS	0.04	NS	NS	0.01	NS
p: Y1M:Y1F	NS	NS	NS	NS	NS	NS	0.006	0.008
Y2M:Y2F	0.04	NS	NS	NS	NS	NS	NS	NS

Significant gender differences both in terms of experience and confidence were measured. For the complete 31-skill inventory, incoming male students were less experienced (p = 0.0009) and less confident (p = 0.03) than their female counterparts in terms of, for example, managing their learning, handling information and presentation skills, in particular oral presentations (Tables 1–5).

Table 5.  Students’ self-reported experience and confidence in terms of their information-handling skills

	Researching new topic using library resources		Selecting information		Interpreting information		Using information to solve problems or answer questions
Students	Experience	Confidence	Experience	Confidence	Experience	Confidence	Experience	Confidence
Y1 cohort	2.70 ± 0.69	2.67± 0.73	2.98 ± 0.74	2.88 ± 0.73	2.99 ± 0.80	2.70 ± 0.77	3.24 ± 0.77	2.91 ± 0.79
Y2 cohort	3.03 ± 0.64	3.01± 0.69	3.30 ± 0.57	3.05 ± 0.60	3.28 ± 0.68	2.98 ± 0.69	3.32 ± 0.71	3.06 ± 0.74
Y1 males	2.60 ± 0.71	2.47± 0.75	2.77 ± 0.76	2.81 ± 0.77	2.74 ± 0.77	2.59 ± 0.80	2.89 ± 0.89	2.79 ± 0.88
Y2 males	2.85 ± 0.65	2.93 ± 0.72	3.07 ± 0.57	3.02 ± 0.65	3.15 ± 0.73	2.98 ± 0.69	3.12 ± 0.75	3.08 ± 0.66
Y1 females	2.75 ± 0.68	2.75 ± 0.72	3.07 ± 0.71	2.91 ± 0.72	3.09 ± 0.80	2.75 ± 0.75	3.39 ± 0.66	2.96 ± 0.74
Y2 females	3.10 ± 0.62	3.05 ± 0.68	3.39 ± 0.55	3.06 ± 0.58	3.34 ± 0.65	2.98 ± 0.69	3.40 ± 0.68	3.06 ± 0.78
p: Y1:Y2	<0.0001	<0.0001	0.0001	0.03	0.0008	0.001	NS	NS (0.09)
p: Y1M:Y2M	NS (0.08)	0.005	0.04	NS	0.01	0.02	NS	NS (0.09)
p: Y1F:Y2F	0.0001	0.002	0.0004	NS	0.02	0.02	NS	NS
P: Y1M:Y1F	NS	0.03	0.02	NS	0.01	NS	0.0002	NS
Y2M:Y2F	0.04	NS	0.003	NS	NS	NS	0.04	NS

Skills development over the first academic year

After one year of studies, computer and organisational skills remained the most practiced skills. They were also the skills about which students still felt most confident (Tables 1 and 2). Both males and females reported less computer skills practice, but this did not translate into decreased confidence (Table 1).

Although the gender gap for the overall inventory was reduced a year later, some differences persisted. Males reported less experience in most information-handling skills (Table 5) and in their ‘teamwork’ (managing learning) (Table 2) than their female colleagues. Despite ‘teamwork’ not an activity in which male students appeared to have regularly engaged during their first academic year, they were, however, now more confident.

The most noticeable reported skills development over the first academic year was students’ information-handling abilities, particularly ‘researching new topics using library resources’, where experience and confidence both increased (i.e. >3). Significant increases in experience were also measured for ‘selecting’ and ‘interpreting’ information (Table 5), but they reported not being sufficiently confident to be independent when it came to ‘interpreting’ information. In terms of presentation and communication skills, the significant gender gap as incoming students was no longer apparent, with males more confident at writing essays and making oral presentations. For essay writing, their confidence surpassed that of their female colleagues (Table 4).

Over the academic year, female students in particular reported being significantly less practiced in their technical and numeracy skills compared with their level of experience as incoming students. There was a concomitant decline in confidence, which is also reflected in the individual skills of performing calculations and practicing statistics, analysing experimental data and drawing conclusions from data (Table 3). The most significant decline in experience and/or confidence was in terms of performing ‘calculations’.

Discussion

That incoming FMHS students considered themselves computer literate is not surprising. Much like the positive trend of increasing IT experience and confidence in computer skills amongst Leeds medical students reported by Whittle and colleagues (2010) over an eight year period (2000–2008), which those authors ascribe to improved availability of and access to IT, FMHS students are ‘net generation’ learners who are immersed in digital technology in their daily lives. Not only does the electronic delivery of much of the FMHS curriculum (e.g. lecture summaries, timetables, the submission of written assignments via BlackBoard) require students to be au fait with IT from the outset of their studies, it also ensures that existing skills are honed.

Despite considerable reported gains in experience in terms of information-handling and some communication and presentation skills (e.g. essay writing, oral presentations), this was not mirrored by a similar increase in confidence. One probable reason became apparent on follow-up, when learners were asked to identify factors promoting and hindering skills development. English proficiency emerged as a major obstacle, affecting not only skills development, but also behaviour (e.g. too shy to ask questions in class). The difficulty of studying medicine as an English second language learner has been reported for the Middle East (Ahmed et al. 1988; Das et al. 1995; Hassan et al. 1995; Mpofu et al. 1998) and Australia (Hayes & Farnell 1993; Chur-Hansen 1997; Chur-Hansen & Vernon-Roberts 1998). The educational implications of language on skills development are discussed elsewhere (McLean et al. submitted).

Skills such as writing an essay or giving an oral presentation generally require other transferable skills. Thus, the reported increased experience in information-handling (particularly, accessing library resources) and the regular and continued use of IT (e.g. using Word, searching the Internet for information) to a large extent reflect MCSS assignments that aim to develop such skills (in English) through the appropriate use of the biomedical science content. This situation in which skills are supplementary, is, however, not ideal. There is consensus in higher education that generic skills are best developed and assessed within the context of the discipline rather than as a ‘bolt-on’ approach (Bowden et al. 2000; Bath et al. 2004; Barrie & Prosser 2004; Barrie 2006, 2007, Jones 2009a,b). MCSS is often referred to by students and staff as the ‘English course’, as it is perceived as time-consuming, taking learners away from the biomedical content. It has emerged from this study, however, that the value of MCSS lies beyond teaching English, with learners identifying important skills development as a result of MCSS activities. Greater acceptance of MCSS may be obtained if the importance of the transferable skills developed in terms of academic progress and vocational relevance are articulated. Lizzio and Wilson (2004) found that student perceptions of the relevance of skills to future work strongly predicted their motivation for further development.

The lower skills experience and confidence reported by incoming UAEU male students is worthy of discussion. This finding is not only the antithesis of Whittle and Murdoch-Eaton's (2001) generic skills study but is also contrary to the literature on male medical students generally over-estimating and females under-estimating their abilities, with females often less confident of their capabilities and achievements (Rees 2003; Blanch et al. 2008). This gender difference has also been reported in other contexts (Deaux 1979; Pallier 2003), with males generally scoring significantly higher than women on personal self and self-satisfaction self-esteem (Gentile et al. 2009). If the concept of ‘saving face’ in the Arab culture, particularly amongst males (Lundeberg et al. 2000), is taken into account, then the gender gap may in fact be greater than is presently being reported. It is also possible that in the gender-segregated education system of the UAE, female students are much more confident than if they had been in mixed classes.

Local contextual factors should also be taken into consideration when explaining our results. In the first instance, the available pools of male and female students applying for medicine are different. Recruitment of male medical students is difficult as many well-paid career opportunities exist in the armed forces and the police. In Islamic societies, which recognise males as the breadwinners, the 12–14 years of medical training (to specialist level) may not translate into appropriate financial or career returns for some males. Female Emiratis, on the other hand, who have not had the same access to government positions, may perceive education as a way of ensuring employment (Ridge 2009). Education may also be an opportunity for personal freedom in a gender-segregated society. Ridge (2009) has identified a ‘hidden gender gap’ in UAE education, with adverse effects on the male Emirati population. Not only do only 27% of Emirati males (vs. >70% of females) attend higher education, but they are also more likely to drop out than their female colleagues. The reasons cited are numerous: negative schooling experiences of males (vs. positive for females), societal expectations of males (i.e. breadwinners) and the perceived lack of returns for education by males (Ridge 2009).

If the significantly lower self-reported skills level for the combined scores of three male cohorts is representative of male cohorts, and if the measured gender gap persists (as our results suggest), then their less developed transferable skills may contribute to their regularly reported lower grade averages. As many transferable skills facilitate learning, the less developed skills level of incoming Emirati males may then translate into academic disadvantage. In a true learner-centred approach, we should be taking cognisance of the needs of individual students (McLean & Gibbs 2009). Such a skills audit will allow us to identify both male and female students with deficiencies at the outset of their studies. Intervention programmes can then be appropriately tailored to facilitate skills development.

Undertaking such an audit has also highlighted individual skills and skill categories in which learners may not be afforded with opportunities to develop or practice the skills during MSC1. For example, an advertised course outcome is that students will develop ‘skills in practical aspects of the biomedical sciences’. Of the skills listed in the inventory used, technical and numeracy skills such as performing laboratory experiments, designing experiments, calculations, analysing experimental data as well as presentation and communication skills such as writing practical reports, would be logical inclusions in such an outcome. Some of these are the skills which incoming students reported being least practiced and not confident, and which remained so a year later. Performing calculations was a skill in which females in particular reported a significant decrease in experience and confidence over the first academic year. Considering that students should be required to perform calculations in chemistry and physiology, for example, and that they would presumably need to calculate drug doses and fluid replacement volumes during the PBL cases a few years later in OSC and during their clerkships when they manage patients, this should be of concern to course directors and curriculum planners. This phenomenon of poor or declining technical and numeracy skills amongst university students is, however, not unique to FMHS students. It has been reported for incoming medical students (Whittle et al. 2010) and for bioscience undergraduates (Tariq 2002).

The limitations of this study need to be acknowledged. Self-evaluation, a reflective exercise, is not easy and may be inaccurate, with the evidence suggesting that those who are least able are also least able to self-assess accurately (Colthart et al. 2008). The young students of the present study may therefore not have been able to realistically assess their own ability, particularly considering they have been accepted in medicine based on academic merit and excellent school grades (Whittle & Murdoch Eaton, 2001). Although the four-point inventory scale is relatively objective and allows students to quantify their level of experience (e.g. never vs. every week) and their confidence (e.g. need help vs. often help others), without being asked to complete specific tasks involving skills, incoming students may over-estimate their ability, which is not uncommon in the Arab world (Lundeberg et al. 2000). Secondly, some transferable skills are easier to ‘objectify’ than others. For example, in response to ‘how many essays have you written this academic year?’, the answer will invariably be a number. The answer to ‘how often do take responsibility for your learning?’ might depend on one's interpretation of what constitutes ‘taking responsibility’. For a young, incoming student, reading the handouts provided by teachers before the examination may constitute ‘taking responsibility’, while for an advanced learner, this is likely to involve higher level activities such as supplementing lecture notes by reading or drawing concept maps. Varying perceptions in terms of some of the less measurable skills may explain, in part, the high incoming scores (and hence no measured improvement after one year) in skills such as ‘planning’ and ‘taking responsibility for own learning’.

Conclusions

Notwithstanding that the audit is self-reported, the information gleaned from this exercise has been informative in terms of providing a generic skills profile of three cohorts of medical students at the outset of their studies. The data for these cohorts reflect quantitative gender differences in the skills levels of incoming students, with males reporting significantly less experience and practice. This may translate into the lower grades frequently reported for male students. In the spirit of learner-centredness and to ensure that each student can progress satisfactorily, such an audit has merit in evaluating individual incoming student's skills such that deficiencies can be identified and tailored support provided.

This exercise has also highlighted that while the current learning experiences of FMHS first year students, in particular the activities of the MCSS component, contribute to skills development (e.g. some presentation and information-handling skills), other important skills required for PBL in OSC and beyond (e.g. teamwork, giving and receiving feedback; technical and numeracy) are perhaps not being developed in the early stage of the programme. The challenge for curriculum developers will be to provide appropriate opportunities within the biomedical disciplines that foster skills development. Once identified, these generic capabilities and attributes should then to be explicitly articulated and assessed. This would ensure that the skills are recognised and valued by learners and faculty as enabling life-long learning in their chosen profession (Lizzio & Wilson 2004).

Ethical approval

Ethical approval to conduct this study was obtained from the Al Ain District Human Research Ethics Committee in September 2006, Protocol no 06/90.

Declaration of interest: None declared