1. Factors Associated with Anesthesiology Grade Assignments in 5th year Medical Students
P Toomtong, B Sirivanasandha, S Lapmahapaisan, P Waitayawinyu,
P Vichitvejpaisal, J Lertakyamanee.
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital
Mahidol University, Bangkok, Thailand
Research Question
Which parts of the scores for 5th year medical students did make an effect of grade in Anesthesiology?
The rotation is so short, they have to integrate their knowledge in basic sciences with clinical practice, have to participate in case-study, oral presentation of their patient, involvement in bedside teaching in the operating theatres for discussion, hand skills (mask ventilation and endotracheal intubation) and work as a team member, and the examinations in MCQs and Essay.
The sooner or The later medical students have any effects on grading the checklist? The MCQs has been recycled three times a year, does it have an impact on the students’ grade?
A trigger point: a D+ grade was given to one medical student last academic year.
Summary of work
The overall scores, all categories of the score, from bedside teaching, hand-on skills, reports, examinations (MCQs & essays), period of rotation, and set of MCQ papers were analysed with factor analysis. The scores from 470 medical students from academic year 2010 and 2011 were reviewed and entered to principle component factor analysis.
Rotated factors were further analysed with linear regression analysis and final grade results were applied as an independent outcome.
Table 1. Total variance explained with Principle component factor analysis
Component
Initial Eigenvalues
Extraction Sums of Squared Loadings
Rotation Sums of Squared Loadings
Total
% of Variance
Cumulative % 1
2.375
14.847
1.676
10.474 2
1.648
10.298
25.145
1.568
9.802
20.276 3
1.451
9.069
34.214
1.551
9.696
29.971 4
1.297
8.106
42.321
1.537
9.604
39.575 5
1.173
7.330
49.651
1.321
8.253
47.828 6
1.107
6.922
56.573
1.249
7.804
55.632 7
1.026
6.409
62.982
1.176
7.350 8
.841
5.257
68.239 9
.779
4.870
73.109 10
.761
4.756
77.864 11
.742
4.636
82.500 12
.718
4.489
86.989 13
.604
3.778
90.767 14
.578
3.611
94.378 15
.486
3.037
97.415 16
.414
2.585
Table 2. Rotated factor component and factor loading
Factor
Score
Factor loading
1. Self
Bedside teaching 1
Report presentation
Case Study participation
0.776
0.479
0.605
2. Decision
Preoperative investigation
Choice of anaesthesia
Pain control
0.541
0.725
0.752
3. Situation
Airway essay
Crisis management
MCQ examination
0.726
0.627
0.595
4. Skill
Airway management
Skill and Affective
0.819
0.736
5. Time of year
Period rotation
Bedside teaching 2
0.863
0.575
6. Preparation
Preoperative
Lists of MCQs paper
0.586
0.687
7. Problem
Medical problems
0.876
Table 3. Final regression Descriptive Statistics
Model
Unstandardized coefficients
Standardized coefficients t
Sig.
95% Confidence interval
for B
Collinearity Statistics B
Std.error
Beta
Lower bound
Upper bound
Tolerance
VIF
(Constant)
-3.209
0.227
< 0.01
-3.654
-2.763
Self
0.138
0.010
0.382
14.208
0.119
0.157
0.840
1.191
Decision
0.024
0.006
0.093
3.671
0.011
0.037
0.945
1.058
Situation
0.036
0.002
0.481
18.596
0.032
0.039
0.906
1.104
Skill
0.060
0.005
0.351
13.160
0.051
0.068
0.850
1.177
Time of year
0.023
0.873
0.383
-0.002
0.901
1.109
Preparation
-0.009
-0.036
-1.438
0.151
-0.022
0.003
0.968
1.033
Problem
0.027
0.129
5.191
0.017
0.986
1.015
Results & Discussion
The grade assignment comes from nearly all medical student works assigned by the department, they need active participation in bedside teaching and problem-oriented case study, have practise an oral report presentation.
They need to learn an appropriate way to handle an unforeseen problem, choose necessary preoperative investigations, give a reason for a better choice of anaesthesia and plan for patient’s postoperative pain control. They must have a plan for an airway challenge and must be competent to manage respiratory or haemodynamics crisis.
The clinical skills are also important as well as decision making skills.They need to integrate their basic science knowledge and their clinical medicine knowledge to have a bigger and wider picture of perioperative care of their surgical patients, not only focus on their airway management practise.
The period of anaesthesia rotation earlier or later does not have an important effect on their grade earned.
Take home message
It is an individual medical student responsibility to earn a successful grade in the subject of Anesthesiology.
Active Participation in both hand-on skills and bedside teaching
Decision making process has to be encouraged in medical students, they should have made a plan for their surgical patients and gain more experience in this area.
Vigilance is very important in anaesthesia practise, however, it is an essential part in crisis management, we wish to find a way to instill this idea to our medical students.
1. Bacon DR: Iconography in anesthesiology. The importance of society seals in the 1920s and 30s. Anesthesiology 1996; 85: 414-9