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Biomedical subjects

B C Winder

Publications and source records attributed to B C Winder.

12 recordsLinked to original sources
PubMed2002

The causal links between stress and burnout in a longitudinal study of UK doctors.

Burnout and stress are common, linked problems in health-care workers. We aimed to clarify their causal associations. We assessed stress and the three components of burnout (emotional exhaustion, depersonalisation, and low personal accomplishment) using structural equation modelling in a 3-year longitudinal study of a representative sample of 331 UK doctors. Emotional exhaustion and stress showed reciprocal causation: high levels of emotional exhaustion caused stress (beta=0 189), and high levels of stress caused emotional exhaustion (beta=0 175). High levels of personal accomplishment increased stress levels (beta=0 080), whereas depersonalisation lowered stress levels (beta=-0 105).

Adult↗
PubMed2001

UK doctors' attitudes to the General Medical Council's Performance Procedures, 1997-99.

OBJECTIVES: The UK General Medical Council's Performance Procedures were introduced in 1997. This study aimed to assess the changing knowledge and attitudes about the procedures in British doctors at the time of their introduction and in the following 2 years. METHODS: Three questionnaire surveys, of separate representative samples of 800 UK doctors, were carried out in November of 1997, 1998 and 1999. The surveys assessed awareness of Good Medical Practice, attitudes to the Performance Procedures, agreement with Duties of a Doctor as a basis for disciplinary procedures, and attitudes to the Performance Procedures. RESULTS: Although awareness of the procedures increased over the period 1997-99, there was no concurrent increase in agreement with the core principles of the procedures, the Duties of a Doctor, which are spelled out in Good Medical Practice. Of 12 separate attitudes to the procedures, changes were found in eight over the time period, all but two of which were negative, and not in support of the procedures. Nevertheless many doctors were changing their practice as a result of the procedures, and that proportion increased during the period 1997-99. CONCLUSIONS: Although doctors became more aware of the procedures, that increasing awareness was not accompanied by an increasing agreement with the procedures' underlying principles or their wider implications.

Attitude of Health Personnel↗
PubMed2001

The shortened Study Process Questionnaire: an investigation of its structure and longitudinal stability using confirmatory factor analysis.

BACKGROUND: The Study Process Questionnaire (SPQ) is a widely used measure of learning approach and was proposed to have three orientations: surface, deep, and achieving, each with an underlying motive and strategy. AIMS: This study aimed to examine the factor structure and longitudinal stability over five to seven years of a modified shortened 18-item version of the SPQ. SAMPLES: A total of 1349 medical students completed the shortened SPQ at application and in their final year of medical school. Three additional cohorts of students completed the shortened SPQ during their third and fourth year of medical school (sample size: 194, 203, 174). METHOD: Confirmatory factor analysis was used to examine the dimensionality and longitudinal stability of the shortened SPQ. RESULTS: Like the full 42-item version, the shortened SPQ has six subscales and the data are best fit by three second order shared indicator factors (surface, deep and achieving) and a single higher order composite deep-achieving factor. The longitudinal analysis found 26.8%, 26.3%, and 18.7% of the non-attenuated variance of the surface, deep and achieving factor scores in the final year is predicted from the shortened SPQ completed at application to medical school. CONCLUSIONS: The shortened 18-item SPQ has the same six subscales as the full SPQ as well as three second order shared indicator factors (surface, deep, achieving) and one higher order deep-achieving factor similar to that suggested by Biggs (1987). The longitudinal analysis supports this hypothesis and suggests that these learning approaches are partly stable during medical school undergraduate training and partly modifiable under the influence of the educational environment.

Adult↗
PubMed2000

Duties of a doctor: UK doctors and good medical practice.

OBJECTIVE: To assess the responses of UK doctors to the General Medical Council's (GMC) Good Medical Practice and the Duties of a Doctor, and to the GMC's performance procedures for which they provide the professional underpinning. DESIGN: Questionnaire study of a representative sample of UK doctors. SUBJECTS: 794 UK doctors, stratified by year of qualification, sex, place of qualification (UK v non-UK), and type of practice (hospital v general practice) of whom 591/759 (78%) replied to the questionnaire (35 undelivered). MAIN OUTCOME MEASURES: A specially written questionnaire asking about awareness of Good Medical Practice, agreement with Duties of a Doctor, amount heard about the performance procedures, changes in own practice, awareness of cases perhaps requiring performance procedures, and attitudes to the performance procedures. Background measures of stress (General Health Questionnaire, GHQ-12), burnout, responses to uncertainty, and social desirability. RESULTS: Most doctors were aware of Good Medical Practice, had heard the performance procedures being discussed or had received information about them, and agreed with the stated duties of a doctor, although some items to do with doctor-patient communication and attitudes were more controversial. Nearly half of the doctors had made or were contemplating some change in their practice because of the performance procedures; a third of doctors had come across a case in the previous two years in their own professional practice that they thought might merit the performance procedures. Attitudes towards the performance procedures were variable. On the positive side, 60% or more of doctors saw them as reassuring the general public, making it necessary for doctors to report deficient performance in their colleagues, did not think they would impair morale, were not principally window dressing, and were not only appropriate for problems of technical competence. On the negative side, 60% or more of doctors thought the performance procedures were not well understood by most doctors, were a reason for more defensive practice, and could not be used for problems of attitude. Few differences were found among older and younger doctors, hospital doctors, or general practitioners, or UK and non-UK graduates, although some differences were present. CONCLUSIONS: Most doctors working in the UK are aware of Good Medical Practice and the performance procedures, and are in broad sympathy with Duties of a Doctor. Many attitudes expressed by doctors are not positive, however, and provide areas where the GMC in particular may wish to encourage further discussion and awareness. The present results provide a good baseline for assessing changes as the performance procedures become active and cases come before the GMC over the next few years.

Attitude of Health Personnel↗
PubMed1999

Are UK doctors particularly stressed?

Doctors are thought to have higher levels of stress than the general population. However, in a survey of a nationally representative sample of UK doctors, we found that stress levels were equivalent to those in the general population; previous findings may have been biased by inappropriate use of the general health questionnaire.

Analysis of Variance↗
PubMed1999

Intercalated degrees, learning styles, and career preferences: prospective longitudinal study of UK medical students.

OBJECTIVES: To assess the effects of taking an intercalated degree (BSc) on the study habits and learning styles of medical students and on their interest in a career in medical research. DESIGN: Longitudinal questionnaire study of medical students at application to medical school and in their final year. SETTING: All UK medical schools. PARTICIPANTS: 6901 medical school applicants for admission in 1991 were studied in the autumn of 1990. 3333 entered medical school in 1991 or 1992, and 2695 who were due to qualify in 1996 or 1997 were studied 3 months before the end of their clinical course. Response rates were 92% for applicants and 56% for final year students. MAIN OUTCOME MEASURES: Study habits (surface, deep, and strategic learning style) and interest in different medical careers, including medical research. Identical questions were used at time of application and in final year. RESULTS: Students who had taken an intercalated degree had higher deep and strategic learning scores than at application to medical school. Those with highest degree classes had higher strategic and deep learning scores and lower surface learning scores. Students taking intercalated degrees showed greater interest in careers in medical research and laboratory medicine and less interest in general practice than their peers. The effects of the course on interest in medical research and learning styles were independent. The effect of the intercalated degree was greatest in schools where relatively few students took intercalated degrees. CONCLUSIONS: Intercalated degrees result in a greater interest in research careers and higher deep and strategic learning scores. However, the effects are much reduced in schools where most students intercalate a degree. Introduction of intercalated degrees for all medical students without sufficient resources may not therefore achieve its expected effects.

Attitude↗
PubMed1998

Clinical experience, performance in final examinations, and learning style in medical students: prospective study.

OBJECTIVE: To assess whether the clinical experience of undergraduate medical students relates to their performance in final examinations and whether learning styles relate either to final examination performance or to the extent of clinical experience. DESIGN: Prospective, longitudinal study of two cohorts of medical students assessed by questionnaire at time of application to medical school and by questionnaire and university examination at the end of their final clinical year. SUBJECTS: Two cohorts of students who had applied to St Mary's Hospital Medical School during 1980 (n = 1478) and 1985 (n = 2399) for admission in 1981 and 1986 respectively. Students in these cohorts who entered any medical school in the United Kingdom were followed up in their final clinical year in 1986-7 and 1991-2. MAIN OUTCOME MEASURES: Student's clinical experience of a range of acute medical conditions, surgical operations, and practical procedures as assessed by questionnaire in the final year, and final examination results for the students taking their examinations at the University of London. RESULTS: Success in the final examination was not related to a student's clinical experiences. The amount of knowledge gained from clinical experience was, however, related to strategic and deep learning styles both in the final year and also at the time of application, five or six years earlier. Grades in A level examinations did not relate either to study habits or to clinical experience. Success in the final examination was also related to a strategic or deep learning style in the final year (although not at time of entry to medical school). CONCLUSIONS: The lack of correlation between examination performance and clinical experience calls into question the validity of final examinations. How much knowledge is gained from clinical experience as a student is able to be predicted from measures of study habits made at the time of application to medical school, some six years earlier, although not from results of A level examinations. Medical schools wishing to select students who will gain the most knowledge from clinical experience cannot use the results of A level examinations alone but could assess a student's learning style.

Clinical Competence↗
PubMed1996

Final examination performance of medical students from ethnic minorities.

It has recently been claimed that UK medical students from ethnic minorities perform less well than White students in final undergraduate examinations and that this results from discrimination in clinical examinations. In this paper the authors examine the performance of students in two prospective studies of 1981 and 1986 entrants to London medical schools taking finals in 1986, 1987, 1991 and 1992. Overall, 18.2% of students in the survey failed one or more examinations at finals. UK ethnic minority students were 2.09 times more likely to fail one or more examinations than were UK White students. Male students were also 1.65 times more likely to fail an examination than female students. More detailed analysis of individual marks confirmed that UK ethnic minority students performed less well than UK White students, although non-UK ethnic minority students performed better than UK White students. The difference between UK White and ethnic minority students could not be explained by differences in educational achievement, study habits or clinical experience. The poorer performance of UK ethnic minority students extended across multiple-choice questions (MCQ), essay, clinical and oral examinations. Ethnic minority students performed particularly poorly on examinations in medicine and surgery as compared with pathology and clinical pharmacology. Although UK-born ethnic minority students perform less well in final examinations than UK White students, this is unlikely to be explained by racial discrimination as the difference is present in MCQ examinations marked by machine and as non-UK ethnic minority students perform better than UK White students. The cause of the difference in performance is therefore not clear and requires further study.

Educational Measurement↗
PubMed1995

Medical school applicants from ethnic minority groups: identifying if and when they are disadvantaged.

OBJECTIVE: To assess whether people from ethnic minority groups are less likely to be accepted at British medical schools, and to explore the mechanisms of disadvantage. DESIGN: Prospective study of a national cohort of medical school applicants. SETTING: All 28 medical schools in the United Kingdom. SUBJECTS: 6901 subjects who had applied through the Universities' Central Council on Admissions in 1990 to study medicine. MAIN OUTCOME MEASURES: Offers and acceptance at medical school by ethnic group. RESULTS: Applicants from ethnic minority groups constituted 26.3% of those applying to medical school. They were less likely to be accepted, partly because they were less well qualified and applied later. Nevertheless, taking educational and some other predictors into account, applicants from ethnic minority groups were 1.46 times (95% confidence interval 1.19 to 1.74) less likely to be accepted. Having a European surname predicted acceptance better than ethnic origin itself, implying direct discrimination rather than disadvantage secondary to other possible differences between white and non-white applicants. Applicants from ethnic minority groups fared significantly less well in 12 of the 28 British medical schools. Analysis of the selection process suggests that medical schools make fewer offers to such applicants than to others with equivalent estimated A level grades. CONCLUSIONS: People from ethnic minority groups applying to medical school are disadvantaged, principally because ethnic origin is assessed from a candidate's surname; the disadvantage has diminished since 1986. For subjects applying before A level the mechanism is that less credit is given to referees' estimates of A level grades. Selection would be fairer if (a) application forms were anonymous; (b) forms did not include estimates of A level grades; and (c) selection took place after A level results are known.

Black or African American↗
PubMed1993

The changing clinical experience of British medical students.

The UK National Health Service is undergoing fundamental reforms, which might have a detrimental effect on the training of doctors, not least with respect to the amount of clinical experience that medical students get. We compared the practical experience gained by two cohorts of students at medical schools throughout the UK, who had started their training in 1981 or 1986. The assessment was made by questionnaire at the end of their final clinical year. Experience of acute medical conditions, surgical operations, and practical procedures differed significantly between groups of medical schools, and showed a significant decline in the past five years. This decline in the clinical experience of medical students has coincided with the introduction of the health service reforms. We suspect that the university-based clinical education designed for a lifetime of change is in danger of being replaced by a dispersed clinical apprenticeship for current practice.

Analysis of Variance↗
PubMed1993

Why do medical school applicants apply to particular schools?

5427 applicants to British medical schools indicated the importance of each of 22 specific reasons for applying to the five choices they had put on their medical school application. The 24852 applications were aggregated by medical school, and the profile of reasons analysed for each school. Factor analysis showed four clear dimensions, labelled as 'Reputation', 'Personal contact', 'Location' and 'Prospectus'; scores and rank order for each school on each factor are reported. Scrutiny of the pattern of ratings of individual schools suggested that although many of the applicants' perceptions were probably valid, there were some perceptions which appeared inconsistent with other evidence. Cluster analysis showed that in general the London schools clustered together as did the provincial schools of England and Wales, and the Scottish schools; Oxbridge and Belfast were perceived as very separate from the other schools.

Choice Behavior↗