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Biomedical subjects

I C McManus

Publications and source records attributed to I C McManus.

At least 37 records · Page 2Linked to original sources
PubMed2004

Right-left and the scrotum in Greek sculpture.

The scrotum in humans is asymmetric, the right testicle being visibly higher than the left in most men. Paradoxically, it is also the case that the right testicle is somewhat larger, rather than smaller, as might be expected. Greek classical and pre-classical art, which took great care in its attention to anatomical detail, correctly portrayed the right testicle as the higher, but then incorrectly portrayed the left testicle as visibly larger. The implication is that the Greeks used a simple mechanical theory, the left testicle being thought to be lower because it was larger and hence more subject to the pull of gravity. The present study examines data on scrotal asymmetry in more detail, and puts them in the context of Greek theories of functional differences between the right side and the left side.

Cultural Characteristics↗
PubMed2003

A levels and intelligence as predictors of medical careers in UK doctors: 20 year prospective study.

OBJECTIVE: To assess whether A level grades (achievement) and intelligence (ability) predict doctors' careers. DESIGN: Prospective cohort study with follow up after 20 years by postal questionnaire. SETTING: A UK medical school in London. PARTICIPANTS: 511 doctors who had entered Westminster Medical School as clinical students between 1975 and 1982 were followed up in January 2002. MAIN OUTCOME MEASURES: Time taken to reach different career grades in hospital or general practice, postgraduate qualifications obtained (membership/fellowships, diplomas, higher academic degrees), number of research publications, and measures of stress and burnout related to A level grades and intelligence (result of AH5 intelligence test) at entry to clinical school. General health questionnaire, Maslach burnout inventory, and questionnaire on satisfaction with career at follow up. RESULTS: 47 (9%) doctors were no longer on the Medical Register. They had lower A level grades than those who were still on the register (P < 0.001). A levels also predicted performance in undergraduate training, performance in postregistration house officer posts, and time to achieve membership qualifications (Cox regression, P < 0.001; b=0.376, SE=0.098, exp(b)=1.457). Intelligence did not independently predict dropping off the register, career outcome, or other measures. A levels did not predict diploma or higher academic qualifications, research publications, or stress or burnout. Diplomas, higher academic degrees, and research publications did, however, significantly correlate with personality measures. CONCLUSIONS: Results of achievement tests, in this case A level grades, which are particularly used for selection of students in the United Kingdom, have long term predictive validity for undergraduate and postgraduate careers. In contrast, a test of ability or aptitude (AH5) was of little predictive validity for subsequent medical careers.

Career Choice↗
PubMed2003

Pilot study of the roles of personality, references, and personal statements in relation to performance over the five years of a medical degree.

OBJECTIVES: To compare the power of three traditional selection procedures (A levels, personal statements, and references) and one non-traditional selection procedure (personality) to predict performance over the five years of a medical degree. DESIGN: Cohort study over five years. SETTING: Nottingham medical school. PARTICIPANTS: Entrants in 1995. MAIN OUTCOME MEASURES: A level grades, amounts of information contained in teacher's reference and the student's personal statement, and personality scores examined in relation to 18 different assessments. RESULTS: Information in the teacher's reference did not consistently predict performance. Information in the personal statement was predictive of clinical aspects of training, whereas A level grades primarily predicted preclinical performance. The personality domain of conscientiousness was consistently the best predictor across the course. A structural model indicated that conscientiousness was positively related to A level grades and preclinical performance but was negatively related to clinical grades. CONCLUSION: A teacher's reference is of no practical use in predicting clinical performance of medical students, in contrast to the amount of information contained in the personal statement. Therefore, simple quantification of the personal statement should aid selection. Personality factors, in particular conscientiousness, need to be considered and integrated into selection procedures.

Adolescent↗
PubMed2003

Reliability of the MRCP(UK) Part I Examination, 1984-2001.

OBJECTIVES: To assess the reliability of the MRCP(UK) Part I Examination over the period 1984-2001, and to assess how the reliability is related to the difficulty of the examination (mean mark) and to the spread of the candidates' marks (standard deviation). METHODS: Retrospective analysis of the reliability (KR20) of the MRCP(UK) examination recorded in examination records for the 54 diets between 1984 and 2001. RESULTS: The reliability of the examination showed a mean value of 0.865 (SD 0.018, range 0.83-0.89). There were fluctuations in the reliability over time, and multiple regression showed that reliability was higher when the mean mark was relatively high, and when the standard deviation of the marks was high. CONCLUSIONS: The reliability of the MRCP(UK) Examination was maintained over the period 1984-2001. As theory predicted, the reliability was related to the average mark and to the spread of marks.

Clinical Competence↗
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↗
PubMed2002

The relationship between pre-registration house officers and their consultants.

CONTEXT: Previous studies have drawn attention to the importance of the trainee/trainer relationship in determining job satisfaction and motivation to learn. OBJECTIVES: To study the relationship between pre-registration house officers and their consultants through exploring an interpersonal exchange and the emotional context in which the exchange took place. To consider any association between the type of relationship implied and the trainee's attitude to their career. DESIGN: Postal questionnaire covering a wide range of issues. This study focused on an open question about a significant or interesting exchange, followed by supplementary questions exploring the emotional context of the exchange. SETTING: 336 hospitals throughout the United Kingdom. SUBJECTS: A cohort of doctors were followed from the time of their application to medical school, and studied towards the end of their pre-registration year (n=2456). RESULTS: The response rate to the questionnaire was 58.4%. Responses were categorised as Support and supervision; Unreasonable behaviour; Consultant fallibility; Fair criticism and No exchange. Over half the responses described an interaction that made them feel positive. Trainees particularly appreciated positive feedback, clinical support, teaching, career advice, patronage, or social interaction. The importance of formal appraisal or review sessions in providing the setting for a positive exchange was confirmed. Positive interactions were associated with a positive view of medicine as a career. A minority described an interaction that was negative, involving unreasonable demands, criticism (whether perceived as fair or unfair), humiliation, or sexism. These were associated with a more negative view of medicine as a career, and of themselves as doctors.

Adaptation, Psychological↗
PubMed2002

Stressful incidents, stress and coping strategies in the pre-registration house officer year.

CONTEXT: Previous studies have drawn attention to the stresses experienced by doctors in their first year. OBJECTIVES: To gain a deeper understanding of the causes of stress in newly qualified doctors, how they cope, and what interventions might make the year less traumatic. DESIGN: Postal questionnaire. This study focused on an open question asking about a stressful incident, the coping strategy used to deal with it, stressors in general and current levels of stress using the General Health Questionnaire. SETTING: 336 hospitals throughout the United Kingdom. SUBJECTS: A cohort of doctors followed from the time of their application to medical school, studied towards the end of their pre-registration year (n=2456). RESULTS: The response rate to the questionnaire was 58.4%. The incidents were categorised into the major groups Responsibility (33.6%), Interpersonal (29.7%), Overwork (17.0%), Death and disease (13.0%), and Self (6.7%). GHQ revealed psychological morbidity in 31% of respondents. Stress levels were highest in those reporting an incident about Responsibility or Self, lowest in those describing Death or disease. Stressors in general and preferred coping strategies differed between the groups. CONCLUSION: The incidents suggested the following interventions to reduce stress: better supervision in the first few weeks in post, at night, and for medical problems on surgical wards; more attention to avoiding sleep deprivation; more time for discussion with colleagues at work; more personal time with friends and family. The choice of incident described was influenced by the personal characteristics of the respondent.

Adaptation, Psychological↗
PubMed2002

How consultants, hospitals, trusts and deaneries affect pre-registration house officer posts: a multilevel model.

OBJECTIVE: To examine variation in reported quality and working conditions of pre-registration house officer (PRHO) posts. To use multilevel modelling to determine how much of the variation was due to the effects of consultant firms, hospitals, trusts and deaneries, as well as variation at the level of the individual doctor. DESIGN: Questionnaire survey of national sample of PRHOs at the end of the pre-registration year. Multilevel modelling was carried out using MLwiN. SETTING: PRHOs working in UK approved medical and surgical posts in NHS hospitals from August 1996 to January 1999. PARTICIPANTS: One thousand, four-hundred and thirty-five PRHOs who had previously been part of an extended cohort study of medical student selection and training. They reported on a total of 4926 posts, on 2721 identifiable consultant firms, in 336 hospitals, in 264 trusts and in 17 deaneries. MAIN OUTCOME MEASURES: PRHOs' perceptions of the overall quality of all PRHO posts they had worked in, and working conditions in the current post. RESULTS: Twenty percent of PRHO posts were described as excellent and 34% as very good, through to 6% reported as not very good, poor or bad. The overall rating of the post showed highly significant variation at the level of hospital/trust, and consultant firm. Other aspects of posts, such as working conditions showed variation at the level of deanery, trust, hospital and firms, with different patterns for the different measures. Assessments of stress in PRHOs (GHQ, burnout, response to uncertainty), and a desire to leave medicine, showed no variation at the level of deanery, trust, hospital or firm. CONCLUSION: Some aspects of a PRHO post, in particular overall rated quality, but also many aspects of working conditions, show substantial variation at the level of hospital, trust and consultant firm, suggesting that differences reflect local variation in working practices and treatment of PRHOs, with the possibility of change and improvement. The lack of any variation at the level of deanery, trust, hospital or firm in stress of PRHOs suggests that these responses are idiosyncratic, individual responses by doctors themselves, rather than a general characteristic of posts, hospitals, trusts or deaneries.

Attitude of Health Personnel↗
PubMed2002

Linking assessment to learning: a new route to quality assurance in medical practice.

BACKGROUND: If continuing professional development is to work and be sensible, an understanding of clinical practice is needed, based on the daily experiences of doctors within the multiple factors that determine the nature and quality of practice. Moreover, there must be a way to link performance and assessment to ensure that ongoing learning and continuing competence are, in reality, connected. Current understanding of learning no longer holds that a doctor enters practice thoroughly trained with a lifetime's storehouse of knowledge. Rather a doctor's ongoing learning is a 'journey' across a practice lifetime, which involves the doctor as a person, interacting with their patients, other health professionals and the larger societal and community issues. OBJECTIVES: In this paper, we describe a model of learning and practice that proposes how change occurs, and how assessment links practice performance and learning. We describe how doctors define desired performance, compare actual with desired performance, define educational need and initiate educational action. METHOD: To illustrate the model, we describe how doctor performance varies over time for any one condition, and across conditions. We discuss how doctors perceive and respond to these variations in their performance. The model is also used to illustrate different formative and summative approaches to assessment, and to highlight the aspects of performance these can assess. CONCLUSIONS: We conclude by exploring the implications of this model for integrated medical services, highlighting the actions and directions that would be required of doctors, medical and professional organisations, universities and other continuing education providers, credentialling bodies and governments.

Clinical Competence↗
PubMed2002

Is insight important? measuring capacity to change performance.

BACKGROUND: Some doctors who perform poorly appear not to be aware of how their performance compares with accepted practice. The way that professionals maintain their existing expertise and acquire new knowledge and skills - that is, maintain their 'currency' of practice - requires a capacity to change. This capacity to change probably requires the individual doctor to possess insight into his or her performance as well as motivation to change. There may be a range of levels of insight in different individuals. At some point this reaches a level which is inadequate for effective self-regulation. Insight and performance may be critically related and there are instances where increasing insight in the presence of decreasing performance can also cause difficulties. OBJECTIVE: This paper presents an exploration into the nature of insight, its relationship to professional performance and its measurement as part of performance, reflecting the combined experiences of a group of experienced education researchers and the results of literature searches on insight and performance. CONCLUSION: There may be individuals in whom insight is so lacking that they are beyond remediation. If there is a dichotomy between adequate and inadequate levels of insight, testing this could be a cost-effective way of determining where efforts for remediation should be focussed.

Clinical Competence↗
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↗
PubMed2001

Good Medical Practice: comparing the views of doctors and the general population.

OBJECTIVES: To assess the views of the general public and general practitioners (GPs) on the General Medical Council's Good Medical Practice. METHODS: A large national consumer survey organization (MORI) was commissioned to conduct a survey of a representative sample of the general public using quota sampling methods with randomly selected sampling points across Great Britain. A similar survey was carried out of GPs across Great Britain. Questions were asked of the general public about their perceptions on medical practitioners keeping their knowledge sufficiently up to date to do their job, on complaints being properly investigated, and about doctors being removed from the General Medical Council register if they failed to perform a specifically defined duty. The GPs were asked the same questions about duties. The general public was also asked whether they worked in the National Health Service (NHS), about any recent experiences as a patient in the NHS and whether they had ever complained about a doctor. RESULTS: A total of 1949 people were interviewed in their homes along with 199 GPs. Over one-third either worked in the NHS or had friends or relatives who worked in the NHS. Eleven per cent felt they had reason to complain about a doctor although only 6% had made a formal or informal written or verbal complaint. The general public and GPs held similar views on reasons for doctors being removed from the register, although the public's threshold was somewhat lower than the doctors. CONCLUSIONS: GPs and the general public have similar views on good medical practice, although the degree of concern shown by the public is greater than that registered by doctors. Both groups show similar patterns of variation in their perception of the importance of some duties compared with others.

Adolescent↗
PubMed2000

Women in hospital medicine in the United Kingdom: glass ceiling, preference, prejudice or cohort effect?

OBJECTIVE: To assess from official statistics whether there is evidence that the careers of women doctors in hospitals do not progress in the same way as those of men. DESIGN: The proportions of female hospital doctors overall (1963-96), and in the specialties of medicine, surgery, obstetrics and gynaecology, pathology, radiology/radiotherapy, anaesthetics and psychiatry (1974-1996) were examined. Additionally data were examined on career preferences and intentions from pre-registration house officers, final year medical students, and medical school applicants (1966-1991). ANALYSIS: Data were analysed according to cohort of entry to medical school to assess the extent of disproportionate promotion. RESULTS: The proportion of women in hospital career posts was largely explained by the rapidly increasing proportion of women entering medical school during the past three decades. In general there was little evidence for disproportionate promotion of women in hospital careers, although in surgery, hospital medicine and obstetrics and gynaecology, fewer women seemed to progress beyond the SHO grade, and in anaesthetics there were deficits of women at each career stage. Analyses of career preferences and intentions suggest that disproportionate promotion cannot readily be explained as differential choice by women. CONCLUSIONS: Although there is no evidence as such of a "glass ceiling" for women doctors in hospital careers, and the current paucity of women consultants primarily reflects historical trends in the numbers of women entering medical school, there is evidence in some cases of disproportionate promotion that is best interpreted as direct or indirect discrimination.

Adult↗