“There's so much to study!”
Medical students' perceptions of curriculum relevance and
subject balance: results of a survey of three medical schools
Ewan Gray (MPH student)
Paula Lorgelly (Senior Lecturer in Health Economics)
Section of Public Health and Health Policy
Curricular Dilemma
As early as 1876 Thomas Huxley, the famous biologist
and educationalist, observed the medical student…
“risked breaking his intellectual back”
…due to the overloading of knowledge considered to
be required.
Huxley advocated pre-clinical training in the basic
sciences of his day.
The modern medical course
Tomorrow’s doctors
The Scottish Doctor
Students setting the curriculum?!

The decision process in setting the curriculum
rarely has strong student involvement despite
their obvious stakeholder interest and the
evidence of potential benefit in promoting
academic success
 While students may not be able to comment
on the professional/vocational relevance of the
content they are uniquely aware of the
academic relevance
 Student feedback systems popular in many
academic departments
Research Questions

Would students re-balance the
curriculum teaching and learning time
among different subject areas?


Which areas would be prioritised more and
which less?
Do differences exist in the expressed
preferences of students of:
Different universities?
 Different year groups?

Research Methods

An online questionnaire of medical students

Consisting of questions about:
1.
2.
3.

Demographic information
Knowledge of health economics
Views/opinions of health economics and the medical
curriculum.
Offered to all medical students at Glasgow,
Newcastle and East Anglia via linked email

Part of the ‘Medical Students and Health
Economics: What do they know? What do they
need to know?’ study
Survey Monkey – Page 1
Specific Questions (1)

Which of these areas do you feel require more
teaching/learning time? (please tick all that apply)
 Anatomy and Physiology
 Pathology
 Microbiology
 Pharmacology
 Clinical Medicine
 Clinical Skills (e.g. Examination Technique)
 Surgery
 Public Health
 Personal and Professional Development
Specific Questions (2)

In what areas would you be willing to sacrifice
teaching/learning time in order to make room for new
material in the course (not necessarily health
economics)? (please tick all that apply)
 Anatomy and Physiology
 Pathology
 Microbiology
 Pharmacology
 Clinical Medicine
 Clinical Skills (e.g. Examination Technique)
 Surgery
 Public Health
 Personal and Professional Development
Qualitative data collection

Do you feel that the inclusion of broader
health topics places too great a strain or
burden on medical students?

Open-ended question
Response Rates

578 students accessed the survey
Glasgow – 166 responses – 12.7%
 Newcastle – 268 responses – 17%
 East Anglia – 144 responses – 21.5%


423 completed the survey sufficiently for
analysis (answered 5 or more multiple
choice questions)
University by Year statistics
Glasgow
Newcastle
UEA
Total
Year 1
23
27
32
82
Year 2
18
37
21
76
Year 3
17
44
23
84
Year 4
23
53
16
92
Year 5
18
40
18
76
Intercalated
11
0
2
13
Desire for more teaching

General preference for more teaching of:
Pharmacology
 Anatomy & Physiology
 Pathology
 Surgery


Limited support for more teaching of the
non-clinical subjects
Personal & professional development
 Public Health

Pers & Prof Develop
5%
Public Health
17%
Surgery
38%
Clinical Skills
33%
Clinical Medicine
34%
Pharmacology
58%
Microbiology
31%
Pathology
42%
Anatomy & Physiology
0%
57%
10%
20%
30%
40%
50%
% respondents
60%
70%
80%
90%
100%
Teaching desires by university

Considerable differences across
universities




Glasgow and UEA want more pharmacology,
more microbiology and more
anatomy/physiology relative to Newcastle [pure
science]
Glasgow and Newcastle more clinical medicine
and clinical skills [clinical subjects]
Glasgow wants more public health
UEA wants more pathology
p=0.917
Pers & Prof Develop
UEA
Public Health
Newcastle
p=0.003
Glasgow
Surgery
p=0.091
Clinical Skills
p=0.018
Clinical Medicine
p<0.001
Pharmacology
p<0.001
p<0.001
Microbiology
Pathology
p<0.001
Anatomy & Physiology
0%
p<0.001
10%
20%
30%
40%
50%
% respondents
60%
70%
80%
90%
100%
Teaching desires by year of study
 Few
differences across year of study
(excluded intercalated year)

Year 5 want more pharmacology, and
(marginally) more microbiology
p=0.563
Pers & Prof Develop
Year One
Year Two
p=0.654
Public Health
Year Three
Year Four
p=0.278
Surgery
Year Five
p=0.840
Clinical Skills
p=0.481
Clinical Medicine
p<0.001
Pharmacology
p=0.063
Microbiology
p=0.463
Pathology
p=0.256
Anatomy & Physiology
0%
10%
20%
30%
40%
50%
% respondents
60%
70%
80%
90%
100%
Teaching desires by year of study:
Glasgow University only

Greater number of significant differences
across year of study for Glasgow
University students
Year 5 students want more microbiology
 Year 4 & 5 students want more
anatomy/physiology
 Year 3 students want more public health
(marginal)
 Gradient with respect to pharmacology,
increases as year increases (marginal)

p=0.600
Pers & Prof Develop
Year One
Year Two
Public Health
p=0.087
Year Three
Surgery
Year Four
p=0.281
Year Five
Clinical Skills
p=0.263
Clinical Medicine
p=0.374
p=0.097
Pharmacology
Microbiology
p=0.005
p=0.230
Pathology
p=0.004
Anatomy & Physiology
0%
10%
20%
30%
40%
50%
% respondents
60%
70%
80%
90%
100%
Willingness to sacrifice
More than half of all respondents are
willing to sacrifice teaching of personal
and professional development to make
room for new material
 While one third are willing to sacrifice
public health teaching

Pers & Prof Develop
55%
Public Health
33%
Surgery
9%
Clinical Skills
5%
Clinical Medicine
4%
Pharmacology
4%
Microbiology
18%
Pathology
Anatomy & Physiology
0%
8%
5%
10%
20%
30%
40%
50%
% respondents
60%
70%
80%
90%
100%
Sacrifice by university
UEA and Newcastle more willing than
Glasgow to sacrifice public health
teaching
 UEA and Glasgow more willing than
Newcastle to sacrifice surgery and
clinical medicine
 Newcastle and Glasgow more willing
than UEA to sacrifice microbiology

p=0.454
Pers & Prof Develop
Public Health
UEA
Newcastle
p=0.047
Glasgow
Surgery
p=0.042
p=0.117
Clinical Skills
Clinical Medicine
p=0.027
Pharmacology
p=0.595
p=0.027
Microbiology
Pathology
p=0.855
Anatomy & Physiology
0%
p=0.105
10%
20%
30%
40%
50%
% respondents
60%
70%
80%
90%
100%
Sacrifice by year of study
Steep gradient with respect to personal
and professional development,
willingness to sacrifice increases with
year of study
 Year 2 students willing to sacrifice
pharmacology, while year 5 students
didn’t indicate this at all

p=0.001
Pers & Prof Develop
Year One
Year Two
Public Health
p=0.696
Year Three
Surgery
Year Four
p=0.711
Year Five
Clinical Skills
p=0.183
Clinical Medicine
p=0.503
Pharmacology
p=0.021
Microbiology
p=0.189
Pathology
p=0.123
Anatomy & Physiology
0%
p=0.737
10%
20%
30%
40%
50%
% respondents
60%
70%
80%
90%
100%
Sacrifice by year of study:
Glasgow University only
No significant differences across the
various years of study for the Glasgow
sample
 Year 1 students are (marginally) less
willing to sacrifice personal and
professional development compared to
the more advanced students

p=0.096
Pers & Prof Develop
Year One
Year Two
Public Health
p=0.970
Year Three
Year Four
p=0.667
Surgery
Year Five
p=0.156
Clinical Skills
p=0.286
Clinical Medicine
p=0.685
Pharmacology
Microbiology
p=0.117
Pathology
p=0.156
Anatomy & Physiology
0%
p=0.252
10%
20%
30%
40%
50%
% respondents
60%
70%
80%
90%
100%
Measure of expression of preference





Asked to tick all that applied
12% expressed no desire for more teaching,
more than half (59%) wished for more
teaching in 2 to 4 areas
Average amount of more teaching, 3.14
Differed significantly between years 1-3
(µ=2.98) and years 4-5 (µ=3.38), suggesting
some experience effect
Little difference in aggregate willingness to
sacrifice teaching across the two year groups
Qualitative responses

Do you feel that the inclusion of broader
health topics places too great a strain or
burden on medical students?
252 (60%) commented
 64 said yes
 147 said no
 41 said maybe

Are broader aspects of health a
burden? – YES
“Yes. It means that there is a lot to learn and it
is very hard to see what should be sacrificed”
 “Yes, it is difficult to tie all the interlinking ideas
together and often comes at the expense of
more 'core sciences' for which we are often
criticised”
 “I cannot deny that it will be a burden. But I
think broader health topics are important,
outweigh the fact that it will become a burden”
 “Inclusion of any topic adds burden - but this is
tolerable when it's relevant”

Are broader aspects of health a
burden? – NO
“No, but I don't think that they should be
treated as core subjects so students are able
to prioritise”
 “No, we get very little teaching anyway so a
couple of hours lectures on this topic would be
very interesting and beneficial”
 “No. They should realise when they choose
medicine that its a high stress/responsibility
career path”
 “No but it is pretty dull”

Discussion (1)

General preference for more teaching/learning
time dedicated to science subjects



But is this a reflection of enjoyment, need or
difficulty?
Do students want more pharmacology, in terms of
greater coverage or more hours on the same topic?
Evidence of differences across universities
and year groups

To understand why necessary to review all course
documentation
Discussion (2)
Great willingness to sacrifice
learning/teaching time on personal and
professional development to make way
for new material
 Similar across universities and year
groups, although year 5 students are
especially willing to sacrifice personal
and professional development

Discussion (3)
Aggregate found evidence of an
experience effect, year 4 and 5 students
may be better placed to give views of
curriculum design
 What would this mean for Glasgow

More anatomy/physiology, pharmacology,
microbiology and pathology at the expense
of personal and professional development
and possibly public health
 More science less broader health issues
