Effects of curriculum change on medical graduates' preparedness for internship

INTRODUCTION: The University of the Witwatersrand (Wits) changed its medical curriculum in 2003 from a traditional, six-year curriculum to an integrated, problem-based, four year Graduate Entry Medical Programme (GEMP), preceded by two years of basic and medical sciences at university level or a suitable undergraduate degree. AIMS: To compare the preparedness for internship of Wits graduates from the old and new curricula on fifty seven items grouped into nine categories which were identified during the development and validation of a Model of the Competent South African Intern. METHODS: A stratified random sample of interns was drawn from the last graduates of the traditional curriculum and a matched sample of interns from the first graduates of the GEMP. Both quantitative and qualitative methods were used. For each sampled intern a supervisor, colleague and patient were selected by convenience sampling. A questionnaire was completed by interns, supervisors and colleagues followed by an interview to qualify responses at the extremes of the Likert-type scale and link them to curriculum learning opportunities. A semi- structured interview was conducted with patients and a global score allocated. The Cochran-Mantel-Haenszel Statistic for ordinal data was used. Comparisons were drawn between the competence of graduates from the traditional and GEMP curricula from the perspectives of interns, supervisors, colleagues and patients. Interview data were analysed using thematic analysis techniques. RESULTS: Significant differences were reported by interns in six of the nine categories. In one category, “fundamental theoretical knowledge” the GEMP graduates rated themselves significantly less prepared in the basic medical sciences (Pathology, Microbiology and Pathophysiology, p=0.01; Pharmacology, p<0.0001) but highly significantly better prepared in the theory of interpersonal communication, p<0.000001). The GEMP graduates rated themselves significantly better prepared in the other five categories, “medical problem solving” (p=0.009), “holistic patient management” (p=0.0004), “community health” (p=0.0002), “communication skills” (p=0.02) and “self directed learning” (p=0.0001). vii Supervisors reported significant differences in “teamwork” (p=0.045) and “personal attributes” (p=0.045) giving fewer low scores to the GEMP graduates. There were no significant differences between the category scores for colleagues. Qualitative analysis included vertical summaries of interview data and horizontal or comparative interpretations with quotations in order not to lose the voice of the interns, supervisors, colleagues and patients. DISCUSSION AND CONCLUSION: GEMP graduates rated themselves better prepared in those areas which had been identified as reasons for curriculum change but less prepared in specific basic medical sciences. Although these were not reported as significantly different by supervisors or colleagues they require attention. Other than this, according to the judgements of the informants, the competence of GEMP graduates was similar to that of traditional graduates in certain areas and significantly better in others, which appears to justify the major medical curriculum change undertaken at this University.
Ph.D., Faculty of Health Sciences, University of the Witwatersrand, 2011
clinical performance, comparative study, competence, complexity, curriculum change, graduate entry, internship, internship performance, medical education, South Africa