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Doctors’ need for wellbeing support didn’t end with the pandemic, write Peter Brennan and colleagues

Background Reading times are shorter and comprehension is poorer during skim-reading compared to more careful reading for comprehension. Here we provide a novel examination of the effect of skimming on medical students’ reading of clinical texts. Three eye tracking experiments are reported. Each experiment manipulates the reading task (reading for comprehension, skimming for gist) and a key characteristic of the text (legibility, context, accuracy). Together the experiments provide key insights into how medical students read and skim clinical information. Methods Participants were fourth year medical students. In each experiment participants read for comprehension and skimmed for gist. Experiment 1 examined the effect of font legibility, comparing reading behaviour for vignettes presented in a legible vs. less legible font ( n  = 28). Experiment 2 examined the effect of contextual cues, comparing reading of clinical statements that were preceded by a neutral cue vs. a cue stating the diagnosis ( n  = 28). Experiment 3 examined the integration of the text with prior knowledge by comparing reading behaviour for statements that were accurate or inaccurate ( n  = 20). Eye movements were recorded to determine how reading processes differed according to reading strategy and the text manipulations. Results Across all three experiments skim-reading resulted in eye movement indices consistent with more superficial processing of text (shorter first-pass and re-reading times, p s < 0.001). There were fewer and shorter eye fixations during skimming compared to reading for comprehension ( p s < 0.001) (Experiment 1). A less legible font was found to slow down reading ( p s < 0.001), but did so similarly for skimming and reading for comprehension (Experiment 1). There were smaller effects of context (Experiment 2) and text accuracy (Experiment 3) for re-reading measures during skimming, indicating that skimming produces poorer integration of text with patient information or clinical knowledge. Conclusions The eye tracking results are consistent with previous work indicating that levels of comprehension can be reduced during skim-reading. The study also demonstrates that legibility and contextual cues (e.g., diagnosis sub-headings) are important for efficient reading. Especially when learning key concepts or making key decisions, medical students and healthcare practitioners should be aware that content may be missed or only superficially processed during skimming.

Background We investigated whether question format and access to the correct answers affect the pass mark set by standard-setters on written examinations. Methods Trained educators used the Angoff method to standard set two 50-item tests with identical vignettes, one in a single best answer question (SBAQ) format (with five answer options) and the other in a very short answer question (VSAQ) format (requiring free text responses). Half the participants had access to the correct answers and half did not. The data for each group were analysed to determine if the question format or having access to the answers affected the pass mark set. Results A lower pass mark was set for the VSAQ test than the SBAQ test by the standard setters who had access to the answers (median difference of 13.85 percentage points, Z = -2.82, p  = 0.002). Comparable pass marks were set for the SBAQ test by standard setters with and without access to the correct answers (60.65% and 60.90% respectively). A lower pass mark was set for the VSAQ test when participants had access to the correct answers (difference in medians -13.75 percentage points, Z = 2.46, p  = 0.014). Conclusions When given access to the potential correct answers, standard setters appear to appreciate the increased difficulty of VSAQs compared to SBAQs.

ObjectiveTo determine and identify distance patterns in the movements of medical students and junior doctors between their training locations.DesignA retrospective cohort study of UK medical students from 2002 to 2015 (UKMED data).SettingAll UK medical schools, foundations and specialty training organisation.ParticipantsAll UK medical students from 2002 to 2015, for a total of 97 932 participants.Outcome measuresIndividual movements and number of movements by county of students from family home to medical school training, from medical school to foundation training and from foundation to specialty training.MethodsLeslie matrix, principal components analysis, Gini coefficient, χ2 test, generalised linear models and variable selection methods were employed to explore the different facets of students’ and junior doctors’ movements from the family home to medical school and for the full pathway (from family home to specialty training).ResultsThe majority of the movements between the different stages of the full pathway were restricted to a distance of up to 50 km; although the proportion of movements changed from year-to-year, with longer movements during 2007–2008. At the individual level, ethnicity, socioeconomic class of the parent(s) and the deprivation score of the family home region were found to be the most important factors associated with the length of the movements from the family home to medical school. Similar results were found when movements were aggregated at the county level, with the addition of factors such as gender and qualification at entry (to medical school) being statistically associated with the number of new entrant students moving between counties.ConclusionOur findings show that while future doctors do not move far from their family home or training location, this pattern is not homogeneous over time. Distances are influenced by demographics, socioeconomic status and deprivation. These results may contribute in designing interventions aimed at solving the chronic problems of maldistribution and underdoctoring in the UK.

We investigated whether question format and access to the correct answers affect the pass mark set by standard-setters on written examinations. Trained educators used the Angoff method to standard set two 50-item tests with identical vignettes, one in a single best answer question (SBAQ) format (with five answer options) and the other in a very short answer question (VSAQ) format (requiring free text responses). Half the participants had access to the correct answers and half did not. The data for each group were analysed to determine if the question format or having access to the answers affected the pass mark set. A lower pass mark was set for the VSAQ test than the SBAQ test by the standard setters who had access to the answers (median difference of 13.85 percentage points, Z = -2.82, p = 0.002). Comparable pass marks were set for the SBAQ test by standard setters with and without access to the correct answers (60.65% and 60.90% respectively). A lower pass mark was set for the VSAQ test when participants had access to the correct answers (difference in medians -13.75 percentage points, Z = 2.46, p = 0.014). When given access to the potential correct answers, standard setters appear to appreciate the increased difficulty of VSAQs compared to SBAQs.