Student questionnaire

The representatives of the participating medical schools in Europe were requested to distribute the Student Questionnaire "to 5-10 students who within 3 months will graduate as a medical doctor". Apparently this request lacked clarity, because there was an overwhelming amount of respondents who defaulted the limit of 3 months. Therefore it was decided to reset the limit to 9 months. The number of questionnaires returned was 536; processable in terms of the new limit were 383, with 111 falling within the three months limit. The students represented 96 medical schools in 23 European countries.

Some striking results of the Student Questionnaire

Student - cancer patient encounters
Students were asked to indicate the number of new, cured and not-cured cancer patients they had seen. Remarkable was the wide range of answers in the number of new patients seen by students. The variability between tumour types made a lot of difference: students (9 months or less before their final exam) had seen on average 7.5 new patients with breast cancer versus an average of 0.3 new patients with cancer of the vulva. The other average numbers were in between these values.
Apart from the variability between patients with various tumour types, there was also a wide range of variation between individual students. Some students had encountered 70 new patients with lung cancer, while other students had seen no such patients. The same was true for other tumours; some students had seen no patients with a particular malignant disease, while others encountered 20, or 30, or over 100 such patients.

Cancer control and cancer care
Another striking result was that the attention paid to aspects of cancer control and cancer care was - according to the students - predominantly insufficient. Earlier in this report the opinion of the faculty was compared with the student opinion. It could be concluded that both students and faculty were rather unanimous in their opinion that most topics get far from sufficient attention in the curriculum.

Specific clinical instruction
The Student Questionnaire also investigated the existence of specific clinical instruction about some cancer related topics. Generally speaking the picture was positive: most topics are part of the medical curriculum.

Students' suggestions for improvement
The final question of the Student Questionnaire was an open-end question: "What three things would you suggest could be done that would improve cancer education at your medical school?" In order to avoid irrelevant or useless answers from "inexperienced students" (too far away from their final examination), it was decided to accept only suggestions from "experienced" (2 months or less away from their MD-examination) respondents. The following suggestions ranked highest:

1. more psychosocial aspects and communication skills
2. more time for oncology in the curriculum
3. better teaching; teacher training
4. more patients; more bedside teaching.

A further analysis

There were at least two possible explanations for the finding that students vary greatly in the experiences they have met with cancer patients.

1. One was that it reflected the fact that the group of students was heterogeneous with respect to study-progress. Advanced students (one month or less away from their final exam) have more experiences than their younger colleagues who still had nine months to go. Therefore the former group should have encountered more cancer patients. To investigate this, the relation between student-experience and patient-contact has been analysed in two ways:
   a) by adding all encounters per student;
   b) by looking more in detail to some categories of frequently seen patients.
   ad a)  Adding all encounters, and discriminating between experience in terms of study-progress did not give the clear picture one would expect. The group that was about to obtain their MD-degree, was not highest in patient-encounter.
   ad b)  When a subgroup of students who were three month or less away from the final exam (N=111) were compared with the rest of the group (N=272), there was in some cases an increase of patient encounters in the former group, but in other cases there was a decrease in the number of encounters.
   It could be concluded that making progress in the medical study did not necessarily mean progress in the number of cancer patient encounters. Therefore study-progress did not account for the variability in the experiences of the respondents. An illustration of this variability within an individual medical school was the frequency of student-patient encounters with patients suffering from leukemia was that one student had seen 10 patients with leukemia, while five colleagues had seen none. This situation was by no means exceptional. It could thus be demonstrated that within medical schools the opportunities to see cancer patients were distributed in a very uneven manner.
2. A second plausible explanation of the variability of student-patient encounters was that it was related to the fact that respondents stemmed from different medical schools. But this explanation did not suffice either. It could be demonstrated that there was a wide variance within medical schools.

Discussion

Student-encounters with cancer patients have been advocated by different authors for different reasons. Whether such encounters really take place, depends on opportunities, on teacher policies and on student initiatives. The results from the Faculty Questionnaire showed that opportunities were unequally distributed among medical schools. This explained at least partly the low average number of cancer patients seen by medical students.
The results of the Student Questionnaire evoked several items for discussion. The average number of patients with a particular malignant disease, seen by a large group of students, varied between 0.3 (cancer of the vulva) and 7.5 (breast cancer).

 

Questions

Is it acceptable that two out of three students graduate as a medical doctor without ever having seen a patient with a particular tumour? For instance, a patient with cancer of the vulva was seen by four out of ten students. Of course the incidence of cancer of the vulva is relatively low, but on the other hand it is a tumour that can relatively easily be detected by physical examination.

• Is it reasonable and/or acceptable that cutaneous melanoma had a modest position compared to a high position of lung cancer?
  
  
• If the incidence of a particular tumour is a causal factor in these questions, should one compensate for a low incidence? How?