Factors influencing medical student attrition and their implications in a large multi-center randomized education trial.
Factors influencing medical student attrition and their implications in a large multi-center randomized education trial.
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影响医学生流失的因素及其在大型多中心随机教育试验中的影响。
DOI：
10.1007/s10459-012-9382-z
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Pusic,MV
中科院分区：
文献类型：
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作者：
Kalet,A;Ellaway,RH;Song,HS;Nick,M;Sarpel,U;Hopkins,MA;Hill,J;Plass,JL;Pusic,MV
如果参与者不坚持参与研究的方式与那些能够影响实验结果的参与者不同，参与者流失可能会对教育研究结果的普遍性造成重大威胁。不同的基于计算机的教学策略的有效性的多中心试验给了我们机会，观察机构和学生的因素，从一项研究和他们改变参与配置文件的方式磨损。这些数据来自一项在美国七所医学院进行的随机对照试验，该试验调查了外科文员基于计算机的学习模块的不同教学设计对教育的影响。所有在参与学校从事外科实习的学生都被邀请参加，那些同意的学生被要求在他们的外科实习期间完成五项学习措施。研究损耗率的变化进行了探讨，机构和参与者的自我调节，自我效能，任务价值的感知，并掌握目标取向测量进入研究。在1，363名受邀参与者中，995名（73%）同意参与并提供了基线数据。在五个研究里程碑中的每一个里程碑的参与率都有显著下降，902（94%）人完成了两个模块后测试中的至少一个，799（61%）人完成了两个模块后测试，539（36%）人完成了中期旋转评估，252（25%）人完成了最终评估。在生存分析中，不同机构的治疗效果不同（p< 0.001）。观察到自我调节（p= 0.01），自我效能（p= 0.02）和任务价值（p= 0.04）的小但统计学显著性差异，但在掌握或绩效目标定向措施（p= NS）。学习损耗与国家医学考试委员会学科考试成绩较低相关，教育试验的结果应理解为，坚持的学生可能比辍学的同龄人更能自我调节，自我效能和更高的成就，因此并不代表整个班级。
Participant attrition may be a significant threat to the generalizability of the results of educational research studies if participants who do not persist in a study differ from those who do in ways that can affect the experimental outcomes. A multi-center trial of the efficacy of different computer-based instructional strategies gave us the opportunity to observe institutional and student factors linked to attrition from a study and the ways in which they altered the participation profile. The data is from a randomized controlled trial conducted at seven US medical schools investigating the educational impact of different instructional designs for computer-based learning modules for surgical clerks. All students undertaking their surgical clerkships at the participating schools were invited participate and those that consented were asked to complete five study measures during their surgery clerkship. Variations in study attrition rates were explored by institution and by participants’ self-regulation, self-efficacy, perception of task value, and mastery goal orientation measured on entry to the study. Of the 1,363 invited participants 995 (73 %) consented to participate and provided baseline data. There was a significant drop in the rate of participation at each of the five study milestones with 902 (94 %) completing at least one of two module post-test, 799 (61 %) both module post-tests, 539 (36 %) the mid-rotation evaluation and 252 (25 %) the final evaluation. Attrition varied between institutions on survival analysis (p< 0.001). Small but statistically significant differences in self-regulation (p= 0.01), self-efficacy (p= 0.02) and task value (p= 0.04) were observed but not in mastery or performance goal orientation measures (p= NS). Study attrition was correlated with lower achievement on the National Board of Medical Examiners subject exam. The results of education trials should be interpreted with the understanding that students who persist may be somewhat more self-regulated, self-efficacious and higher achievers than their peers who drop out and as such do not represent the class as a whole.