Mini-Med School: promoting awareness of medicine as a career for

suburban and rural high-school students

Faisal M. Shaikh,* Mahwash Babar* and K. Simon Cross
Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
Key words
high-school students, medical profession awareness,
rural suburban.
Correspondence
Mr Faisal M. Shaikh, Department of Surgery, Royal
College of Surgeons in Ireland, 123 St Stephens Green,
Dublin 2, Ireland. Email: faisalshaikh@rcsi.ie
F. M. Shaikh MD, MRCSI; M. Babar MD, MRCSI;
K. S. Cross MD, MMedSci, FRCSI (Gen), FRCS (ED).
*Faisal M Shaikh and Mahwash Babar shared rst
authorship.
Accepted for publication 3 September 2012.
doi: 10.1111/j.1445-2197.2012.06288.x
Abstract
Background: There is a global shortage of medical manpower. One approach to
resolve such deciencies is to effectively promote health careers to high-school stu-
dents. Summer programmes held by medical faculties provide ideal opportunities for
pre-medical students to examine the possible career opportunities in medicine.
Methods: The Royal College of Surgeons in Ireland has recently launched a Mini-
Medical School (MMS) programme for suburban and rural high-school students in
the South Eastern Region of Ireland. This paper illustrates the MMS project and
describes the participants reaction and evaluation of the programme and the factors
inuencing their desire to practise medicine in future.
Results: A total of 90 students completed the online survey (response rate 75%).
Eighty-two per cent of the students indicated denitive and strong desire to study
medicine after secondary school. There was no difference in interest between male and
female students (P-value 0.665). The main factors inuencing this interest were
personal. Forty-four per cent of participants attributed this to the opportunity to help
others while 30% to the intellectual challenge, whereas family, friends and other
factors accounted for the rest of inuential factors to study medicine. The majority
agreed (60%) that the programme was quite accessible and easy to have a place.
Opinions about the content of the programme focussed mainly on the interactive
sessions. Forty-seven per cent liked the live patientdoctor interaction session the
most, and 43% found the live video session very informative.
Conclusion: The MMS is a highly effective platform for both the medical specialties
and the high-school students.
Introduction
Geographical mal-distribution and shortage of health-care providers,
especially physicians, is a ubiquitous problem, affecting many coun-
tries and regions across the globe.
1,2
Recruitment and retention of
health professionals to work in rural and remote communities is
problematic and is inuenced by numerous factors. Rural origin has
been identied as the most signicant predictor of a medical profes-
sional working in rural areas after graduation.
35
One strategy for
improving the shortages of health professionals in rural areas is to
effectively promote health careers to rural high-school students.
6
However, research has demonstrated that many medical students
lack insight into their chosen careers,
7
frequently regret the decision
8
and often leave medicine.
9
One of the various efforts to increase students enrolment in health-
related professions is the establishment of summer programmes for
high-school and college students.
1012
The rationale for this approach
was to address the problem of quality and quantity of applicant pool at
an early stage in the academic preparation of students. Despite the
implementation of diverse education courses and workshops to improve
the promotion of health careers to high-school students, little research
has been undertaken to measure the learning outcomes and the impact
of such programmes on the participants.
Ireland is a small island nation situated in Western Europe, inhab-
ited by a population of just over 4.42 million people. About 40% of
the national population of Ireland lives in remote and rural areas
(Central Statistics Ofce, 2006 census). There has been a long-
neglected shortage of medical manpower in Ireland.
13
These short-
ages are attributed to numerous factors including low production of
indigenous doctors, resignation and emigration to other countries,
and expansion of health-care facilities.
14,15
Recently, there have been
growing concerns about the serious shortage of medical manpower
both at academic and governmental (service) levels. The Royal
College of Surgeons in Ireland (RCSI) located in the heart of Dublin,
SURGICAL EDUCATION: ORIGINAL ARTICLE
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2012 The Authors
ANZ Journal of Surgery 2012 Royal Australasian College of Surgeons ANZ J Surg 83 (2013) 481486
is a prestigious institution leading the way in medical education and
professional competence. The RCSI has played a major innovative
role in medical education, training and research by sponsoring
numerous courses essential to medical practice including the
recently launched Mini-Medical School. This course is focused on
transition year, high-school students, who have the potential to take
tertiary health training, particularly in medicine. The programme
centres on medicine itself as a unifying theme. Transition Year is an
optional 1-year school programme in Ireland that can be taken in the
year after the Junior Certicate examination and is intended to make
the senior cycle a 3-year programme encompassing both Transition
Year and the Leaving Certicate examination course. Following the
success of the pilot Mini-Medical School and consecutive courses in
Dublin, the need to expand and introduce the educational pro-
gramme in the suburban and rural community was realized. Water-
ford Regional Hospital is one of the RCSI teaching hospitals in the
South East of Ireland and offers an ideal central and accessible
geographical suburban and rural location, particularly for the Tran-
sition Year students.
In this article the authors disclose the planning and setting up of
the Mini-medical School programme for suburban and rural high-
school students in the South Eastern region of Ireland and describe
the participant reaction and evaluation of the programme and the
factors affecting their opinion of medicine as a career.
Methods
The Mini-Med School Programme planning committee (four con-
sultant physicians/RCSI clinician educators and one RCSI Surgical
Tutor) in Waterford Regional Hospital designed a 4-day pro-
gramme for 120 students. Formal invitations were sent out to all the
schools in the South Eastern Region. The planning committee met
several times and discussed what would comprise a successful pro-
gramme. The committee also recalled what they themselves had not
known as young students and drew on their experience in previous
health sciences careers. The aim of the planning committee was to
deliver a course that addressed the components of medical educa-
tion and the content of medical knowledge and thus provide a
deeper understanding of the medical practice among Transition-
Year students.
The planning process was challenging, exciting and extensive,
and the committee reached a consensus on four knowledge areas for
the programme: (i) the need for knowledge of the structure of under-
graduate and graduate medical education; (ii) the language or ter-
minology on which medicine is based; (iii) a typical physicians
approach to and techniques for physical examination and diagnosis;
and (iv) the interface of various subspecialties of medicine including
oncology, radiology, ophthalmology, cardiology/renal medicine,
surgery, public health and general practice. The committee subse-
quently put out a call for experienced health sciences professionals
to participate in the programme. Agreat deal of energy was focussed
on selecting teaching faculty for the Mini-Medical School for
Transition-Year Students. Faculty were selected based on their
medical expertise with particular emphasis on their teaching exper-
tise. The committee sought experienced clinician-educators who
approached teaching with enthusiasm and who exhibited the ability
to translate complex medical concepts into terms easily understood
by a younger audience. Faculty members were encouraged to
prepare lectures and be ready for interactive question-and-answer
sessions with attendees. To complement the lectures and discussion
sessions, the planning committee also developed curriculum support
materials, including faculty-approved subject bibliographies, copies
of each presenters presentation slides, and faculty biographies.
After consecutive meetings and reviews, the programme was
developed into a course containing a lively and informative balance
of lecture-based presentations and interactive question-and-answer
discussions supported by practical hands-on sessions and exercises
(Figs 13). Instead of having all attendees sit through the pro-
gramme in a large and monolithic group, the programme committee
decided to divide participants into small groups during the practical
sessions (Fig. 4) creating another layer of instructorparticipant
interaction. Alive video operating session from the theatre and a real
patientdoctor scenario in an outpatient setting were also incorpo-
rated into the main programme to further enhance the students
insight into the medical profession.
Methodology used to measure impact
and outcomes
The planning committee designed a programme based on adult
learning principles and effective continuing professional develop-
ment methods. The planners wanted to ensure that attendees would
retain knowledge and be afforded the opportunity to change their
vision for the future. As an integral part of the planning process, a
strategy was devised to measure the learning outcomes and the
Fig. 1. Students at the Intravenous
cannulation station.
482 Shaikh et al.
2012 The Authors
ANZ Journal of Surgery 2012 Royal Australasian College of Surgeons
impact on the participants of the Mini-Med School course. Using a
structured post-symposium follow-up survey; the participants were
invited to engage in self-evaluation and also assess the quality of the
programme. The survey was administered online via SurveyMon-
key.com a commercial survey administration service and was sent
out to participants via email soon after the completion of the pro-
gramme. The survey consisted of four parts:
(1) Self-evaluation of the interest in medicine, its various sub-
specialties and the factors inuencing the interest including
personal, family, peers and media inuence prior to attending
the programme;
(2) Self-evaluation of the top ve career (Central Admission
Ofce degree course) choices prior to attending the pro-
gramme and inuence of the programme on any change in
career choices after the programme;
(3) Post-programme self-assessment of the understanding of the
medical procedures, particularly of an operation before and
after the LIVE video of a surgical operation in real time; and
(4) Evaluation and feedback about the programme itself, focus-
ing mainly on the practical interactive sessions.
The participants response was quantied by a score where they
were asked to rate their answer on a score of 15 (1 being the lowest
score in the answer and 5 being the highest).
Results
A total of 120 students attended the Mini-Medical School
programme and were invited to complete the survey. Ninety
students completed the online survey, giving the response rate of
75%. Table 1 shows the participants demographics. The age of par-
ticipants varied from 15 to 18 with a mean age of 16 years. The
majority were Irish nationals and were from suburban areas of
Waterford, Tipperary and Wexford.
The majority of the participants indicated denitive (44%) and
strong (38%) desire to study medicine after leaving secondary
school (Table 2). There was no difference in interest between male
and female students (P-value 0.665). The main factors inuencing
these choices and interest were personal. Forty-four per cent of
participants attributed this to the opportunity to help others, while
30% related their interest in medicine because of the intellectual
Fig. 2. Students at the surgical skills station.
Fig. 3. Student auscultating chest on a dummy intubated patient.
Mini-Med School 483
2012 The Authors
ANZ Journal of Surgery 2012 Royal Australasian College of Surgeons
challenge, whereas family, friends and other factors accounted for
the rest of inuential factors to study medicine in future. The factors
inuencing women to study medicine were their desire to help
others, intellectual challenge and advice from family. Men are likely
to go for nancial rewards, personality t for medicine and past
experience with doctors (P = 0.01). Twenty-two per cent of the
participants had one or more family members who were doctors,
78% of whom agreed that this was an inuence in driving their
interest in medicine. Men had more family members as doctors (P =
0.015), and that is denitely an inuence on choosing the profession
in men as compared with women; however, there was no signicant
difference (P = 0.07). The relative inuence of the different medical
television programmes with a medical theme was similar among all
the participants (Table 2).
A signicant proportion of participants (44%) showed interest in
surgery. The next most popular Specialty was emergency medicine
(32%). For those interested in surgery, manual dexterity and
hands-on work was the main driving force in 50% of the participants
followed by intellectual challenge in 31%. Only 2% were interested
in surgery as a nancially rewarding specialty. Also, 62% admitted
to having a good understanding of a surgical operation before the
live video demonstration, whereas 97% agreed that their understand-
ing had improved after the live video session (Table 3).
Opinions about the content of the programme focussed mainly on
the interactive sessions. Forty-seven per cent liked the live patient
doctor interaction session the most, and 43% found the live video
session very informative. A majority agreed (60%) that the pro-
gramme was quite accessible and easy to have a place, whereas 40%
pointed out that allocation of places was difcult to almost impos-
sible in about 3% (Table 4).
Discussion
Ensuring a sufcient supply of physicians for rural communities is a
policy concern in many countries around the world.
1619
The strong-
est predictor of rural recruitment and retention is a rural background
for the health professional.
1719
However such students wishing to
enter and to successfully complete a tertiary health course face a
myriad of difculties, including restricted school subject choices,
lack of peer pressure for academic achievements, high nancial
costs and limited exposure to role models.
6
Research show that
health career workshops and programmes have a major impact on
student career selection, enabling students to be better informed
about career plans, for a wide range of health careers while raising
awareness of health professions in general.
20
Mini-Medical Schools are educational programmes designed
originally for the amateur, keen to learn about health knowledge,
specic clinical topics and the practice of medicine. Usually spon-
sored by medical schools or hospitals and delivered by the medical
faculty, Mini-Medical Schools generally consist of a series of
lectures, addressing a broad range of health topics. The programmes
are a brief and supercial synopsis of medical information that
encourages participants to interact with health-care professionals.
21
The number of Mini-Medical School programmes has grown sig-
nicantly from the time the concept was pioneered in 1990 by Cohen
at the University of Colorado.
22
According to the National Institutes
of Health, more than 70 such programmes are offered in the USAon
a regular basis.
22
Mini-Medical Schools are very popular, well
attended and often lled to capacity.
23
These programmes serve two
purposes. Firstly, they are public relations tools, fostering goodwill
between the sponsoring institutions and the general public. Sec-
ondly, they are useful vehicles for disseminating important con-
sumer health information. They are, in effect, a mix of public
Fig. 4. Student with a consultant showing endotracheal intubation.
Table 1 Participants demographics
Number (%) 90 (75)
Mean age (median) 16 (16)
Sex
Male (%) 35 (40)
Female (%) 55 (60)
Nationality
Irish (%) 85 (95)
Others (%) 5 (5)
County of residence (%)
Waterford 25 (28)
Tipperary 19 (21)
Wexford 14 (15)
Kilkenny 9 (10)
Cork 9 (10)
Carlow 7 (8)
Others 7 (7)
484 Shaikh et al.
2012 The Authors
ANZ Journal of Surgery 2012 Royal Australasian College of Surgeons
service and public relations and showcase faculty and resources of
medical centres, slake public thirst for medical knowledge, and knit
closer ties to the community.
24,25
This study shows that the Mini-
Medical School programme, already being successful with the lay
public, additionally has proved to be a well-received and effective
educational tool for the Transition Year high-school students. While
the Mini-Medical School does not provide attendees with the level
of instruction necessary to claim subject expertise, it does serve as a
strong introduction for the younger ambitious generation and allows
lling in the blanks in their career choice understanding.
Career guidance and choices are one of the most difcult stages
for high-school students and in todays world, it is imperative to be
as well informed as possible to make the correct decision. There are
several programmes that have operated to encourage rural students
to consider careers in medicine.
1012
To our knowledge, this is the
rst programme for suburban and rural students in Ireland with
published results of inuence on the participants course and career
decisions.
School visits by undergraduate health students have been used
successfully to motivate rural students to pursue health careers in
Australia and the USA.
26,27
In our programme, one of the sessions was
informal conversations with medical students, trainee doctors in
different specialties and visiting fellows. This was to highlight the
journey in medicine, which the participants found very entertaining
and informative. Our preliminary results have shown that the Mini-
Medical School was very well received by the Transition-Year stu-
dents. Many of the students fromthe periphery could not have availed
of the Dublin opportunity because of the logistics and having such a
focussed career guidance package close to home was very attractive.
All of the schools were given equal opportunity and allocations on a
rst come, rst served basis and the autonomy of selecting students
remained with the schools (linked with the students interests). Most
of the students had an established interest in medicine as quantied by
the survey with personal factors being the main driving force. Inter-
estingly, the specialty of surgery along with emergency medicine was
among the top most preferred specialty choice with manual dexterity
and intellectual challenge as the main factors behind this preference.
A similar attitude was reected during the rating of the live video
demonstration of an operation, which was very well received, with a
Table 2 Interest in medicine and factors inuencing the interest
Number (%) Female (%) Male (%) P-value
Level of interest in medicine
Denite 40 (44) 25 (62) 15 (38) 0.665
Strong 34 (38) 19 (56) 15 (44)
Moderate 16 (18) 11 (69) 5 (31)
Factors inuencing the level of interest 0.01
Wanting to help others 40 (44) 27 (67) 13 (33)
Intellectual challenge 26 (30) 20 (77) 6 (23)
Personality t with medicine 11 (12) 3 (27) 8 (73)
Past experience with doctors 5 (6) 1 (20) 4 (80)
Advice from family and friends 4 (4) 3 (75) 1 (25)
Financial rewards 4 (4) 1 (25) 3 (75)
Family member being a doctor 0.015
Yes 19 (22) 7 (37) 12 (63)
No 71 (78) 48 (67) 23 (33)
Family member being a doctor inuencing the interest in medicine 0.07
Moderate to denite 15 (79) 4 (26) 11 (74)
None to slight 4 (21) 3 (75) 1 (25)
TV programme inuencing the interest in medicine 0.38
Greys anatomy 28 (31) 15 (54) 13 (46)
ER 26 (29) 17 (65) 9 (35)
Casualty 20 (22) 8 (40) 12 (60)
Others 16 (18) 8 (50) 8 (50)
Table 3 Level of interest in sub-specialty and factors inuencing the
interest
Level of interest in sub-specialty in medicine
Surgery 40 (45)
ED doctor 29 (32)
Child doctor 11 (12)
Family doctor 10 (11)
Factors inuencing the level of interest in surgery
Enjoy working with hands 45 (50)
Intellectual challenge 28 (31)
Personality t with surgery 15 (17)
Financial rewards 2 (2)
Good understanding of a surgical operation
Before the live video 56 (63)
After the live video 87 (97)
Table 4 Overall rating of the programme and its inuence
Most valuable section of the session
Live patient session 42 (47)
Live Surgery 38 (42)
Clinical skills 8 (9)
Research/communication and others 2 (2)
Role of mini-med school in inuencing the Central Admission
Ofce choices
No 51 (57)
Yes 39 (43)
Ease of access to mini-med school
Easily accessible 54 (60)
Not easily accessible 36 (40)
Mini-Med School 485
2012 The Authors
ANZ Journal of Surgery 2012 Royal Australasian College of Surgeons
reported improvement in understanding of a surgical procedure. It is
important to note here that the various medical television programmes
have a signicant, although similar, inuence in Transition-Year
students understanding and interest in medicine.
About 60% of the participants in our study were females. This is
an interesting observation, reected in other studies and easily
explained by the obvious interest and drive in this group. The female
to male ration of Mini-Medical School applicants may be inuenced
by the distribution of co-educational and non co-educational schools
in the South Eastern Region. Another interesting nding of our
survey is that the majority of the participants had already decided
their top career choices prior to the programme (with majority inter-
ested in medicine) and although they felt that Mini-Medical School
programme was very effective and useful, nevertheless it did not
alter their choices afterwards. This might be reected by the fact that
participants who already had made their decision felt that the Mini-
Medical School, however, did help them understand one of their
career choices better. This trend may be claried better after a longer
follow-up and increasing number of consecutive Mini-Medical
School programmes. Whereas 43% of the participants did believe
that the Mini-Medical School had inuenced their career choice
decision to change towards medicine.
In summary, the Mini-Medical School is a highly effective plat-
form for both the medical specialties and the Transition-Year
students. It not only informs the public and enhances their under-
standing, but also helps foster a good relationship between the
society and the clinician/educators. Most importantly, it serves as a
useful tool for guiding the ambitious young students in their career
path, which may help them in adopting a systematic approach in
lifetime career choices.
Acknowledgements
The authors wish to thank the following for their invaluable contri-
bution: Dr R. Mulcahy Senior Lecturer Royal Collage of Surgeons in
Ireland and Consultant Geriatrician Waterford Regional Hospital; Mr
Joe OBeirne, Consultant Orthopaedic Surgeon Waterford Regional
Hospital; Professor Fred Jackson Honorary, Associate Professor of
the Royal College of Surgeons of Ireland and Consultant Haematolo-
gist Waterford Regional Hospital, Waterford, Ireland; and Mr Eric
Clarke, lecturer in health informatics, RCSI, Dublin, Ireland.
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