title: Medical student satisfaction, coping and burnout in direct-entry versus graduate-entry programmes.
abstract: BACKGROUND
  There is ongoing debate regarding the optimal length of medical training, with concern about the cost of prolonged training. Two simultaneous tracks currently exist in Australia: direct entry from high school and graduate entry for students with a bachelor degree. Medical schools are switching to graduate entry based on maturity, academic preparedness and career-choice surety. We tested the assumption that graduate entry is better by exploring student preferences, coping, burnout, empathy and alcohol use.
  
  
  METHODS
  From a potential pool of 2188 participants, enrolled at five Australian medical schools, a convenience sample of 688 (31%) first and second year students completed a survey in the middle of the academic year. Participants answered questions about demographics, satisfaction and coping and completed three validated instruments.
  
  
  RESULTS
  Over 90% of students preferred their own entry-type, though more graduate-entry students were satisfied with their programme (82.4% versus 65.3%, p < 0.001). There was no difference between graduate-entry and direct-entry students in self-reported coping or in the proportion of students meeting criteria for burnout (50.7% versus 51.2%). Direct-entry students rated significantly higher for empathy (concern, p = 0.022; personal distress, p = 0.031). Graduate-entry students reported significantly more alcohol use and hazardous drinking (30.0% versus 22.8%; p = 0.017).
  
  
  CONCLUSIONS
  Our multi-institution data confirm that students are generally satisfied with their choice of entry pathway and do not confirm significant psychosocial benefits of graduate entry. Overall, our data suggest that direct-entry students cope with the workload and psychosocial challenges of medical school, in the first 2 years, as well as graduate-entry students. Burnout and alcohol use should be addressed in both pathways. Despite studies showing similar academic outcomes, and higher total costs, more programmes in Australia are becoming graduate entry. Further research on non-cognitive issues and outcomes is needed so that universities, government funders and the medical profession can decide whether graduate entry, direct entry, or a mix, is ideal.
authors.affiliation: Rural Health Academic Centre, Melbourne Medical School, Shepparton, Victoria, Australia.
authors.forename: Dawn
authors.initials: D
authors.lastname: DeWitt
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: Benedict J
authors.initials: BJ
authors.lastname: Canny
authors.affiliation: School of Medicine and Dentistry, University of Rochester, Rochester, New York, US.
authors.forename: Michael
authors.initials: M
authors.lastname: Nitzberg
authors.affiliation: School of Medicine and Dentistry, University of Rochester, Rochester, New York, US.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Choudri
authors.affiliation: School of Medicine and Dentistry, University of Rochester, Rochester, New York, US.
authors.forename: Sarah
authors.initials: S
authors.lastname: Porter
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology; D002055:Burnout, Professional / Q000523:psychology*; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D009517:New South Wales; D010549:Personal Satisfaction; D012577:Schools, Medical; D013337:Students, Medical / Q000523:psychology*; D014739:Victoria