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FROM NURSE TO DOCTOR: A NARRATIVE INQUIRY

An Undergraduate Thesis Presented to the Faculty College of Nursing,


Davao Medical School Foundation, Davao City

In Partial Fulfillment
Of the Requirements for the Degree
Bachelor of Science in Nursing

SUBMITTED BY:

AGALIN. YASIERAH K.
ALONDAY, CHRISTINE JOY R.
MELLORIA, JELANIE M.
REBOSURA, DIRK LOWELL G.
SARZONA, SHAHANNA ELOISE A.

SEPTEMBER 30, 2017


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TABLE OF CONTENTS

Title page ...................................................................................................................... i

Table Of Contents .........................................................................................................ii

CHAPTER I ..................................................................................................................... 3
Background of the Study .............................................................................................. 3
Review of related literature and studies ....................................................................... 5
Statement of the problem ........................................................................................... 11
Purpose of the study .................................................................................................. 11
The grand tour questions and sub-questions ............................................................. 11
Scope and limitations ................................................................................................. 12
Significance of the study ............................................................................................ 12
Definition of Terms ..................................................................................................... 13

APPENDICES ............................................................................................................... 14
Appendix A - Letter to the Dean, College of Nursing ................................................. 14
Appendix B Informed consent ................................................................................. 15
Appendix C - Guided questions for interview ............................................................. 17
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CHAPTER I

INTRODUCTION

Background of the Study

Before an aspiring physician can advance into medical school, he/she must finish

a preparatory course to equip him/her with adequate knowledge and skills upon for

studying medicine; this undergraduate major is referred to as a premedical course.

According to Gross (2008) the premedical experience provides students with the

necessary knowledge and skills to succeed and play a major role in building the

character of the next generation of physicians.

Bachelor of Science in Nursing (BSN) is one of the health-related courses that

meet the criteria for a premedical course; this course involves basic sciences like

chemistry and anatomy which are pre-requisites for studying medicine in conjunction

with clinical exposures in different health-care areas that starts during sophomore years.

For this reason, nursing graduates who choose to pursue their education and study

medicine reported that their nursing experience helped them best during their last two

years of schooling when they started having their clinical exposures. According to some

nursing clinical instructors, their previous students who proceeded to medicine told

them, that what they studied in nursing helped them a lot during their clinical rotation.

Accordingly they said "we were already familiar with the routine and what should be

done in the clinical area because we had clinical rotations when we were nursing

students. According to Lee (2013) the clinical experience is the greatest advantage of
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being a nursing-medical student, Nursing students have the opportunity to have clinical

studies earlier while most premedical majors do not gain this experience until the

second half of medical curriculum.

Despite of this, BSN is not among the most common premedical course choices,

According to an annual survey conducted by the association of American medical

colleges, specialized health sciences (BSN included) represented only 3.02% of the

total number of US medical school applicants as of 2016-2017. This can be attributed to

the fact that medical school requires a strong science foundation of knowledge, as a

matter of fact, medical students who are BSN graduates needed great adjustment

during the first two years compared to their science-graduate classmates since their first

two years medicine are more on theoretical medical science, we struggled a lot during

our first and second years because we were not used to this great deal of medical

science and we needed to double our effort and time to study.

Choosing the right premedical course can be a hard decision for aspiring

physicians, thus, the purpose of this study is to determine the insights of being a BSN

graduate physician and gain a better understanding of the advantages and

disadvantages of having Bachelor of Science in Nursing as a pre medical course. This

study is significant to aspiring medical students as well as nursing students who want to

take up medicine for the outcomes of this study will serve as their basis for deciding

what pre-medical course they should undertake to prepare for their medical career.
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Review of related literature and studies

Undergraduate medical education plays an important role in building up a strong

foundation of knowledge for the aspiring medical students development. According to

Sun et al (2014) The educational objective of premedical education is to provide

desired college-level training in liberal arts as well as sciences, and to provide a basis

for future medical studies., Regardless of the chosen major, pre medical education

must advance the improvement of basic judgment and intelligent appraisal of truths and

issues and their application to real issues the student might experience as a medical

professional , the premedical experiences helps as well in making the character of the

upcoming future doctors (Gross, 2008).

The Philippines Universities and colleges guide defined the Bachelor of Science

in Nursing (BSN) as a four year degree program that teaches students the necessary

skills and knowledge to care for the sick and injured. The program revolves around four

main components; health promotion, disease prevention, risk reduction and health

restoration

According to the correlational study of De Clerq, Pearson and Rolfe (2001) which

aimed to determine the relationship of the previous tertiary education background and

the performance of the first year medical students at the Newcastle University,

Australia. The researchers identified and examined the different tertiary education

background, the level of degree, academic achievements and whether or not the

students had postgraduate qualifications. Also, the relationship of age and gender was

also examined in the research. The researchers gathered all the number of students
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admitted to medical course from the year 1990 to 1998 who had tertiary education

experience and entered via "standard" entry pathway. The first and final assessment

was the outcome measures. Logistic regression was used to examine the relationship

between the predictor and variables and outcomes. With the results of the first

assessment students who had nursing and arts background were most likely to receive

a "not satisfactory" assessment. At the final assessment, students with nursing

background and those who had less than distinction average were more likely to receive

"not satisfactory" result; consequently these students were required to repeat first year.

With this the researchers have suggested that identifying the students who had

encounter more academic difficulties can assist medical schools to focus academic

support appropriately. Based on this study, students with a previous tertiary

background in nursing or art have a higher chance of receiving a non-satisfactory

result and therefore repeat first year, however, according to the study by Grey et al that

was conducted in the same year, those who survived medical school into internship

showed no significant difference in performance between those with an educational

background in nursing compared to those with backgrounds in arts or science, The

researchers aimedto determine whether students who took non-science course

performs as well as students who took science courses in basic and clinical assessment

during the first three years of the four year graduate-entry program at the University of

Sydney. The chosen students were grouped into five categories: Health Professions,

Biomedical Sciences, Other Biology, Physical sciences or Non-science. The students'

performance rank in each group were examined for single best answer and modified

essay assessments separately and also calculated the relative risk of failure in the
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summative assessments in the second and third year. With the achieved results, the

researchers have concluded that, even if there are small differences in the

performances in Basic and Clinical assessments during the early part of the program,

these differences lessen with time. (Grey et al, 2001)

With regards to the academic performance in medical school, a study conducted

by Craig et al (2004) showed students with a Health Profession background have a

significantly better academic performance compared to biomedical major students

during their first year but later on their scores tend to converge with other students,

this study was supported by Berghout (2014) who described the same findings in her

study, she recognized that students with health related background have the advantage

of being familiar with certain subjects or skills from their previous study. Berghout further

elaborated that students with a non-science background struggle at first due to the big

gap in knowledge and demonstrate more effort in studying theory, but as they proceed

to the clinical phase, the previous clinical experience proves to be an advantage

especially for health-allied graduate students.

One clear advantage of being a nursing graduates is the early clinical experience

in different hospital settings that begins as early as second year, according to the

Philippines universities and colleges guide, these clinical duties are part of what is

called Related Learning Experience where nursing students are Supervised by an

experienced clinical instructor who will monitor their performance as they perform

nursing procedure on actual patients

Furthermore, nurses spend more time with their patients which plays a great role

in developing their assessment and communication skills, they are familiar with medical
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terminology and medical procedures as well as working in collaboration in hospital

settings (Morris, 2015), Berghout (2014) attributed this to those students previous

experiences in the medical field that have a positive impact on their performance, those

students are more familiar with what must be done and how as future physicians.

A number of studies have showed the positive impact of early clinical exposure

on the medical students performance, Jackson et al (2009) proved in their study that

pre clinical skills curriculum leads to positive improvements in the performance of third

year medical students,this study conducted in the university of Washington was aimed

at gaining at better understanding of the impact o such curriculum on the students

performance, the researchers reviewed the students performance evaluation before and

after the curriculum implementation and noted significant improvements mainly in terms

of communication and students attitude and increased level of confidence.

Dornan et al (2006) confirmed that early clinical experience helps improve the

preparation of pre-clinical students for their clinical rotations by introducing them to the

reality of the clinical environment, and facilitating application of knowledge to clinical

practice, they further explained in their results that Early experience helped medical

students to adjust to clinical environments and have a more professional, confident

interaction with patients and helped them develop their communication and basic

clinical skills , in addition, it also supplemented what they already learnt in classroom

setting and made it more real and relevant to clinical practice.(Dornan et al, 2006) it also

plays a great role in helping students integrate their knowledge regarding basic

sciences with clinical concepts which leads to observable improvements in the students

understanding and interest.( Widyandana et al, 2011)


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Studies in southern east Asia were supportive of this study results, Widyandana

et al ( 2011) conducted a study conducted in Gadjah Mada University, Indonesia

exploring the effects of early clinical experience (ECE) in comparison to students trained

only in skills laboratory, both groups of students had their clinical skills training program

in the skills in the skills laboratory but a selected group had the chance to have special

clinical skills training in public healthcare centres for 11 days while the other group had

more clinical skills training in the laboratory for the same time span, based on the

students feedback, those who were part of the ECE were more confident and had

better clinical and communication skills, they had the chance to see the difference

between the skills laboratory and a clinical environment and some of them were even

given the chance to perform clinical skills on actual patients which those students

perceived to be helpful in boosting their confidence and clinical skills application.

A similar study conducted in the Taibah University Medical Sciences in Malaysia

was aimed at determining the effectiveness of clinical skills training introduction during

preclinical years, the study surveyed the perception of 220 medical students with the

use of a questionnaire and results showed that study Early exposure to clinical skills

was proved to be helpful in integrating students knowledge in basic sciences with

clinical concepts as well as building confidence in performing physical examination and

taking health history, this integration enhances students understanding and interest.

Early Clinical Skills Learning was well-perceived by students in preparing them for their

clinical years. (Shuid et al, 2015)

Further studies showed that the implementation of an early student-patient

contact programs results in positive improvements in medical students performance,


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Ottenheijm at el (2008) stated that it would be feasible to implement such programs.

moreover, Peeraer at el (2009) conducted a study to evaluate the effectiveness of a

new curriculum applied at the University of Antwerp in Belgium, the new curriculum

involved Clinical and communication skills training starting from first year while basic

sciences courses were limited to the first one and half years, the outcomes of this study

showed no significant difference in the academic performance between the old and new

curriculum however the new curriculum graduates demonstrated a significant increase

in basic skills performance.

Studies showed that students entering the clinical phase of the medical

education encounter difficulties in applying the clinical skills learnt in actual patient

interaction (Radcliffe, 2003 ; Godefrooij, 2010), Sarikaya et al (2006) further explained

that the students anxiety arises from their fear of causing harm to their patients, early

introduction of clinical skills was confirmed to be associated with increased comfort level

of third year medical students during the application of clinical skills, it also helps

decrease their anxiety caused by transition into the clinical phase of the medical

curriculum (Whipple et al, 2006)

Furthermore, Diemers at el (2007) surveyed the perceptions undergraduate

medical students on preclinical contact of actual patients through in depth interview, the

outcomes of this interview were consistent with previous studies supporting the

conclusion that such a early patient contact is certainly advantageous for medical

students, in their study, it was affirmed to be beneficial in three aspects, the students

learning, knowledge construction and clinical reasoning.


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In terms of the students learning, it gave students motivation to study as they

didnt want to fail in performing the procedure in front of the patient; it also helped them

understand the disease process judging from the symptoms they can observe in the

patient. Regarding knowledge construction, the researchers confirmed that Real

patients stimulate not only acquisition of new knowledge but also activation of

existing knowledge and the actual contact with the patient helped integrate both types

of knowledge. As for clinical reasoning, the respondents stated that their preclinical

contact with the patient helped them develop analytic and non-analytic types of

reasoning and therefore improve their ability to diagnose and understand the patients

problem.

Statement of the problem

The study aims to gain an understanding of how a premedical course in BSN

affected the medical career of a Registered Nurse - Practicing physician.

Purpose of the study

The purpose of this study is to determine how does having BSN as a premedical

course help graduated nurses who chose to study medicine based on the insights and

experiences of a practicing physician who graduated Bachelor of Science in Nursing as

her premedical course.

The grand tour questions and sub-questions

What are the different a practicing physician who is a Bachelor of Science in

Nursing graduates on how her chosen pre-medical course and how it affected her

performance in their medical school years as well as medical practice. Specifically, this

study seeks to answer the following questions:


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1. What are the thoughts and feeling of a physician Bachelor of Science in

nursing graduate on BSN as a pre medical course?

2. What are the experiences of a physician who graduated BSN as a premedical

course?

3. Is a Bachelor of Science in nursing degree beneficial as a premedical course?

4. What are the advantages of BSN as premedical course?

5. What are the disadvantages of BSN as a premedical course?

Scope and limitations

This study will be focused on the insights and experiences of a practicing

physician who studied bachelor of science in Nursing as her premedical course and had

finished both courses Davao medical school foundation, Inc. The review of literature is

limited due to lack of researches and studies about the said topic.

Significance of the study

The outcomes of this study will be significant to the following:

Student nurses: This study will give an idea to student nurses who consider

proceeding to medicine regarding the impact of a nursing premedical course on their

performance in medical school as well as improving their understanding of the possible

challenges they are going to encounter in medical school.

Medical Students: This study will give idea to medical students with premedical

course other than BSN about the unique strengths and weakness of their classmates

who are BSN graduates, thus promoting understanding and sharing of experiences.
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Incoming College Students: The positive outcomes of this research will give

them information especially to those students who are aspiring to be future physicians

on how BSN is beneficial as a premedical course which encourages them to take up

nursing.

College of Nursing: this study will serve as basis for the college to recommend

nursing as a premedical course and widen its students understanding of the how a

premedical course in BSN can help those among them who want to take up medicine.

Future researchers: This study will serve as a guide and basis for future

researchers who will conduct a research similar to this topic.

Those who would like to study medicine would consider this study as a good

reference for choosing their pre medical course.

Definition of Terms

In order to deepen the comprehension of terms included in the study, the

following keywords are operationally defined:

Insights in this study, it is defined as the way the respondent understands and

views the advantages and disadvantages of taking Bachelor of Science in Nursing as a

pre-medical course.

Experiences in this study, it is defined as the collection of knowledge and skills

gained throughout medical school as well as during clinical practice as physicians

Premedical Course- preparing for or relating to the studies that prepare one for

the study of medicine


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.
APPENDICES

Appendix A - Letter to the Dean, College of Nursing

June 14, 2017

Mrs. Sherlita P. Lapore, RN, MAN


Dean, College of Nursing
Davao Medical School Foundation

Dear Maam,

Good Day!
We, the third year student nurses of Davao Medical School Foundation Inc.
are conducting a research entitled from Nurse to Doctor: A case study . This study will
be present to the faculty of Davao Medical School Foundation, college of nursing as
part of our requirement in Nursing. It will entail a series of Data gathering through
interviews
Having said these, we are formally asking for your permission to grant us
authorization in conducting an interview. Rest assured that the personal data of the
respondents will definitely remain private and confidential.

Hoping for your kind consideration on this matter.

Thank you and God bless!

Respectfully Yours,

Jelanie M. Melloria
Research Team Member

Signed by:

Sherlita P. Lapore, RN, MAN


Dean, College of Nursing
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Appendix B Informed consent

We, the fourth year student nurses of Davao Medical School Foundation

Inc., would like to inform you that we will be conducting a study entitled From Nurse to

Doctor: A case study. This study will be present to the faculty of Davao Medical School

Foundation, college of nursing as part of our requirement in Nursing. It will entail a

series of Data gathering through interviews.

Having said these, we are formally asking for your permission to grant us

authorization in conducting an interview. Rest assured that all information gathered and

the results of the study will be used for academic purposes only.

Hoping for your kind consideration on this matter.

Thank you and God bless!

Respectfully Yours,

Agalin, Yasierah K. Rebosora, Dirk Lowell G.

Alonday, Christine Joy R. Sarzona, Shahanna Eloise A.

Melloria, Jelanie M.

Noted by:

Mrs. Mary Ann C. Casas, RN, MAN Mrs. Nayla C. Pangan, RN, MAN
Research Mentor Research panel member

Mrs. Cecilia Grace F. Acua RN, MN Mrs. Sherlita P. Lapore, RN, MAN
Research Instructor Dean, College of Nursing
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Your presence is invited to participate in a study conducted by the 4 th year

student nurses of Davao Medical School Foundation Inc. entitled From Nurse to

Doctor: A case study. We hope to learn about the experiences you had in your medical

education years and how did premedical course affect both your academic and clinical

performance in medical school of DMSF. You are selected as a possible participant of

this study because you are qualified to the criteria for this study.

If you decide to participate, we will conduct an in depth interview that will last

for at least thirty minutes to an hour. We will be recording the interview for the accurate

gathering of information. Questions that will asked are relevant to the study and can

help students who are aspiring to become physicians and consider to take the same

path as you. Any information that is obtained in connection with this study will remain

confidential and will be within the Davao Medical School Foundation Inc. only with your

permission.

You will be given a copy of this form to keep.

Your signature indicates that you have decided to participate, having read

this information provided above.

CONSENT FORM
I have read and understood the above information and had been given the opportunity
to consider and ask questions regarding the involvement in this study. I voluntary agree
to participate

__________________________________ Date: ________________


Name and signature of the participant
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Appendix C - Guided questions for interview

insights and experiences of a BSN-physician as a BSN student


-Did you have plans to proceed to medicine before you took up nursing?
If yes then why did you take up nursing?
Were there other premedical courses you were considering to take as
your premed?
If no then what made you decide to take up medicine?
Did you take the lisensure nursing exam for nursing?
If yes then did you work as a nurse before going to med school?
If no then why not?
-as a medical student how significant were your nursing concepts and theories
during medical school?
As a medical student how significant were your clinical rotations to you as a
medical student?
-what Nursing subject/s do you think were the most helpful in Medical school and
why?
In your opinion, what is the role of a premedical course in preparing the student
for medicine?

insights and experiences of a BSN-Physician as a medical student


What subjects in medicine did you find easier and why?
What subjects in medicine did you struggle in the most and why?
what challenges did you face as a medical student coming from a nursing
course? And how did you overcome those challenges?
According to most BSN medical student, the first and second year were the
hardest during medical school, do you agree with them, and why?
Based on your experiences, what aspects of your medical education do you think
your BSN premed course helped you in best?
How Did your previous experience in clinical duties help you when you started
having clinical rotations as a medical student ?
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How would evaluate your academic performance during your medical education
years compared to your peers with different premedical backgrounds?
How would evaluate your clinical performance during your medical education
years compared to your peers with different premedical backgrounds?
In your opinion, what is unique about a medical student who is a BSN graduate?
In your opinion, what were the advantages and disadvantages of nursing for you
as medical student?
Were there any similarities between nursing curriculum and medical curriculum?
What are the differences you noticed between nursing curriculum and medical
curriculum?
Were there any similarities you have noticed between the work of a nurse and
the work of a doctor?
Considering your overall experience, do you think it was easier or hard for you to
become a doctor?
According to many medical students, the third and fourth year medicine can be a
hard part because there is this transition from the theoretical phase to the clinical
phase, did you experience this kind of difficulty as a medical student?
Does becoming a medical student require adjusting certain study habits that you
had in nursing?
Considering that first and second year is the hardest part of studying medidicne
for BSNs, what advice can you give to those BSN medical students?
In your opinion, How can BSN medical students conpensate for there lack of
knowledge in medical subjects?

insights and experiences of a BSN-Physic ian as a Medical intern


Nurse are good in communication, why do you think communication is important
for a physician?
How was your hospital exposure as an intern compared to your hospital
exposure as a nursing student?
What is the easiest part of duty in your opinion? (ex. Charting, speaking to
patient, diagnosis.....)
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insights and experiences of a BSN-Physician as a Medical practitioner


in your opinion, what makes a nurse-physician unique or different from other
physician with different premedical course
would you recommend nursing as a premedical course, and why?
what would you advice nursing students who are willing to proceed to medicine?
do you believe in the saying that medicine requires the person to be intelligent
and smart bright to become a good doctor and why?
How is it feel to be a Doctor in your first day of duty?

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