Profile of the graduate student population in U.S. medical schools

The Association of American Medical Colleges (AAMC) sponsored surveys of accredited U.S. medical schools in 1994-95 and in 1995-96 to gather enough data to determine an accurate profile of the population of students enrolled in and/or graduated from biomedical PhD and MD-PhD programs at these institutions. Previously collected data on the graduate student population at medical schools often did not distinguish between PhD students at the medical school and graduate students in other parts of the university. The AAMC surveys defined a medical school PhD- or MD-PhD-trained student as one whose major professor holds his or her primary appointment in a department of the medical school. The data were the result of census-taking by the responding schools on October 1, 1994, and October 1, 1995. There were 81 responses to each of the two surveys. Overall, 104 medical schools supplied data in either one or both of the survey years. When the data are extrapolated from the sample to the total population of 122 medical schools that award graduate degrees, a number of interesting estimates emerge. (1) When compared with the 1995 data for 18 biomedically-related biological science disciplines from the National Research Council's Survey of Earned Doctorates, the AAMC survey indicates that approximately 60% of the 4,000 PhDs awarded were earned by students studying at U.S. medical schools. (2) The total enrollment of PhD students in U.S. medical schools is approximately 18,600, a number that is about 25-30% of the number of medical students currently enrolled at all accredited U.S. medical schools. In some institutions, the number of graduate students rivals the number of medical students. (3) PhD students are enrolled in a wide variety of programs bearing titles reflective of a trend toward "interdisciplinary" rather than "departmental" degrees. (4) At a given time, the number of students supported by National Institutes of Health (NIH) research grants is nearly twice that provided for by NIH traineeships. In addition, all forms of institutional support provide for more than one-third of the PhD students in U.S. medical schools. (5) Approximately 24% of enrolled students are international students on temporary or permanent visas. (6) The data obtained from the two surveys of graduate programs within medical schools are relatively consistent, enabling more confidence in the reliability and accuracy of findings presented in this report.     

Mixed messages about primary care in the culture of U.S. medical schools

PURPOSE: To examine the contributions of school-level variables associated with primary care career choice to students' enthusiasm for and perceived encouragement toward primary care. METHOD: Multilevel analysis of 264 fourth-year students and 500 clinical faculty members at 59 medical schools using data obtained in 1993 to 1994 from telephone interviews of a national stratified probability sample of students (response rate 90%) and faculty (response rate 81%). RESULTS: On average, students reported slightly positive regard for primary care and felt neither supported nor unsupported in their interests in primary care. Students' reports of encouragement toward primary care showed some consistency within schools (intraclass correlation = .08); their regard for primary care did not (intraclass correlation = .02). Regard for primary care was associated with students' intended specialty choices (p < .001), with students who planned to enter primary care careers reporting more positive attitudes. Students' perceptions of encouragement toward primary care careers were unrelated to their intended specialty choices, but significantly related to their schools' historical primary care production (p < .0001), federal research funding (p < .01), and school ownership (p < .01). CONCLUSION: Schools that have primary care missions and have historically produced more generalists transmit higher levels of encouragement to their students about primary care. However, even at schools with strong primary care missions, students hold unenthusiastic attitudes about primary care practice.     

The influence of accreditation on educational change in U.S. medical schools

The authors examined the influence of accreditation on educational change and reform in U.S. medical schools in the past decade, by reviewing the survey databases and site visit reports of 90 schools that had comprehensive accreditation surveys by the Liaison Committee on Medical Education (LCME) between July 1992 and June 1997. In this study, substantive change was defined as centralizing the design and management of the curriculum, as well as one or more of the following reforms: integrating basic and clinical science instruction and/or conversion to interdisciplinary courses; implementing methods of active, small-group, independent, and hypothesis-based learning; and substantially increasing students' exposure to ambulatory and primary care. Accreditation reports were reviewed to determine the extent to which the LCME previously had admonished schools for shortcomings in their educational programs and advised curricular changes. Notice was taken of grant support by national foundations promoting educational reform, in relation both to the correction of accreditation deficiencies and to curricular reform undertaken by schools on their own initiative. The study also scrutinized the evolution of accreditation standards promoting educational reform, and the LCME's support of initiatives for shortening the period of medical education and promoting performance-based teaching and the assessment of clinical skills. On entering the 1990s, the LCME toughened the standards for design and management of the medical curriculum and for the evaluation of educational program effectiveness that schools must conduct. The greater assessment rigor identified educational shortcomings in 61 of 90 medical schools coming up for accreditation surveys during 1992-1997. On those occasions, 34 of the 61 schools had instituted reforms or were on the verge of doing so. Twenty-five of the schools carrying out reforms (73%) had received major foundation grants, compared with ten of the 27 schools (37%) that had accomplished little. Fifteen schools that had not been reproached earlier were found on the 1992-1997 surveys to have undertaken substantial innovation on their own initiative, five with the help of major foundation awards. The study also shows that a number of schools implemented parts of more sweeping reforms with the help of smaller foundation grants for more discrete purposes. In some instances, it has not been possible to differentiate the influence of the LCME as a force for educational reform from the incentives for change created by national foundations. Overall, the LCME, through its standards and assessment practices, and in synergy with schools and kindred agencies promoting change, is now on the leading edge of improved education and evaluation in the nation's medical schools.     

Psychologists in medical schools.

Describes developments at a medical school on which H. A. Witkin et al (1972) based their article on approaches to the problem of autonomous organization and function of psychologists in medical schools. The Rush-Presbyterian-St. Luke's Medical Center established the Department of Psychology and Sciences of Society. The Department is independent and autonomous; it embraces all psychologists and social scientists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists in medical schools.

Describes the results of a survey conducted by the Committee on Psychology in Medical Schools for the Education and Training Board of the American Psychological Association, utilizing 84 reports from medical schools in 1967-1969 period. Psychology's growth in medical school has followed no standard pattern, but has developed in unique fashion at each school as a function of local constellations of factors. The great expansion of psychology in medical schools has occurred in the last 2 decades, but the period of rapid growth has now ended. While psychology is still most often based within the department of psychiatry, greater diversity of locations is found in schools where psychology was established more recently. Teaching is a major function of medical school psychologists. Their main teaching contribution is to medical education, but they are also involved at all levels of psychological education. Research, which covers the full range of psychological interests, and clinical services, which are beginning to reach out into the community, are the other main functions of medical school psychologists. The satisfactions found in the medical school as a professional environment relate to the vast array of clinical populations, research facilities, and disciplines available there. Dissatisfactions are primarily a result of inadequate recognition as an independent discipline. Overwhelmingly, medical school psychologists desire a more autonomous position for psychology, most often through the mechanism of an independent department of psychology. Other mechanisms recommended are the behavioral sciences department and the "single faculty model" in which 1 university department provides psychological training to all the schools of the university. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dynamics of dimensions of age-related disability 1982 to 1994 in the U.S. elderly population

Declines in chronic disability were observed in the National Long Term Care Survey (NLTCS) 1982 to 1994. We analyzed the 1982, 1984, 1989, and 1994 NLTCS to identify the dimensions of chronic disability from multivariate analyses of a rich battery of measures of the ability (or inability) to perform specific activities. Changes over time in the prevalence of individual disability dimensions can be tracked to evaluate the rate of age-related losses of specific functions, 1982-1994. Seven dimensions described changes in the age dependence of 27 activities of daily living, instrumental activities of daily living, and physical performance measures in community and institutional resident elderly individuals over the 12 year period. Adjusted for age, the healthiest dimension with the best physical function experienced the largest increase in prevalence (3.3%) implying a decline in age-related disability. Disability declines were correlated with reductions in select health conditions (e.g., dementia and circulatory disease) over the study period.     

The purposes of psychology curricula in medical education.

Among the general objectives of psychological instruction in medical education are providing sound conceptual backgrounds in general psychology, growth and development, motivation and emotion. A second objective would be "a program of theoretical and practical training in such professional skills as interviewing, observing, gaining and maintaining rapport, interacting in transference relationships… ." The role of the psychologist on a medical school faculty and problems of psychological instruction in graduate medical education are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender sensitivity in medical curricula

Both sex--the biologic aspects of being female or male--and gender--the cultural roles and meanings ascribed to each sex--are determinants of health. Medical education, research and practice have all suffered from a lack of attention to gender and a limited awareness of the effects of the sex-role stereotypes prevalent in our society. The Women's Health Interschool Curriculum Committee of Ontario has developed criteria for assessing the gender sensitivity of medical curricula. In this article, the effects of medicine's historical blindness to gender are explored, as are practical approaches to creating curricula whose content, language and process are gender-sensitive. Specific areas addressed include ensuring that women and men are equally represented, when appropriate, that men are not portrayed as the prototype of normal (and women as deviant), that language is inclusive and that women's health and illness are not limited to reproductive function. By eliminating or at least addressing the subtle and often unintentional gender stereotyping in lecture material, illustrations and problems used in problem-based learning, medical educators can undertake a much-needed transformation of curriculum.     

U.S. Navy Dental Corps Survey of 1994: analysis of narrative responses

The transfer of control of institutional health delivery from the medical profession to the managerial model and it's implications for the nursing profession is the subject of my enquiry. As the basis for an interpretation of Foucalt's work, I have used a previously unpublished text on power by Foucault, published in 1982 by Dreyfus & Rainbow as an 'afterword' for their book. I have used Michel Foucault's five factors for analysis of power, to summarise the elements which are exercised in these two forms of control. Although emphasis has been given to the effects of control on nursing practice, it is in nursing education that I have found possibilities for the nursing profession to address the challenges it now faces.     

Psychologists in Canadian medical schools.

Conducted a national survey of 67 psychologists holding academic appointments in 16 Canadian medical schools. The number of psychologists, their professional activities and work attitudes, and the organizational models of psychology at the medical schools were examined. Results indicate major differences in the average number of psychologists at Canadian and US medical schools. However, among the 2 groups of psychologists, a number of strong similarities in work activities and attitudes were found. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

U. S. medical graduates versus foreign medical graduates. Are there performance differences in practice?

This study has attempted to determine the relationship between physicians' medical education and their performances (technical quality and utilization of medical care resources) in offices and hospitals. The sample consisted of 506 physicians of Hawaii, involving 18 specialty categories. The study finds little evidence of the influence of the type of medical schools on physicians' technical quality and utilization of medical resources in practice. The mean differences between the categories of medical schools were not statistically significant (except for the quality when specialists practiced within their own areas of specialization). There is no evidence that all categories of U.S. medical graduates provided a higher quality care and better utilization than all categories of foreign medical graduates. There was no consistent pattern of performances within the categories of U.S. medical schools and of foreign medical schools in these dimensions of performances.     

Resource Use and Environmental Emissions of U.S. Construction Sectors

Reducing the environmental effects of construction is a continuing professional and social concern to promote sustainable development. In this paper, we estimate the major commodity and service inputs, resource requirements, and environmental emissions and wastes for four major U.S. construction sectors as defined by the Department of Commerce: (1) highway, bridge, and other horizontal construction [0.6% of the 1992 U.S. gross domestic product (GDP)]; (2) industrial facilities and commercial and office buildings (1.5% of GDP); (3) residential one-unit buildings (1.9% of GDP); and (4) other construction (towers, water, sewer and irrigation systems, railroads, etc.) (2.4% of GDP). Our estimates include the entire supply chain of material, energy, and service suppliers for these sectors with the use of a detailed 1992 input-output model of the U.S. economy and publicly available environmental data. We find that in general, the four major U.S. construction sectors appear to use fewer resources and have lower rates of environmental emissions and wastes than their share of the GDP might suggest.     

Psychologists in medical schools in 1997.

The activities, income, and medical staff membership and limitations on that membership for psychologists working in U.S. medical school settings in 1997 were examined. A total of 1,938 psychologists responded to a survey conducted by the Research Office of the American Psychological Association, in conjunction with the Association of Medical School Psychologists. Some of the most salient findings were that (a) the largest number of psychologists was involved in research activities, (b) just over half of medical school psychologists were required to generate all or part of their own income through clinical work and research, and (c) the majority of these psychologists were members of a medical staff but were not extended full medical staff privileges. These and other results are discussed in the context of academic rank, tenure status, and other relevant factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Study of U.S. medical school applicants, 1974-75

The applicant activity for the 1974-75 first-year class in U.S. medical schools presents an unusual combination of statistics. There were more applicants than ever before, but the annual growth rate showed a decline, a trend that began in 1973-74; the national acceptance average remained unchanged; and the average application frequency per individual was accelerated. Most of the traditional tables cover five years of historical data (1970-71 through 1974-75), while the new features--acceptance success for first-time and repeat applicants and ability levels by acceptance success and application frequency--depict data for one year (1974-75). As in past studies, the conclusion enumerates major efforts instituted by the Association of American Medical Colleges to assist medical schools with admission problems. The most important innovations among these were two new task forces--one for minority admissions and one for financial aid.     

Psychologists in medical schools: Comment.

Comments on the article by S. Williams and J. L. Kohout (see record 1999-10642-004) which presented data from a large survey of psychologists employed by medical schools and concluded that there is a growing marginalization of the psychologists' role in medical schools. The authors note that it is unfortunate that Williams and Kohout based their conclusions on limited evidence from their own survey and disregarded preexisting literature. The authors discuss methodological similarities and differences between their own survey conducted in 1994 and the survey of Williams and Kohout that have direct bearing on the interpretation of the results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cancer curricula for secondary schools: making the right choice

The American Cancer Society has produced and distributed for use in secondary schools a curriculum package entitled Right Choices. This article considers the development, testing, and marketing of the new cancer education program. Of particular interest is the selection of the theoretical perspective, evaluation methodology, and marketing strategy employed in its production, given the direction in which the field of health education is moving and the political context in which the curriculum has emerged. The author concludes that in selecting cancer prevention curricula for the schools, making the right choice may not be as simple as adopting what is available from the American Cancer Society. The case of Right Choices also serves to illuminate concerns about the American Cancer Society raised by others and bolsters the call for an examination of the organization's role in an effort to control cancer.     

Physician migration to the U.S.--foreign aid for U.S. manpower

Data were obtained from the American Medical Association on Iranian physicians practicing in the U.S., and from the Iranian Medical Registry on U.S.-trained Iranian physicians who have returned to practice in Iran. There were 2,066 Iranian physicians practicing in the U.S. in 1972, 1,234 (60%) of whom were not undergoing any training. Only 600 of Iran's 9,535 physicians in 1972 had been trained in the United States. Thus, less than one-third of the specialists who have completed training in the U.S. have returned to practice in Iran. The specialist group with the highest rate of return is the combined surgery subspecialties (neurosurgery, thoracic surgery, orthopedic surgery, and plastic surgery). The specialist groups with the lowest rates of return were pathology, anesthesiology, and psychiatry. A comparison is made of the manpower problems Iran faces and the American problems in the area of physician manpower.