Changes in medical students' perceptions of family practice resulting from a required clerkship

BACKGROUND: Career choice research has shown that exposing medical students to family medicine, through a special medical school emphasis or a required clerkship, correlates with an increased rate of selection of family practice. It has been hypothesized that actual exposure to family medicine mitigates the negative stereotypes held by many medical students. METHODS: This study used a qualitative strategy to examine how a family medicine clerkship altered medical students' perceptions and attitudes toward this specialty. A series of 12 focus groups were conducted with the students who had just completed a required family medicine junior core clerkship at our institution. RESULTS: Focus group findings confirmed the existence of negative stereotypes about family practice among medical students and provided additional information on their nature and origins. In addition, student comments indicated that a third-year family medicine clerkship experience dispelled this negative stereotyping and instilled in students a greater respect for and interest in family practice. CONCLUSION: Third-year clerkships can enhance students' perceptions of family practice by dispelling negative stereotypes and by providing medical students with a more accurate portrayal of the nature of this primary care specialty.     

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.     

Prevalence of harassment and discrimination among 1996 medical school graduates: a survey of eight US schools

CONTEXT: Harassing and discriminating behaviors on the part of instructors or supervisors are known to affect the quality of work performed by medical students, influence their career decisions, and have other undetermined long-term consequences. OBJECTIVE: To assess the prevalence and forms of harassment and discrimination experienced by 1996 medical school graduates. DESIGN: A self-administered survey of harassment and discrimination mailed to graduating medical students. SETTING AND PARTICIPANTS: A total of 1001 graduating medical students at 8 US medical schools (4 public and 4 private), chosen from each of the 4 regions designated by the Association of American Medical Colleges for geographic categorization. OUTCOME MEASURE: The number of reported experiences of various forms of harassment and discrimination while attending medical school. RESULTS: Of 1001 surveys, 548 (55%) were returned. Overall, 46% of the students reported experiencing some form of harassment and 41% some form of discrimination from instructors or supervisors while attending medical school. Nonsexual verbal harassment was reported by 41%; sexual verbal harassment was reported by 10%. Discrimination based on gender was reported by 29% of students; discrimination based on race was reported by 12%. CONCLUSIONS: Harassment and discrimination of medical students by instructors and supervisors continue to occur frequently, and new approaches are needed to address these problems.     

Review of the regulations on quality control of human albumin

PURPOSE: To assess medical students' perceptions of the ethical environment across four years of medical school. METHOD: In the spring of 1996, the authors distributed a questionnaire to all four classes at the Wake Forest University School of Medicine. The students provided demographic information and information about their exposures to or participation in unethical situations. Results were analyzed using multiple analysis of variance, univariate analysis of variance, Pearson correlation, and cross-tabulations. RESULTS: The response rate was 71%. The students reported that exposures to unethical behavior started early and continued to increase with each year in school. For example, 35% of the first-year students reported observing unethical conduct by residents or attending physicians. This percentage rose to 90% of the fourth-year students. The authors found no significant relationship between demographic variables other than the year in school and the ethical dilemma variables. CONCLUSION: Medical students face perceived ethical dilemmas beginning as early as the first year of medical school. Thus ethics instruction must begin in the freshman year. In addition, there must be changes to the environment in which clinical education is conducted to enhance the positive enculturation of students into the medical profession.     

On rising medical student debt: in for a penny, in for a pound

Using national databases of the Association of American Medical Colleges, the authors have examined reasons for the rising indebtedness of U.S. medical students, looking across the past decade at the influence of tuition and fees (tuition-fees) alone and the total costs of attending school, the effects of the changing demographics of medical school enrollments and lengthened graduation times, the relationship between the availability of school-funded scholarships and the amount of student loan disbursements, the pattern of student financial aid, and the reliance on borrowing to cover the costs of medical education. In constant dollars, the average indebtedness of students graduating from public schools increased 59.2% between 1985 and 1995, and that for graduates of private schools increased 64.2%. The fraction of graduates bringing debt with them when they entered medical school declined from 42.1% in 1985 to 33.6% in 1995. Premedical debt as a fraction of total debt declined at public schools from 9% in 1985 to 7% in 1995, and at private schools from 7.8% in 1985 to 5.9% in 1995. For public schools, tuition-fees increased 60.1% between 1985 and 1995, and average medical school debt increased 60.9%; for private schools, tuition-fees increased 30.1% over that period, while average medical school debt increased 66.2%. On average, public school graduates accrued debt greater than their four-year tuition-fee payments, while the average debt accrued by private school graduates was less than tuition-fee amounts. In 1995, graduates of public schools had debt accumulations representing 62% of the average total cost of attendance (tuition, fees, books, supplies, equipment, and living expenses), and the indebtedness of private school graduates was 55% of the average total cost, findings suggesting that total costs were the stronger driver of the amounts borrowed. On a national scale, the influences on medical school debt of longer graduation times, the growing number of women students, greater racial-ethnic diversity, and the admission of more older students age were negligible or small. The average parental income, adjusted to constant dollars, actually increased between 1985 and 1995. For public schools, the aggregate amounts of student aid have climbed at a steeper rate than schools' tuition-fee revenues during the past decade. For public schools, tuition-fee revenues rose 66.7% between 1985 and 1995, while the amount of loans to students at public schools increased 92.7%. For private schools, tuition-fee revenues went up 36.5%, and the amount of loans to students rose 57.9% during the same period. Federal Stafford Loans represented the major financing source, increasing from 71.5% of public schools' tuition-fee revenue in 1985 to 92.2% in 1995, and from 23% of private schools' tuition-fee revenue in 1985 to 38% in 1995. Over the decade, scholarship support kept pace with tuition-fee increases at public schools, but lagged behind the increases at private schools. The recent escalation of student debt has coincided with the lifting of the federal loan borrowing limits under the Higher Education Act. In parallel, entering medical students have declared their intentions to rely more heavily on loans as a means of financing. These findings, although based on national data and trends, provide a framework for exploration of the factors affecting educational costs and financing at individual medical schools. The importance of doing so is mounting, as students may be throwing caution to the winds in the more favorable climate for borrowing, ignoring indicators of changing practice opportunities and incomes ahead.     

Familial occurrence of a del(Xp-) chromosome: pitfall in karyotype/phenotype correlation

PURPOSE: To examine the attitudes of physicians practicing in New Mexico toward gay and lesbian medical students, house officers, and physician colleagues. METHOD: In May 1996, the authors mailed a questionnaire with demographic and attitude questions to 1,949 non-federally employed physicians practicing in New Mexico. The questionnaire consisted of questions dealing with medical school admission, residency training, and referrals to colleagues. The response rate was 53.6%. RESULTS: Of all the responding physicians, 4.3% would refuse medical school admission to applicants known to be gay or lesbian. Respondents were most opposed to gay and lesbian physicians' seeking residency training in obstetrics and gynecology (10.1%), and least opposed to their seeking residency training in radiology (4.3%). Disclosure of homosexual orientation would also threaten referrals to gay and lesbian obstetrician-gynecologists (11.4%) more than to gay or lesbian physicians in other specialties. CONCLUSION: Physicians' attitudes toward gay and lesbian medical students, house officers, and physician colleagues seem to have improved considerably from those reported previously in the literature. However, gay men and lesbians in medicine continue to face opposition in their medical training and in their pursuit of specialty practice.     

Tobacco use disorder]

PURPOSE: To compare first- and fourth-year medical students' opinions about primary care practice. METHOD: A cross-sectional survey was made of medical students at New York Medical College (NYMC) and East Carolina University School of Medicine (ECUSOM) over three years (1993-94, 1994-95, and 1995-96). Three consecutive classes of first-year students from both schools (n = 807), two consecutive classes of fourth-year NYMC students (n = 373), and three consecutive classes of fourth-year ECUSOM students (n = 221) were given a self-administered questionnaire about professional aspects of primary care practice. Responses to ten items about primary care practice were the independent variables in a logistic regression analysis. Career choice, categorized as primary care or non-primary care, was the dependent variable. Independent, two-tailed t-tests were employed to compare the responses of the first-year students interested in primary care careers with those of the fourth-year students interested in primary care careers. RESULTS: In all, 639 (79%) of the first-year students and 396 (67%) of the fourth-year students returned completed questionnaires. The first-year students interested in primary care careers were significantly more likely to believe that primary care practice has more prestige, has more intellectual stimulation, needs a large knowledge base, and involves work that is more important than that of non-primary care physicians, and were significantly more likely to disagree with the assertion that in primary care practice, physicians have more control over their working hours. With one exception (prestige of primary care practice), all these independent variables were significant for the fourth-year students as well. The comparison of the first- and fourth-year students indicated that the fourth-year students were significantly more likely to believe that primary care practice has more intellectual stimulation, needs a large knowledge base, and requires knowledge that non-primary care practice may not; they were also significantly more likely to disagree with the assertions that primary care practice is adequately compensated, has more prestige, and allows more control over working hours. CONCLUSION: It appears that students' positive perceptions about primary care practice may change as realistic perceptions about the professional demands on primary care physicians develop during medical school.     

Primary care by desire or default? Specialty choices of minority graduates of US medical schools in 1983

This study was undertaken to determine if US medical school students of different racial/ethnic backgrounds demonstrate similar patterns of evolution of specialty choice between their senior year of medical school and their third postgraduate year. The study identified the specialty choices of US medical school seniors in 1983 through their responses to the Association of American Medical Colleges Graduating Medical Student Questionnaire (GQ). The cohort was classified into three groups: underrepresented minorities, non-underrepresented minorities, and whites. Using these AAMC data as baseline, each racial/ethnic background group was tracked through their third residency year. Comparisons were made between anticipated specialty choices as senior medical students and actual specialties as revealed through residency tracking. The study found that more than 95% of the cohort began residencies in specialties compatible with their GQ choices. Unexpectedly, almost 20% of blacks, Commonwealth Puerto Ricans, and other Hispanics were not in graduate medical education in their third postgraduate year. This group needs to be studied further in order to learn the proportion of these physicians who subsequently completed residency training and the reason(s) for attrition in physicians who did not fulfill minimum training requirements for board certification.     

The link between parents' perceptions of the school and their responses to school bullying: Variation by child characteristics and the forms of victimization.

A growing number of researchers encourage parents to notify the school when their children are bullied and work collaboratively with the school to resolve the situation. However, there is limited research on factors that are associated with parents' responses to their child's victimization. Using data from an online survey of 773 parents of victimized students enrolled in 93 schools (elementary, middle, and high), the current study employed structural equation modeling to examine the association between parents' perceptions of the school's climate and parents' responses to their child's victimization. The results indicated that the more favorable parents' perceptions of the climate were, the less likely they were to contact their child's school or talk to their child in response to the victimization. The parents' perception of the climate and response choice also varied as a function of the child's age and the form of bullying experienced. These findings suggest that parents' perceptions of the school are associated with their responses to their child's victimization. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effect of debt level on the residency preferences of graduating medical students

BACKGROUND: The increased educational indebtedness of graduating medical students has led to speculation about the effects of students' debt levels on their choices of practice specialties as evidenced by their residency preferences. METHOD: Information was analyzed for 1,658 medical students who graduated from six private medical schools in 1988, 1989, and 1990; 1,431 of these students had educational debts. Chi-square analysis was used to compare the 1,431 students' average levels of indebtedness with their selections of residencies leading to specialties with higher or lower potential incomes. For this analysis, the students were grouped into four clusters based on the potential incomes of their specialty preferences. In addition, various subgroups, i.e., men, women, need-based scholarship recipients, and underrepresented-minority students, were also studied. RESULTS: For all the students, there was no relationship among their average levels of indebtedness and their specialty preferences. Similar results were obtained for all the subgroups--men, women, underrepresented-minority students, and scholarship recipients. However, the women students tended to have higher levels of indebtedness than the men. CONCLUSION: The results do not support the hypothesis that debt level is a determining factor among the variables that influence choices of residency by graduating medical students.     

Clinical teachers as humanistic caregivers and educators: perceptions of senior clerks and second-year residents

BACKGROUND: The acquisition and nurturing of humanistic skills and attitudes constitute an important aim of medical education. In order to assess how conducive the physician-learning environment is to the acquisition of these skills, the authors determined the extent to which clinical teachers are perceived by their trainees as humanistic with patients and students, and they explored whether undergraduate and graduate students share the same perceptions. METHODS: A mail survey was conducted in 1994/95 of all senior clerks and second-year residents at Laval University, University of Montreal and University of Sherbrooke medical schools. Of 774 trainees, 259 senior clerks and 238 second-year residents returned the questionnaire, for an overall response rate of 64%. Students' perceptions of their teachers were measured on a 6-point Likert scale applied to statements about teachers' attitudes toward the patient (5 items) and toward the student (5 items). RESULTS: On average, only 46% of the senior clerks agreed that their teachers displayed the humanistic characteristics of interest. They were especially critical of their teachers' apparent lack of sensitivity, with as many as 3 out of 4 declaring that their teachers seemed to be unconcerned about how patients adapt psychologically to their illnesses (75% of clerks) and that their teachers did not try to understand students' difficulties (78%) or to support students who have difficulties (77%). Compared with the clerks, the second-year residents were significantly less critical, those with negative perceptions varying from 27% to 58%, 40% on average. Except for this difference, their pattern of responses from one item to another was similar. INTERPRETATION: This study suggests the existence of a substantial gap between what medical trainees are expected to learn and what they actually experience over the course of their training. Because such a gap could represent a significant barrier to the acquisition of important skills, more and urgent research is needed to understand better the factors influencing students' perceptions.     

Perceived stress of nonhospitalized children during the hospitalization of a sibling

The purpose of this research was to examine nonhospitalized children's perceptions of the stress of the hospitalization of a sibling. The subjects were 45 nonhospitalized children (5-12 years of age), and their parents, who had a sibling hospitalized over 24 hours for a medical or surgical condition. The Child Drawing: Hospital (CD: H) was used to measure the perception of stress related to a sibling's hospitalization. The nonhospitalized children perceived the stress of hospitalization at a level of stress (anxiety) equal to the level of stress of hospitalized children and higher than children in a school setting found by previous investigators. Sex and age were not related to the degree of perceived stress (anxiety). The perception of stress varied significantly in relation to the type of sibling relationship, residence of the well sibling during the hospitalization, frequency of sibling visitation, and amount of parental behavior change as identified by the nonhospitalized children.     

Perceptions of the school social context across the transition to middle school: Heightened sensitivity among Latino students?

The current study was designed to examine the ways in which perceived behavioral norms among grade mates and school social climate vary across the transition to middle school. The main goals of the study were to test whether Latino students may be more sensitive to the school social climate than White students and whether perceived behavioral norms might help explain this association. Cross-sectional analyses comparing Latino and White students (N = 383) revealed that perceptions of school social climate and behavioral norms became more negative across the middle school transition. Multiple regression analysis showed that school climate perceptions predicted self-reported academic compliance and rule breaking only for Latino students. Mediational analysis revealed that the association between perceived climate and self-reported rule breaking was partially accounted for by perceptions of behavioral norms for rule breaking only among Latino students. Taken together, the results suggest that compared with White students, Latino students are more sensitive to school social climate as it relates to their school conduct. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Successful treatment of severe cytomegalovirus retinitis with foscarnet and intraocular injection of ganciclovir in a myelosuppressed unrelated bone marrow transplant patient

PURPOSE: To compare U.S. medical student Match results in 1996 for 19 categorical residency positions by specialty with those of the overall Match reported by the National Resident Matching Program (NRMP). METHOD: Data for the numbers of "active" senior U.S. student applicants (those who submitted rank lists), the numbers of U.S. seniors matched, and the numbers of unfilled positions for 19 specialties were obtained from a variety of sources. Chi-square analysis was performed to compare Match results for each independent specialty with the overall Match results. The level for statistical significant was set at p < .005. RESULTS: Eight specialties were identified as significantly more competitive than the overall Match process for both the percentage of U.S. seniors who successfully matched in that specialty and the ratio of unmatched U.S. senior applicants to unfilled categorical positions. Five specialties were identified as significantly less competitive for these two measures. Six specialties showed no significant difference in the percentages of U.S. students matching, but for three of these specialties there were more unmatched students than unfilled categorical positions. CONCLUSION: U.S. medical student Match results for categorical residency positions for different specialties vary significantly from the overall Match process. This information can be used in counseling senior medical students on their specialty selection and the residency application process.     

Performance on the radiology component of a critical clinical skills examination

RATIONALE AND OBJECTIVES: Clinical competence certification is now required in some specialties in medicine. A Comprehensive Clinical Assessment (CCA) was created to test mastery of critical skills by students at the end of the 3rd year of medical school. METHODS: The CCA is a series of stations that test skills the faculty consider important for all medical students (eg, breast examination, electrocardiogram reading, chest pain assessment, ophthalmology photographs). The radiology station was designed to evaluate imaging skills believed to be taught and learned in the core 3rd-year rotations. RESULTS: External measures (National Board Examinations, grade point average, and overall score) of clinical performance of the 608 medical students who completed the CCA examination between 1991 and 1993 were found to be correlated with the radiology station scores. CONCLUSION: The radiology station in the CCA examination is a reproducible measure of clinical performance.     

Dynein inner arm heavy chain identification in cAMP-activated flagella using class-specific polyclonal antibodies

In 1993, the Medical College of Pennsylvania (MCP), mindful of the rapidly changing environments of health care delivery, created three surveys to gather information from outside the school that would help the faculty plan how the curriculum and advising system could better prepare students and residents for the demands of twenty-first-century medicine. The first survey focused on the MCP seniors graduating that year and asked about their perceptions of their medical education and their specialty and residency choices. The second survey, directed to 40 medical residency program directors in family medicine, internal medicine, pediatrics, and surgery, sought to identify the characteristics of applicants that these directors valued when selecting entrants to their programs. The third survey, of 30 employers of physicians representing four practice environments (private practice, hospitals/other health systems, academic medical centers, and health maintenance organizations), sought information on hiring and recruitment practices and the skills, competencies, and attitudes these employers valued most when hiring recently graduated physicians. The responses showed several differences and/or misperceptions among the views held by the three groups surveyed and suggest that medical educators have not adapted as rapidly as have employers to changes in the health care environment. Academic health centers must broaden their missions and make changes in their own institutional cultures, both to maintain their own viability and to train physicians who have the balance between scientific and technical competency and essential personal characteristics (such as empathy) that the next century's practice will probably demand.     

Locus of control in Mexicans and Chicanos: The case of the missing fatalist.

Studied the extent to which a stereotype of Mexican or Chicano students as fatalistic is supported by their locus of control scores. Data came from Rotter's Internal–External Locus of Control Scale scores of male college students in 4 nations: US (86), Mexico (57), Ireland (47), and West Germany (54). Data show the Mexican Ss to be significantly more internally oriented than Ss from each of the other nations. Locus of control scores (determined with a scale developed by H. Levenson, 1974) for 151 Anglo and 95 Chicano senior high school students were also compared. Scores for Chicanos were nearly identical to those obtained from Anglo students. Only Chicano male high school students not planning to enter college showed any tendency toward a more external locus of control. It is concluded that to the extent a perceived external locus of control would be indicative of a fatalistic outlook, such perception is lacking in most data in Mexican and Chicano respondents. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Average thresholds in the 8 to 20 kHz range in young adults

RATIONALE AND OBJECTIVES: The Comprehensive Clinical Assessment (CCA) examination at the University of Michigan Medical School is a series of test stations through which the mastery of clinical skills is evaluated. The purpose of this study was to determine whether student performance on the radiology station improved in years when radiology faculty presented case-of-the-week unknowns to the 3rd-year students. MATERIALS AND METHODS: The authors compared four separate classes of medical students in examination years 1993, 1994, 1995, and 1996 by using the total CCA examination score, the radiology station score, and radiology station pass/fail rates. Radiology case-of-the-week presentations were given by the radiology faculty only in academic years 1993-1994 and 1994-1995 (examination years 1994 and 1995). RESULTS: The means and standard deviations of the radiology station scores for the examination years when case-of-the-week presentations were not given, 1993 and 1996, were 78.92 +/- 13.62 and 79.76 +/- 13.62, respectively. In the years case-of-the-week presentations were given, 1994 and 1995, the radiology station scores averaged 90.83 +/- 8.58 and 89.97 +/- 9.66, respectively (P < .001, global alpha = .05). Total CCA percentage correct scores were similar for all years studied. In 1993 and 1996, 7.6% and 5.3% of students, respectively, failed the radiology station. In 1994 and 1995, 0.4% and 0% of students, respectively, failed (P < .0001). CONCLUSION: Case-of-the-week presentations by radiology faculty increased 3rd-year students' basic radiologic knowledge as evidenced by increased scores on the radiology station of the CCA examination.