Professional development of medical students: problems and promises

Observers and critics of the medical profession, both within and without, urge that more attention be paid to the moral sensibilities, the characters, of medical students. Passing on particular moral values and actions to physicians has always been an essential core of medical training, and this call for renewal is not new in modern medicine. Some of the structures and characteristics of modern medical education, however, often work directly against the professionalism that the education espouses. For example, medical students are socialized into a hierarchy that has broad implications for relations among health care professionals, other health care workers, and patients, and academic medicine has not promoted and taught critical reflection about the values and consequences of this hierarchy. Further, behind the formal curriculum lies the "hidden curriculum" of values that are unconsciously or half-consciously passed on from the faculty and older trainees. Two resources for thinking anew about professional development for medical students are feminist standpoint theory and critical multicultural theory, each of which raises important and fundamental questions about defining the role of medicine in society and the role of the physician in medicine. The author discusses these two theories and their implications for medical education, showing how they can be used to move discussions of professional development into analysis of the widespread social consequences of how a society organizes its health care and into critical reflection on the nature of medical knowledge.     

Reminiscences on a British Psychological Society Convention.

In this article the author comments upon being able to attend the 1963 spring convention of the British Psychological Society (BPS). He explains the location of the convention and briefly discusses some of the papers that were presented. He notes one of the largest audiences was drawn by a presentation by Neal Miller, reviewing, in the Midwestern "genre," some of the recent work done by himself and his students. At another interesting session, Eysenck lectured upon, and discussed, some of the theorizing and evidence presented in his Handbook of Abnormal Psychology. Overall, the author reports that the Reading BPS Convention was a most memorable event in his year's sojourn in Europe. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Oakley Stern Ray (1931-2007).

Presents an obituary for Oakley Stern Ray. Ray was a teacher--whether in the role of professor, chief, or colleague. Late in his life, he described himself as having had four "day jobs," although he could not have accomplished so much if he had limited himself to daylight hours. He so completely inhabited each role that the colleagues he knew in one capacity were often unaware the others existed. These four careers were Veterans Administration (VA) psychologist, professor, author, and executive. He always had at least two of these careers going at the same time, usually three. During the 1970s and 1980s, he was productive in all four simultaneously. Oakley's 76th birthday was February 6, 2007; he died of leukemia on February 7, 2007. He is survived by his wife Kathy Ray, his sons Steve, Christian, and Tom Ray, his daughter Deb Scanlon, his grandchildren--and thousands of students. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Academic deans' perceptions of current and ideal curriculum emphases

This study assessed the current and ideal for dental curriculum emphasis of thirty-three curriculum topic areas and evaluated barriers to curriculum change. A forty-six item survey was mailed to the academic deans of all U.S. dental schools with an 86 percent e response rate (n = 57). The means of their responses for current curricular emphasis and ideal emphasis on the thirty-three topic areas were compared. "Health promotion/disease prevention," "primary care," and "effective patient-provider relationships/communication" were the three topic areas rated most highly (for ideal emphasis) by the academic deans. "Case management," "outpatient/ambulatory care," and "continuous quality improvement" also received high mean scores for ideal emphasis. The most significant barrier to curriculum reform was "an already crowded curriculum." The academic deans reasserted the traditional emphasis in dentistry on primary care. There also appears to be considerable support for educational programs that will foster better patient relationships and greater quality assurance and control.     

Consulting in the midst of differences and similarities: Related tensions and complexities.

As a context for exploring the evolution of his work in the diversity arena, the author briefly describes community and academic milieus that have shaped his personal development and also his professional approach to diversity. He also shares some of the challenges he has encountered going about his consulting endeavors and managing client-consultant relationships. The author reviews what his responses to these challenges have been, and how the milieus that influenced his development have informed his strategies for managing client-consultant interactions. He concludes by recommending that consultants view relationship challenges with their clients as diversity issues and advocates that consultants practice "what they preach" about diversity to address these challenges--that is, that they should apply their diversity models to these difficulties. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Pure Types are Rare.

Reviews the book, Pure Types Are Rare by Irwin Silverman. This is a provocative book. In it, Silverman, with ambitious abandon, sets out to denude the "medical model of mental illness" of its Emperor's Clothing. Unceremoniously, Silverman strips away the clothing of the medical model: psychiatric diagnoses are unreliable and invalid, labels are applied at the whim of the psychodiagnostician; mental illness bears no resemblance to physical disease, mental "illness" is a myth; biological causes of mental illness do not exist; biological treatments serve only to mask the real social and psychological causes of madness; psychotherapy is no treatment at all, there are no "treatment" principles or methods. What remains after Silverman's assault on the medical model? The medical model as Emperor remains, albeit naked. Silverman views the medical model and the entire mental health enterprise as an Emperor indeed: it is a political ideology that serves to control the socially and economically impoverished. Silverman goes on to offer an alternative to the medical model, a social psychological perspective on madness. He favours a view of madness as a social role which may be adopted by a person in the process of coping with life conflict. Silverman attacks practically all of the important assumptions and practices of psychiatry and clinical psychology. His radical social perspective on mental illness is at such odds with the common psychological perspective that, obviously, most psychologists, be they practitioners or researchers, will not like this book. Silverman insists on too radical a departure from our common beliefs. Despite the reviewer's disagreement with Silverman's radical social perspective on mental illness, he thinks that this is a worthwhile book. While the reviewer disagrees with his premise that clinical practices are exclusively or primarily political in essence, the reviewer does agree that there are essential social and political functions served by our practices. Silverman relentlessly and effectively uncovers important social and political meanings of diagnostic and treatment practices. This, according to the reviewer, is the strength of the book. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Canada's king: An essay in political psychology.

Reviews the book, Canada's king: An essay in political psychology by Paul Roazen (1998). This book offers us an intriguing look at a set of psychiatric notes and files on Canada's longest-serving prime minister, William Lyon Mackenzie King. While not intended to be a full biography of King, Roazen does succeed in shedding light on a dark corner of this man's "dual" life. Roazen presents King as a man full of paradoxes, not the least of which is his distinguished but relatively unknown place in history. During his lifetime, his visits to mediums, holdings of seances, and hosts of other supernatural predilections remained guarded secrets. King naturally portrayed himself as the dutiful "public servant," skillful negotiator, and polished professional, with his private, spiritual/mystical side tucked "in the closet." After his death, King's "other" side has slowly been revealed to the public. The reviewer might have preferred a stronger sense of "leadership" or more insight into the evidence, but he never failed to find Roazen informative and his scholarship sound, if somewhat historiographically undernourished. Roazen concludes, and the reviewer would agree, that the most remarkable thing about King and the uncovering of his psychiatric file is how such an odd mix of ambition, mysticism, "neuroticism," and political savvy combined to give Canada its longest-serving prime minister and one of its most successful politicians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

APA and (AP)–2.

Psychology developed 100 yrs ago as a laboratory "science," and there was no real interest in application until World War I. After World War I, psychology became more applied, but after World War II it exploded as clinical psychology. Clinical psychologists sought a professional society in the state psychological associations and eventually gained the support of the American Psychological Association (APA). The author emphasizes that, although basic and applied training procedures parallel the medical model, clinical psychologists are not junior psychiatrists and that they make a unique contribution because of their training in research and statistics. The author further states that their contributions should be supported by all psychologists for the benefit of everyone, including academic psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sampson among the Philistines.

Comments on E. Sampson's (see record 2001-16333-002) linking individualism and collectivism to religious origins. The author comments critically on Sampson's grouping of all branches of Christianity in his critique of Protestant individualism. He points out theological subtleties and their historical roots to demonstrate the heterogeneous nature of Christianity and the relative similarity of Christian and Jewish intellectual traditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The organization of behaviour revisited.

Provides an overview of major themes in D. O. Hebb's thought in behavioural neuroscience. Hebbs saw psychology as a biological science, but one in which the organization of behaviour must remain the central concern. Through penetrating theoretical concepts, including the "cell assembly," "phase sequence," and "Hebb synapse," he offered a way to bridge the gap between cells, circuits and behaviour. He saw the brain as a dynamically organized system of multiple distributed parts, with roots that extend into foundations of development and evolutionary heritage. He understood that behaviour, as brain, can be sliced at various levels and that one of the challenges is to bring these levels into both conceptual and empirical register. He could move between theory and fact with an ease that continues to inspire both students and professional investigators. Although facts continue to accumulate at an accelerating rate in both psychology and neuroscience, and although these facts continue to force revision in the details of Hebb's earlier contributions, his overall insistence that we look at behaviour and brain together, within a dynamic, relational and multilayered framework, remains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Democracy’s discontent.

Reviews the book, Democracy’s discontent: America in search of a public philosophy by Michael Sandel (1996). This book has been widely read by academics, politicians and others in public life, and interested citizens, giving him the stature of a leading public intellectual in contemporary America. Even though it is a work of political philosophy, I believe that Sandel’s writings have a special relevance for theoretical and philosophical psychology. At the outset of this book Sandel delivers his often-quoted observation that the “anxiety of the age” is the “fear that, individually and collectively, we are losing control of the forces that govern our lives” and that “from family to neighborhood to nation...the moral fabric of community is unraveling around us” (p. 3). He then describes how this loss of a sense of personal efficacy and meaningful human ties might derive from the dominance in our society of the “public philosophy of contemporary liberalism.” (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Boulder model's fatal flaw.

The author argues that the Boulder model contained a fatal flaw that has distorted and damaged the development of clinical psychology ever since. It is suggested that the uncritical acceptance of the medical model, the organic explanation of mental disorders, with psychiatric hegemony, medical concepts, and language was the fatal flaw. The author contends that after World War II, psychologists were needed to provide psychiatric services for the vast number of veterans needing interventions for mental and emotional disorders. He maintains that by placing psychology graduate students in psychiatric settings for training and service, psychologists lost their students to the invalid, ideological tattered, often incompetent psychiatric worldview. In addition, the author suggests that there are major political differences between a medical/organic/brain-defect model to explain mental disorders and a social-learning, stress-related model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A blueprint for academic obstetrics and gynecology

A consensus conference sponsored by the Council of University Chairs of Obstetrics and Gynecology in February 1997 formulated the organization's response to the many external issues affecting academic medicine and obstetrics and gynecology including 1) a new practice model based on "wellness," 2) reimbursement changes that have jeopardized traditional revenue sources, 3) an emphasis on quality assurance based on outcomes research and evidence-based medicine, 4) the concept of lifelong learning dictated by an expanding knowledge base and new technology, 5) insufficient resources for basic and clinical investigation in obstetrics and gynecology, 6) workforce statistics indicating stabilization in the number of subspecialists, 7) the increasing diversity of the United States population. Recommendations were developed that are intended to foster change and contribute to the design of academic programs. These include appropriate training for residents as providers of primary care, with an emphasis on continuity clinics, an interdisciplinary curriculum in women's health for medical students; promotion of gender, racial, and ethnic diversity at all levels of medical education and academic leadership; creation of clinical trials research units; and the development of expanded opportunities for research in obstetrics and gynecology supported by the National Institutes of Health.     

Teaching gastroenterology in a private outpatient clinic

In this essay I review how I have taught clinical gastroenterology to residents and fellows and medical students for the past 40 years in an academic private outpatient clinic. Private patients can serve as "teaching patients," even in an ambulatory setting, and even in a managed care environment that encourages productivity.     

The class analysis of poverty: a response to Erik Olin Wright

In Erik Olin Wright's recent essay "The Class Analysis of Poverty," his principal argument was about the centrality of class for understanding and analyzing poverty. While agreeing with this central argument, the author of this article takes issue with Wright's analysis of class relations and in particular the position of the so-called underclass. The author offers instead an analysis that identifies poverty as a peculiar feature of capitalism and its class relationships, pointing to the need for a broader understanding of poverty and of the political forces that need to be mobilized for its eradication.     

Review of Theory and problems of adolescent development.

Reviews "Theory and problems of adolescent development," by David P. Ausubel (see record 1955-00581-000). Unlike most other books in this area, this book offers a systematic presentation of psychological knowledge woven around a dynamic point of view. It is a scholarly book written in language that makes for easy and interesting reading. The author opens his book with an organized set of arguments designed to convince his readers that there is justification for a book on the "Psychology of Adolescent Development." His major premise states that "adolescence is treated as a separate developmental period not because it covers a decade but because it spans an interval in which distinctive changes occur in a biosocial status of the human organism. The author has marshaled his psychological knowledge and psychiatric experience into a well-organized book. Dr. Ausubel quotes freely from other authors and from his own writings and research. There are extensive references contained in the bibliography at the end of each chapter. Although the author states that "this book is primarily intended as an advanced textbook in adolescent psychology for graduate students in psychology and education," it would appear that this book is written with sufficient clarity and nontechnical language to be used in any college course dealing with adolescent behavior. It would be especially desirable in clinically-oriented courses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Milgram, Kohlberg, and Dostoevsky.

Comments on a article by Blass (January 2009) (see record 2008-19206-006) who pointed out his historical perspective on human welfare problems facing a democratic society. The author would like to add some information from the cognitive-developmental framework that seems most pertinent to these larger issues of obedience and disobedience. It is relevant to note that a number of analogous studies reached similar conclusions on rates of obedience and disobedience to authority figures. Kohlberg (1984) and Jim Rest (1986), one of his closest colleagues, published a large number of studies outlining the base rates of moral judgment as assessed through the dilemma interview method and with the Defining Issues Test. The rates, as in the Milgram studies, remain remarkably stable; namely, about one third were rated at the postconventional level and two thirds at lower levels of moral judgment. These overall findings suggest that raising levels of moral and ethical judgment may be at least one factor in achieving the goals of a democratic society. It is only a short step, as Blass (2009, p. 37) noted, from obedience to the Holocaust. The author suggests that it is time to consider remedies to this human condition of obedience to authority. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coda--After "The end of the end of ideology."

Replies to comments by M. Glassman and D. Karno (see record 2007-18356-016) and R. K. Unger (see record 2007-18356-017), on the author's original article (see record 2006-12925-001) on ideology. J. T. Jost thanks Glassman and Karno for returning him to his philosophical roots. Glassman and Karno argued in favor of an "instrumental pragmatist" approach to the study of ideology that emphasizes the strategic, purposive, goal-directed nature of political rhetoric and belief. He agrees that such an approach is helpful and empirically sound. He also agrees that ideological movements are often orchestrated by elites (e.g., party leaders) for strategic political purposes in a top-down manner. There are several other points, however, on which Glassman and Karno seem to misunderstand him. Regarding Unger's comments, Unger pointed out, quite correctly, that Jost said relatively little about the role of religious ideology in his discussion of ideological polarization in the United States. The ideological gulf between religious traditionalists and secular humanists has indeed been widening since 1980, and it corresponds strongly to right-left differences in political attitudes. Jost mentioned, somewhat cryptically, at the end of his article that "similarly fruitful analyses could be undertaken with respect to religious and other belief systems," and he is grateful for Unger's invitation to elaborate on this point. (PsycINFO Database Record (c) 2010 APA, all rights reserved)