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.     

Differential perception of certain jobs and people by managers, clerks, and workers in industry.

"… describes the use of the semantic differential for the study of how certain jobs and certain people are perceived by various groups of industrial Ss… . Five jobs and 6 people were rated on 38 scales of corresponding semantic differentials by 156 Ss representing various groups in industry." Supervisors considered successful and unsuccessful by vice-presidents were both considered successful by subordinates. "… the most significant variable in the perception of jobs is the level of the job… . the managers make finer discriminations between jobs than do the workers… . The findings suggest that management ought to consider the tendency of workers to value their jobs more than management values them, in its communication to them." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Categories of thought of managers, clerks, and workers about jobs and people in an industry.

What effect does the use of categories by various groups have on communication? What can be gained by analyzing categories of thought about jobs and people in industry? "Triads of jobs and people were presented to 105 Ss. The Ss were managers, clerks, and workers in a small New York State industrial concern. The Ss were asked 'Which one of these three jobs (people) is more different from the other two?' and 'Why?' The characteristics that differentiated one member of the triad from the other members were listed. Certain differences in the lists obtained from the various groups were observed. An attempt was made to assess the significance of these differences for inter-group communications in industry." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Globalization in the pharmaceutical industry, Part I

This report on the pharmaceutical industry will be published in two parts. Part I begins with a summary of the study and its conclusions. The authors then provide an overview of the characteristics of the industry and current trends in its growth and structure: production and consumption, employment, research and development, capital investment, firm and product concentration and product competition, and pricing. A discussion of international trade follows, covering intra- and inter-regional, intra-firm, and intra-industry trade. The report will continue in the next issue of the Journal (Part II) with a look at foreign direct investment, inter-firm networks, and governmental policies.     

Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public

BACKGROUND: Euthanasia and physician-assisted suicide are pressing public issues. We aimed to collect empirical data on these controversial interventions, particularly on the attitudes and experiences of oncology patients. METHODS: We interviewed, by telephone with vignette-style questions, 155 oncology patients, 355 oncologists, and 193 members of the public to assess their attitudes and experiences in relation to euthanasia and physician-assisted suicide. FINDINGS: About two thirds of oncology patients and the public found euthanasia and physician-assisted suicide acceptable for patients with unremitting pain. Oncology patients and the public found euthanasia and physician-assisted suicide least acceptable in vignettes involving "burden on the family" and "life viewed as meaningless". In no vignette--even for patients with unremitting pain--did a majority of oncologists find euthanasia or physician-assisted suicide ethically acceptable. Patients actually experiencing pain were more likely to find euthanasia or physician-assisted suicide unacceptable. More than a quarter of oncology patients had seriously thought about euthanasia or physician-assisted suicide and nearly 12 percent had seriously discussed these interventions with physicians or others. Patients with depression and psychological distress were significantly more likely to have seriously discussed euthanasia, hoarded drugs, or read Final Exit. More than half of oncologists had received requests for euthanasia or physician-assisted suicide. Nearly one in seven oncologists had carried out euthanasia or physician-assisted suicide. INTERPRETATION: Euthanasia and physician-assisted suicide are important issues in the care of terminally ill patients and while oncology patients experiencing pain are unlikely to desire these interventions patients with depression are more likely to request assistance in committing suicide. Patients who request such an intervention should be evaluated and, where appropriate, treated for depression before euthanasia can be discussed seriously.     

Medical referrals for hypnotherapy: opinions of physicians, residents, family practice outpatients, and psychiatry outpatients

Previous studies surveying attitudes and education regarding the clinical use of hypnosis have been conducted with patient populations only. The current study was undertaken to assess the attitudes, experiences, training levels, and interest in future education regarding the use of hypnosis by staff physicians, medical resident physicians, family practice outpatients, and psychiatry outpatients. All subjects were drawn from a 400-physician group practice in Central Texas affiliated with a large university health science center. Results indicate that the majority of physicians (79%) and residents (67%) had received no prior training and even fewer had experienced hypnosis. The percentages for personal experience with hypnosis were similar for psychiatric outpatients, physicians, and residents. The need for patient and practitioner education was elucidated by the high rate of endorsement of misconceptions regarding hypnosis by patients (over half) and by some medical practitioners as well. Limited awareness of the appropriate applications of hypnosis was reported. However, 85% of practitioners expressed an interest in hypnosis education. Further research in medical setting demographics is recommended to validate generalizability of results and facilitate construction of medical education programs in hypnosis.     

Drug experiences, knowledge, and attitudes of high- and low-guilt individuals.

Administered the Mosher Forced-Choice Guilt Inventory and a drug attitude and use questionnaire to 121 undergraduates. Findings clearly indicate a relationship between guilt and experience, attitudes, and knowledge about drugs and support D. Mosher's view that guilt as a personality predisposition results in the inhibition of behaviors that are culturally prohibited. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beliefs and attitudes of interns at Ibadan General Hospitals concerning ten medical specialties

The authors report on a 62-year-old woman who suffered from partial nuclear oculomotor nerve palsy and the medial longitudinal fasciculus (MLF) syndrome caused by midbrain infarction. The lesion was confirmed to be in the mesencephalic tegmentum by axial sections acquired by magnetic resonance imaging (MRI). The lesion was located in the caudal region of the mesencephalic tegmentum by the sagittal MRI sections, and showed low signal intensity in T1-weighted images and high signal intensity in T2-weighted images. The patient exhibited bilateral ptosis due to the disturbance of caudal central nucleus and the supra-oculomotor area on both sides innervating the levator muscles of the upper eyelid. She also showed bilateral limitation of ocular adduction and supraduction; mild infraduction of the left eyeball; left monocular nystagmus; and disturbance of convergence, indicating partial involvement of the lateral somatic cell column innervating the muscles of the eyeball, the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF) and the MLF. Furthermore, transient visual hallucinations similar to hallucinose pédonculaire were confirmed. We are not aware of any reports describing simultaneous occurrence of bilateral ptosis, MLF syndrome, and transient visual hallucinations similar to hallucinose pédonculaire in the same patient.     

Interactions of consumption situations and brand attitudes.

Variables corresponding to individual consumption situations were used with an aggregated attitude-toward-the-object variable to predict 182 Ss' brand behavioral intentions. Multiple regression analysis was used to assess the influence of the situations compared with the influence of the attitude measure to explain the formation of behavioral intentions. An attempt was made to assess the Situation * Attitude Toward the Object interaction, using a multiplicative interaction variable. The inclusion of the situational variable significantly increased the variance explained in behavioral intentions across situations and brands. In general, the interaction variable also improved overall explanatory power. Approximately 50% of all interaction terms were significant. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mother-child treatment in psychiatry. I: Overview of experiences up to now

Basing on the growing interest in the work with relatives of mentally ill people, psychiatric inpatient treatment of mentally ill mothers together with their infants or toddlers is described. The introductory overview gives an account of various international experiences with psychiatric inpatient treatment of mother and child, the conditions existing especially in England are described, and hints are given in respect of the need to adopt that treatment model.     

Natural product source material use in the pharmaceutical industry: the Glaxo experience

Glaxo PLC has had a significant involvement with Natural Product Source Materials for all of its commercial history and, most recently, has pursued this interest by use of such materials as templates for new lead discovery. Through the expertise and facilities in its Natural Products Discovery Department, Glaxo extracts relatively small quantities of plant material (typically 200-250 g dry weight) and cultures microorganisms from environmental samples (typically 10-50 g). Extracts and fermentation broths are screened in order to detect bioactive principles (BPs). If the potency, selectivity and specificity of the BP is acceptable, isolation, purification and structural elucidation follows. It is most unlikely, in our experience, that the BP itself will become a drug; it is much more likely that we shall need to initiate a medicinal chemistry synthesis program in order to try to produce a molecule that has both the essential biological and desirable chemical properties to become a drug development candidate. This synthetic process is often a long one and our confidence that such a process is worth undertaking is greatly improved if the BP is novel. An essential component of any medicinal chemistry strategy is that it allows us to obtain secure intellectual property rights through patents. Acquisition of product claim protection, the strongest form of patent protection, is of great importance. Safety testing and clinical development of the candidate drug can take 7-10 years, and often more, during which patent protection is constantly eroding. Recognizing that acquisition of Natural Products Source Materials is an issue of growing concern, Glaxo Research and Development Ltd. (GRD), in the early part of 1992, implemented a policy for plant supply. This policy was subsequently modified to embrace source materials such as environmental, soil and marine samples from which fungi, micro- and microorganisms may be obtained. As a direct consequence of this policy, Natural Product Source Materials supply agreements are only concluded with national and international organizations who possess the expertise to identify and collect the samples. It is equally important that our suppliers have the authority, which must be provided to GRD in writing, to collect such materials and to provide them to GRD for extraction and screening purposes. Such materials must be from sustainable and accessible sources. We will not seek to collect any endangered species. Though ethnomedical information can be helpful, it is not essential. Plants must be taxonomically classified. We reimburse the supplying institute for their efforts and their expertise, and recognize an obligation to offer a royalty to the institute in the event that drug discovery, with subsequent commercialization, owes its origin, however indirectly, to a material that it provided. In discussions with the institute, we insist that "a fair proportion' (>40%) of that royalty be used for the direct benefit of the people in the collection source area. In this context, GRD recognizes the importance of local training and education.     

Uses of field desorption mass spectrometry in the pharmaceutical industry

Field desorption (FD) is a gentle method of ionizing molecules from the solid state. The method is still in its infancy and remains more of an art than a science. Purines, pyrimidines, pteridines, and nucleosides represent some of the compound classes which are studied repeatedly in our laboratory. Often the primary information sought is the molecular weight. Many of these compounds are thermally unstable or nonvolatile. In these instances, FD mass spectrometry has proven to be quite helpful. Molecular weights are obtained in a short time, eliminating the need for more time-consuming derivatization or chemical degradation methods. FD has been applied to the study of drug metabolism and has shown great promise in determining polar metabolites, including direct analysis of glucuronide, sulfate, and amino acid conjugates. Some problems have been encountered in handling samples of biological origins. Salt impurities introduced by the separation procedure may interfere with the desorption process. Cluster ions and background noise make it difficult to assign molecular ions, and some compounds do not yield molecular ions with FD.     

Preemployment predictors of union attitudes: The effects of parental union and work experiences.

Tested an expanded model of the socialization of union attitudes using data from 120 undergraduates and their parents. As hypothesized, students' perceptions of parental union attitudes, union participation and job satisfaction were significantly predicted by parental self-reports. Moreover, tests of three competing models suggested that student perceptions mediated the relationships between parental work and union experiences and students' own union attitudes and work beliefs. These findings are taken as support for the family socialization of work beliefs and union attitudes. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Philosophy, psychiatry and psychoanalysis: the case of Nietzsche

In this work dedicated to Frederic Nietzsche, we were first interested by the philosopher's personal psychopathology. Biographic and personality factors, the physical and moral pain, the mood variations, hypersensitivity, solitude and finally megalomanic traits have probably contributed to the development of his thought. Nietzsche gave personal interpretations of his own suffering. Freud himself recognized the organic component of the philosopher's illness. We reviewed the different symptoms in favor of a progressive general paresis. Philologist and moralist, Nietzsche was also a "psychologist". His intuitions in this area often preceded and prepared those of Freud. The relationship is surprising on certain points such as love and sexuality, the unconscious, the interpretation of dreams. We wish to remind readers that a prepsychoanalytic stream of thought, at the end of the 19th century, preceded the teaching now ascribed to Freud and his followers.     

Background factors, sexual experiences, and attitudes toward treatment in two "normal" homosexual samples.

Administered a questionnaire, the MMPI, and the Family Adjustment Test to a total of 60 male and 11 female nonpatient self-labeled homosexuals (mean age = 27.5) in 2 experiments. Differences between males and females were found in the proportion of homosexual marriages, the number of homosexual partners, and expressed satisfaction with the homosexual role. Comparisons are made with other samples of "normal" homosexuals, and implications of the present data for constructing a general theory of homosexuality are discussed. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of mild lameness in horses trotting on a treadmill by clinicians and interns or residents and correlation of their assessments with kinematic gait analysis

OBJECTIVE: To estimate sensitivity and accuracy of subjective evaluation of mild lameness in horses during treadmill locomotion and to correlate subjective evaluation with kinematic analysis. ANIMALS: 19 lame and 5 clinically normal horses. PROCEDURE: Lameness was evaluated by subjective score and kinematic analysis before and after palmar digital nerve block (PDNB). Evaluations were made by 6 clinicians and 7 interns or residents. Within- and between-observer agreement analyses (kappa values) were calculated and compared, using a Student's t-test. Pearson's product-moment correlation coefficients were calculated between clinician's change in score and the change in kinematic variables after PDNB. RESULTS: Within-observer agreement was within the range expected for conditions of moderate diagnostic difficulty. Within-observer agreement was higher for clinicians than for interns or residents. Between-observer agreement was acceptable for scores within 1 value of each other. Between-observer agreement of change in lameness score after PDNB was poor. When kinematic variables were ranked with each clinician's subjective change in score, only 2 were among the top 3 for the majority of clinicians. Asymmetry of vertical head movement between contralateral forelimb stance phases and the point of maximum hoof height during swing decreased as lameness subjectively improved. CONCLUSION: Mild lameness may be difficult to evaluate during treadmill locomotion. Although clinicians were more repeatable in their subjective evaluation of lameness than interns or residents, they were not more reliable at detecting the true state of lameness. CLINICAL RELEVANCE: Lack of agreement between clinician scoring of mild lameness emphasizes the need to use more objective measures for quantifying lameness.