Career preferences and career outcomes of Australian medical students

Students entering three Australian medical schools were followed over a 15-year period to trace both movement into the profession and the longer-term outcomes of early career aspirations. A variety of student entry characteristics are examined together with aspirations, attainments and self-images. The results indicate that women, rather than men, are more likely to enter medical school with aspirations that involve specialty training. As they proceed through medical school, both groups move away from the idea of pursuing specialty training, although women tend to decide earlier than men that specialty practice is not for them. Women students are more likely than men to attain career goals if these involve general practice and less likely to if these involve specialization. The results indicate that although at graduation women medical practitioners have the same career goals and desires as men, if additional training is required women are unlikely to have their aspirations fulfilled.     

Career preference and choice of practice locations by Saudi medical students

Summary. The identification of career preference and intended practice location of medical students may provide a useful contribution to the projections and distribution of doctors across different specialties in the country. Information for this study was obtained from a survey of medical students in the final years at King Saud University College of Medicine in Saudi Arabia. This included demographic characteristics, career choice, training location, qualification in view and intended practice locations. The majority (61.2%) intended to specialize and subsequently practise in the major disciplines of medicine, surgery, paediatrics and obstetrics. Twenty-eight per cent were not sure of their future career choice. Only a few (3.5%) chose primary care and none chose pathology or anaesthesia. More men chose medicine, paediatrics and surgery, but more women chose obstetrics and primary care. The majority (81.2%) would like to have foreign certificates, but all the Saudis would subsequently practice in Saudi Arabia and mainly in large cities. The implications of this career pattern and practise locations are discussed with recommendations for health planners and medical schools.     

Attitude of medical students towards psychiatry

Findings are presented from a survey of all medical students at the College of Medicine, Abha, Saudi Arabia dealing with students' attitudes towards specialization in psychiatry. The health region of Asir in south-west rural Saudi Arabia, of about one million inhabitants, needs Saudi Nationals to specialize in psychiatry to provide planned future delivery of services. Medical students all over Saudi Arabia, however, have not been choosing psychiatry for their specialization after graduation. The Scientific Committee for Mental Health, convened at the Ministry of Health in Riyadh in February 1986, invited representatives of psychiatry from medical schools in the nation to discuss this priority topic. A year later, a new course called 'Introduction to Psychosomatic Medicine' was introduced as an elective for medical students with its practice at the general hospital. It tries to introduce students to 'voluntary and active as against passive learning ... and problem-solving rather than imposed memorizing' of medicalized forms of psychiatry, an innovation compared with the previous conventional method. A significant difference in attitude was demonstrated between students who had their exposure to psychiatry from this course and those who followed only the conventional methods of learning.     

Effects of cadaver dissection on the attitudes of medical students

Summary: Summary. A study was conducted to determine whether the attitudes of medical students to death and caring changed during the 3 months following exposure to cadaver dissection. All first-year students were invited to complete a questionnaire immediately before their initial cadaver dissection experience, after 6 weeks, and after a further 3 months. The questionnaire reflected attitudes to death, violent death, death of someone known to the respondent and caring when someone known to the respondent is seriously injured. Ethnicity and previous exposure to dying has no effect on responses, but overall men students' reactions were significantly less than for women ( P < 0.001). The responses given on the final part of the questionnaire after 3 months were significantly lower than those to most questions in the first part of the questionnaire. The exceptions were those questions where the subject in the given scenario was known to the respondent, where reactions were rated significantly greater ( P < 0.001) in the follow-up questionnaire and can be explained on the basis that they were a personal referent.
Students rapidly develop a coping mechanism which enables them to view cadaver dissection as an occupation quite divorced from living human beings. During these early months of training solicitude decreases for those who die who are unknown to them, but concern for personal referents increases. Educators should be aware of the dramatic change of attitudes among students and the process of professionalization which might influence their caring of future patients.     

What motivates medical students: how they see themselves and their profession

This paper describes a repertory grid study of medical students' perceptions of medicine and its specialties. By sampling student attitudes at different stages of training, the authors show that in this sample, final-year medical students have a more vocational out-look than first-year students, in whom concern with relief of suffering is more important than aiming at cure and in whom materialistic success matters less than doing something 'important for mankind.' This is reflected in a shift of interest away from the surgical specialties.     

Hostility and the medical student: how a trait measure influences perception of medical specialties

This paper describes the influence of hostility as a trait on medical students' perception of medicine and its specialties. By means of Repertory Grid analysis, the authors compare the preferences of students having internally and externally directed hostility. The findings suggest that students with low levels of internal hostility are attracted to the popular image of the surgeon as a highly achieving and successful individual who is oriented towards cure. In contrast, those with high levels of internally directed hostility show an interest in specialties which allow for close human contact, particularly within general medicine. A psychological interpretation of these findings is offered.     

Career patterns of women medical graduates 1974–84

A postal questionnaire was carried out in 1984 to determine the career pattern of United Kingdom women medical graduates of 1974. The response rate was 57%. The median age was 33 and 82% were married. Eighty-nine per cent were employed in a vast range of specialties; most of those not working at the time of the survey planned to return to work within 6 months. Many expressed a need for more career advice at all stages, and for more training in the community-based specialties.     

Comparison of medical and non–medical student attitudes to social issues in medicine

A 63-item questionnaire on attitudes to psychosocial issues in medicine was administered to final-year students in the Faculties of Medicine ( n = 104), Pharmacy ( n = 57) and Arts and Social Sciences ( n = 75) of the University of Benin. The responses given were analysed by the summation and Cornell scalogram techniques for content and intensity. On aggregate, the pharmacy students scored significantly higher than their medical and arts/social science counterparts ( P < 0.001). The advantage over medical students was on only one subscale: paramedical cooperation. The scores of the pharmacy and arts/social science groups were significantly lower than those of medical students on the social factors sub-scale. On issues that threaten to diminish the traditional role and status of the medical profession (e.g. paramedical cooperation and government intervention), the attitude of medical students was either unenthusiastic or clearly resentful. However, they shared the same orientation as the other groups towards matters which did not challenge the prerogatives of medical doctors (e.g. preventive medicine and doctor–patient relationship). It is suggested that measures be adopted to raise the level of awareness of non-health professionals vis-à-vis the non-biological antecedents of disease and also to bridge the gap in attitudes among groups in the health care team.     

Uncertainties and ambiguities: measuring how medical students cope

Summary: Summary. To develop psychometric measures specific to the ambiguities encountered in medicine and determine their value in predicting medical students' attitudes to wards patients and their choice of residency, we administered to senior and first-year medical students a 25-item Likert-type questionnaire to assess their intolerance of ambiguity (ITA). Factor analysis yielded two dimensions that were converted to scales: 'Aversion to uncertainties in clinical medicine' (ITA1) and 'Preference for highly structured training environs' (ITA2). First-year students scored higher on ITA1 and lower on ITA2 than seniors. An excessive reliance on high-technology medicine, a negative orientation toward psychological problems, and Machiavellianism predicted ITA1. ITA1 was the best predictor of senior medical students' negative attributional style toward hypochondriac, geriatric and chronic pain patients. The following rank order of seniors' career choice was predicted by ITA1 scores: internal medicine, psychiatry and family medicine (lowest); radiology, surgery and anaesthesiology (highest). And by ITA2 scores: surgery, obstetrics and gynaecology, and surgical subspecialties (lowest); radiology, psychiatry and anaesthesiology (highest). We concluded that personality traits and role characteristics which predict 'Aversion to uncertainties in clinical medicine' are maladaptive to managing many primary care patients, and this mismatch is reflected in seniors' residency choice.     

The effect of compulsory participation of medical students in problem-based learning

Problem-based learning (PBL) is an instructional method that has attracted many advocates since its introduction in medical education almost 20 years ago. PBL features the use of student-directed tutorials, medically relevant problems to set study objectives, and independent learning. Educators have worried that not all students will do well with this method. This study compared a group of students who had chosen to be in a PBL curriculum with a group who had not, as they undertook a curriculum that contained both PBL and lecture-based courses. Academic performance was virtually identical regardless of learning method. Students slightly favoured the courses that featured the method they had originally chosen, but a significantly larger proportion of students shifted their preference from the lecture to the problem-based approach than vice versa. Students' academic performance does not appear to suffer when they are involuntarily enrolled in a PBL curriculum and many come to prefer this type of curriculum.     

The effect of medical education on the attitudes of medical students towards disabled people

The negative attitudes of society towards disability and the resulting prejudicial behaviour affects the lives of disabled people. One of the declared aims of the Faculty of Medicine of the University of Southampton is to improve attitudes. Hence, an attempt has been made to assess differences in the attitudes held by first- and fourth-year medical students, senior house officers and members of the general public towards disabled people. The measurement instrument used was the 'Attitudes Towards Disabled Persons (ATDP) Scale'. The total number of subjects in the survey was 428, of whom 263 (61%) responded. No significant differences were found between the attitudes of the four groups studied. However, a subpopulation of subjects who agreed with the statement that 'Disabled people cause more problems to doctors than non-disabled people' had attitudes which were significantly more negative.     

Do conventional and innovative medical schools recruit different students?

A mail questionnaire was used to survey the social and demographic characteristics, educational background, attitudinal profiles and expected career choice of 243 first-year students enrolled in three US medical schools. The aim was to determine whether different types of schools selected different types of students. Two schools were considered as conventional whereas one school was considered as innovative both in its admission policies and in its curriculum which emphasizes a biopsychosocial approach to health care. The survey achieved an 84% response rate. The results showed no difference in students' career expectations. Students recruited in the innovative school, however, differed from students recruited in the conventional schools with regard to their social and demographic characteristics, educational background and attitudinal profiles. This study suggests that as some medical schools are innovating in their curriculum and admission policies, new types of medical students are entering medicine. Implications of these results are discussed.     

Specialty choice of medical students in India

The objectives of this study are to investigate undergraduate medical students' attitudes towards different specialties and to investigate whether there are any differences between the attitudes of students of different sex and different socio-economic background. The sample consisted of 692 final-year students from 11 medical colleges in India. Scale values were worked out to find out the actual distance between students' attitudes. Sex differences were observed in the attitude towards surgery, obstetrics and gynaecology, orthopaedics, microbiology, social and preventive medicine and anatomy. There were no statistically significant differences between the attitudes of students from different socio-economic backgrounds.     

How comfortable do first-year medical students expect to be when taking sexual histories?

The authors assessed the expected degree of comfort among first-year students at two California medical schools in taking a sexual history from four types of patients: heterosexual men; heterosexual women; homosexual (men and women combined); and an AIDS patient. Data were from questionnaires administered at two California medical schools (response rate = 87%). Students expected to be significantly more comfortable with heterosexual patients who were the same sex as the student. Students who had previously taken a sexual history anticipated relatively more comfort with heterosexual patients. The lowest expected comfort was for the AIDS patient. Older students expected to be more comfortable with the AIDS patient, independent of the student's personal sexual experience. Students with a homosexual friend anticipated more comfort with both the AIDS patient and the homosexual patients.     

Approaches to learning of students in an Indonesian medical school

This paper reports on a study of approaches to learning of undergraduate medical students in the University of Gadjah Mada, Indonesia. The Lancaster Approaches to Studying Inventory was translated into Indonesian and the translated form pilot tested. The instrument was then completed by 90 students, 30 each in first, second and fifth year in the Faculty of Medicine. It was found that Indonesian students generally gave higher rates than previous studies have reported. Factor analysis of their responses showed strong resemblances to other groups in the factors of meaning and reproducing orientation. Differences found in Indonesian students' responses were in strategic and non-academic orientations. There were differences between the response patterns of first-, third- and fifth-year students. It is concluded that the instrument is valid for use in Indonesia.     

The educational value of clinical electives

One hundred and eighty-four medical students at the University of Queensland were surveyed after they returned from their clinical elective. Approximately half stayed in Australia, and the other half travelled overseas. The United Kingdom was the most popular overseas destination, but there was a wide geographic distribution. The most popular clinical specialties were surgery, medicine, orthopaedics and emergency medicine, while the least popular were geriatrics and psychiatry. They were given a reasonable work schedule, but students remaining in Australia had a heavier work-load. While students on overseas electives received more formal instruction, students remaining in Australian placements received greater responsibility and better acceptance, but the majority in both groups received adequate supervision. Students gained experience in a large number of practical procedures, especially those in Australian placements. More problems were encountered by students in overseas placements, particularly with regard to organizing the elective, finances and personal-social difficulties. The vast majority of students found their clinical elective to be moderately or extremely worthwhile, and cited a number of perceived benefits. These results suggest that the clinical elective can have significant educational value.     

Factors influencing the communication skills of first-year clinical medical students

The aim of this study was to examine the factors influencing medical students' communication skills. The sample comprised all first-year clinical students. Thirty-two received teaching in communication skills during the year; the remaining 56 did not. Students' career preferences, attitudes towards communication skills and confidence in their ability to communicate with patients were assessed by questionnaire at the beginning and end of the year. At the end of the year each student was videotaped interviewing a simulated patient. Students' communication skills were assessed on the basis of this interview by raters using a standardized rating scale, and by patient questionnaires. While there was some evidence that brief communication skills training improved skills, sex of student was a more significant predictor of level of skill. Students who perceived communication skills as less relevant to medicine and those who were more confident about their own communication skills were more likely to prefer a career in hospital medicine. Students' judgements of their ability to communicate effectively were poor. In the main there was no relationship between confidence and level of skill: where they were related, the association was negative. The benefits from communication skills training might be enhanced by involving hospital doctors in the teaching, and providing students with detailed video feedback on their skills at the outset.     

Literature and medicine: a short course for medical students

A course on literature and medicine for medical students is described. A wide range of books, plays and poems were used with medical and non-medical themes. Students enjoyed the course and particularly welcomed the non-medical components. The staff learned at least as much as the students. Several book lists were developed with input from the students. Such a course might have a part to play in several parts of the medical course, such as in the teaching of ethics.     

Death, dying and the medical student

The objective of this study was to determine the extent of medical students' experience of death and dying. A questionnaire was given to two groups of Birmingham medical students at the beginning of clinical studies (third year) and in the final year which was designed to estimate their experience of death and of dying people. The questionnaire also explored the students' attitudes to their own future deaths. Questionnaires were returned by 119 third-year and 143 final-year students. Students had little experience of death and what they did have was largely acquired before entry to medical school or in their social rather than medical lives. Where they did have experience of death this was often traumatic and there was little chance for them to have counselling about it. There is need for increased teaching about death and dying particularly before clinical training and at the time of graduation. Another time may be at the beginning of human dissection.