Integrating educational objectives and the evaluation process in a general surgery residency program.

Although the Accreditation Council for Graduate Medical Education (ACGME) requires that all of its approved residency programs have written goals and objectives and an evaluation process, many programs have difficulty achieving these goals. For eight years, the general surgery residency program at Abington Memorial Hospital has used a system that integrates each rotation's cognitive, clinical, and procedural objectives into the faculty's evaluation of residents and residents' evaluation of the rotation. The integration of goals and objectives with the post-rotation evaluations provides the program with an ongoing and continual assessment of each resident's progress, the effectiveness of the faculty as teachers, and the educational value of each rotation. In this essay, the authors describe this integrated system and provide examples of one rotation's goals and objectives and the evaluation forms used by faculty and residents.     

Does students' exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection?

PURPOSE: To examine the role of gender discrimination and sexual harassment in medical students' choice of specialty and residency program. METHOD: Anonymous, self-administered questionnaires were distributed in 1997 to fourth-year students enrolled in 14 public and private U.S. medical schools. In addition to reporting the frequency of gender discrimination and sexual harassment encountered during preclinical coursework, core clerkships, elective clerkships, and residency selection, students assessed the impact of these exposures (none, a little, some, quite a bit, the deciding factor) on their specialty choices and rankings of residency programs. RESULTS: A total of 1,314 (69%) useable questionnaires were returned. Large percentages of men (83.2%) and women (92.8%) experienced, observed, or heard about at least one incident of gender discrimination and sexual harassment during medical school, although more women reported such behavior across all training contexts. Compared with men, significantly (p 相似文献   

Individual differences in cortisol levels and performance on a test of executive function in men and women

Despite evidence for a high concentration of corticosteroid receptors in prefrontal cortex, little research has examined the relationship between cortisol and prefrontal cortical function other than working memory. We investigated the association between salivary cortisol levels and performance on the Wisconsin Card Sorting Test (WCST) of executive function and on a test of mental rotation (to test specificity of the relationship between cortisol and cognitive performance) in men and women (n=116, ages 17-22). Higher cortisol levels at the beginning of the test session were associated with more errors in women on the WCST and fewer errors in men. However, men's cortisol levels were lower than women's at this point in time. Cortisol levels were not associated with mental rotation scores. Our results suggest that individual differences in cortisol levels among participants upon arrival to a test situation influence performance on a task involving the prefrontal cortex.     

Income expectations of first-year students at Jefferson Medical College as a predictor of family practice specialty choice.

The recent decline in the number of medical students choosing careers in the primary care specialties has engendered increasing concern that economic factors are becoming more important in influencing the career choices of medical students. In order to assess the relationship of first-year medical students' income expectations to whether they chose to specialize in family practice, the authors analyzed data from 532 graduates of Jefferson Medical College (classes of 1987-1989), using the Jefferson Longitudinal Study. At entrance to medical school, each student listed his or her initial specialty preference and future expected peak income; the determination of actual specialty choice was based on the first year of postgraduate training. Both expected peak incomes and freshman specialty choices were independent predictors of actual specialty choices. The students who entered family practice residencies had lower initial expected peak incomes than did the students entering other specialties, especially the surgery specialties. In addition, according to logistic regression analysis, the students with relatively lower income expectations and a freshman preference for family practice were predicted to be nine times more likely to enter family practice residencies than were students with higher income expectations and no initial family practice preference (56% versus 6%). This study suggests that a freshman's income expectation is an important predictor of family practice specialty choice, independent of age, sex, degree of indebtedness, and initial specialty preference. The authors discuss their results in light of the decline in the number of medical students choosing family practice and the other primary care specialties.     

Media Influences on Attitudes and Perceptions Toward the Body Among Adult Men and Women

The current study investigated media influences on men's and women's body perception. Participants were 60 men and 60 women. Men overestimated their chest, waist, and thighs and underestimated their hips. Women overestimated the size of all body parts. Men's and women's perception of their body was not predicted by media exposure or attitudes to the media. Both men's and women's ideal body was different from their current bodies. Attitudes and exposure to the media predicted men's (but not women's) perceptions of the ideal body held by the media, as well as both men's and women's ideal chest and waist. These findings suggest that the media has an impact on the ideal body size of both men and women.     

The influence of controllable lifestyle and sex on the specialty choices of graduating U.S. medical students, 1996-2003.

PURPOSE: To determine whether the preferences of female medical students are sufficient to explain the recent trend of U.S. medical students choosing specialties with controllable lifestyles. METHOD: Specialty choice for graduating U.S. medical students by sex was determined from the responses to the Association of American Medical Colleges' 1996-2003 Medical School Graduation Questionnaires. Using earlier research, specialties were classified as having an uncontrollable or controllable lifestyle. Log-linear models were constructed to assess the strength of association among trends in specialty choice, controllable lifestyle, and sex. RESULTS: The percentage of women choosing specialties with controllable lifestyles increased from 18% in 1996 to 36% in 2003. For men, the percentage grew from 28% to 45%. The change in preference for controllable lifestyle specialties accounted for a large proportion of the variability in specialty choices for both women and men from 1996-2003 (chi2 for changes common to women and men = 920, 1 df, p < .0001). The difference between women and men in the trend toward controllable lifestyle specialties was small relative to the common changes (chi2 for differences = 12, 1 df, p = .0005). CONCLUSION: Controllable lifestyle was strongly associated with the recent trends in specialty choice for both women and men and could not be explained solely by the specialty preferences of women.     

Personality profiles and specialty choices of students from two medical school classes

Changes in the composition of medical school classes, in methods of personality assessment, and in the nature of medical specialties motivated the authors to reexamine the relationship between a student's personality and his or her chosen medical specialty. In the mid-1980s, the authors assessed two consecutive classes of medical school students (120 in each class) on 15 personality measures throughout their four years; usable data were obtained for 199 of the students. The students' specialty choices upon graduation were obtained from the results of the National Resident Matching Program, and were classified as follows: internal medicine, surgery, family practice, pediatrics, psychiatry, obstetrics-gynecology, and hospital-based specialties. The authors constructed personality profiles for the students who had chosen each of these seven specialty groupings, on the basis of t-tests and discriminant function analyses, and discuss these profiles and their associations with the students' specialty choices in the context of earlier research. The personality profiles for surgeons were remarkable for their consistency with reports from the literature from the 1950s and 1960s, while the profiles for obstetricians, psychiatrists, and pediatricians were complex and provocative. Distinctive personality profiles did not emerge for internists or family practitioners.     

Students' evolving attitudes toward family medicine and specialty choices at one medical school

Seventy members of the class that entered Dartmouth Medical School in 1984 responded in 1984 and again in 1988 to statements regarding their attitudes towards family medicine, their general criteria for choosing a specialty, and their concerns about lifestyle; also, the students were asked in 1984 to indicate their interest in a career in family medicine and in 1988 to indicate their long-term specialty choices. The students' attitudes towards family medicine were generally positive on entry and became even more positive by their fourth year. Of the 25 students who indicated an initial interest in family medicine, six chose residencies in this field. Because most of the students studied showed strengthening agreement with both (1) the belief that family practitioners are particularly capable of providing comprehensive care and (2) the desire to concentrate on a specialty that would enable them to feel very competent and sure of their work, the authors hypothesize that the students may have feared that their desire for competence and certainty was incompatible with the comprehensiveness of family medicine.     

Classification model that predicts medical students' choices of primary care or non-primary care specialties.

To identify factors that influence students to choose primary care or non-primary care specialties, the authors surveyed the 509 graduating students at the Medical College of Georgia School of Medicine in 1988, 1989, and 1990. Using a Likert-type scale, the 404 responding students rated potential influences on their specialty choices from 1, very negative, to 7, very positive. The students choosing primary care specialties were positively influenced significantly more often by their desire to keep options open (85% versus 58%, p less than .001) and their desire for longitudinal patient care opportunities (95% versus 54%, p less than .001). Those choosing non-primary care specialties were more often influenced by their desire for monetary rewards (69% versus 35%, p less than .001) and by their perceptions of lifestyle following residency (74% versus 60%, p less than .01) and prestige of the specialty (57% versus 36%, p less than .001). The authors used multiple discriminant analysis to derive a discriminant function that would permit classification of students into primary care and non-primary care groups. The potential influences of desire for longitudinal care opportunities and desire for monetary rewards were statistically and clinically significant for all three years. Using the discriminant function, the authors correctly classified 81%, 79%, and 78% of the students' specialty choices for 1988, 1989, and 1990, respectively. The authors suggest that addressing the issue of monetary rewards will be necessary before the primary care fields again become attractive to students.     

Stability of medical specialty selection at the University of Kentucky.

In the fall of 1989, all graduates of a 30-year-old medical college were surveyed by questionnaire concerning their motivations for their original selections of specialties, motivations for changing their specialties when such changes had occurred, and factors involved in their current choices of specialties. The 723 respondents were grouped by specialty response into one of three groups (primary care plus medicine and pediatrics subspecialties; surgery; or controllable lifestyle), and responses were statistically analyzed. The most important factors influencing initial specialty selection were perceived match of personality and specialty; technology and methodology characteristic of the specialty; and time for family activities, in that order. The ratings of the 175 respondents who stated that they had changed specialties indicated that time for avocational pursuits and time for family activities were the most important reasons for change. The reasons for selecting a different specialty varied. This study's findings suggest that a student's likelihood of making an inappropriate specialty choice may be reduced by a broad undergraduate medical education with realistic experiences in clinical activity. Students' lack of awareness of the lifestyle of a particular specialty may be a significant factor in the flow of physicians from noncontrollable lifestyle specialty areas. Those who counsel medical students need to be aware of the increasing importance of controllable lifestyle features, changing attitudes, faculty role-modeling, and mentors as strong influences on students' choices of specialties.     

Increasing women's leadership in academic medicine: report of the AAMC Project Implementation Committee.

The AAMC's Increasing Women's Leadership Project Implementation Committee examined four years of data on the advancement of women in academic medicine. With women comprising only 14% of tenured faculty and 12% of full professors, the committee concludes that the progress achieved is inadequate. Because academic medicine needs all the leaders it can develop to address accelerating institutional and societal needs, the waste of most women's potential is of growing importance. Only institutions able to recruit and retain women will be likely to maintain the best housestaff and faculty. The long-term success of academic health centers is thus inextricably linked to the development of women leaders. The committee therefore recommends that medical schools, teaching hospitals, and academic societies (1) emphasize faculty diversity in departmental reviews, evaluating department chairs on their development of women faculty; (2) target women's professional development needs within the context of helping all faculty maximize their faculty appointments, including helping men become more effective mentors of women; (3) assess which institutional practices tend to favor men's over women's professional development, such as defining "academic success" as largely an independent act and rewarding unrestricted availability to work (i.e., neglect of personal life); (4) enhance the effectiveness of search committees to attract women candidates, including assessment of group process and of how candidates' qualifications are defined and evaluated; and (5) financially support institutional Women in Medicine programs and the AAMC Women Liaison Officer and regularly monitor the representation of women at senior ranks.     

Early clinical experience enhances third-year pediatrics clerkship performance.

PURPOSE: To determine whether clinical experiences in the preclinical years improve medical students' performances in a third-year clerkship. METHOD: A cohort study reviewed the pediatrics clerkship performances of 400 Eastern Virginia Medical School students in the graduating classes of 1996 through 1999. The first two classes completed a traditional preclinical curriculum with limited clinical experience. The final two classes participated in a mentorship program that provided 18 months of early clinical experience, consisting of one-on-one half-day sessions every other week with a generalist community faculty. The authors compared the clinical clerkship performances of the groups using clinical skills (CS) scores, history and physical examination (H&P) scores, and scores on the NBME pediatrics shelf examination. They also looked at the mean MCAT and USMLE scores for each group. The authors also looked at the scores within each class, comparing students who completed one of the first two pediatrics clerkship rotations with their classmates who completed clerkships later in the academic year. RESULTS: The students' NBME scores rose significantly (p < .05, r2 = 0.95) over the four-year study, paralleling a significant rise in MCAT scores (p < .03, r2 = 0.73). The CS and H&P scores did not rise. Students who had the traditional preclinical curriculum and who completed their clerkships early in the year had significantly lower CS and H&P scores than did their classmates. In contrast, the scores of students who had the early clinical experiences did not differ significantly according to the timing of their rotation. CONCLUSION: Students who had participated in a mentorship program that provided early clinical experience demonstrated significantly improved clinical skills in the pediatrics clerkship early in the academic year.     

Is there hardening of the heart during medical school?

PURPOSE: To determine whether vicarious empathy (i.e., to have a visceral empathic response, versus role-playing empathy) decreases, and whether students choosing specialties with greater patient contact maintain vicarious empathy better than do students choosing specialties with less patient contact. METHOD: The Balanced Emotional Empathy Scale was administered at the beginning of each academic year at the University of Arkansas for Medical Sciences for four classes, 2001-2004. Students also reported their gender and specialty choice. Specialty choice was classified as core (internal medicine, family medicine, obstetrics-gynecology, pediatrics, and psychiatry) or noncore (all other specialties). RESULTS: Vicarious empathy significantly decreased during medical education (P < .001), especially after the first and third years. Students choosing core careers had higher empathy than did those choosing noncore careers. Men choosing core careers initially had empathy exceeding population norms, but their empathy fell to be comparable with that of norms by the end of their third year. The empathy of men choosing noncore careers was comparable with that of norms. Women choosing core careers had empathy scores comparable with those of norms, but the scores of women choosing noncore careers fell below those of the norms by their second year. CONCLUSIONS: The findings suggest that undergraduate medical education may be a major determinant differentially affecting the vicarious empathy of students on the basis of gender and/or specialty choice. The greatest impact occurred in men who chose noncore specialties. The significant decrease in vicarious empathy is of concern, because empathy is crucial for a successful physician-patient relationship.     

Gender Differences in the Factors That Affect Self-Assessments of Health

We hypothesized that women's self-assessments of health (SAH) would decrease more than men's when participants considered the functional limitations of illness and non-health-related sources of emotional distress. We examined the effects of type of illness, illness-produced limitations, and distress from illness- and nonillness-related sources on men's and women's SAH. Women's SAH were significantly more responsive than men's to the affective and functionally limiting aspects of illness. This suggests that women include a broader range of illness factors unrelated to mortality when evaluating their own health and explains why men's SAH have been found to be more strongly related to mortality. Contrary to our hypothesis, men's SAH were significantly more responsive than women's to social sources of distress.     

A clinical internship program in biomedical engineering, Part II: Administration of the program

This paper discusses the administration of a clinical internship for biomedical engineering students. The interns rotate through sequences of hospital services, divided into four sets, separated by intervening elective periods, and spread over different clinical facilities. Rotations include orientation conferences, counseling sessions with staff personnel, and on-the-job training in each hospital service. Students keep logs of their experiences and submit service reports summarizing each rotation. They also write brief reports illustrating engineering contributions to health care delivery. The reports are graded and serve, together with staff and faculty evaluations, to rate the students' overall performance in the program.     

Specialty choices of students who actually have choices: the influence of excellent clinical teachers.

PURPOSE: To determine the influence of the quality of attending physicians and residents on the specialty choices of excellent medical students, who actually have a broad choice of specialties. METHOD: In 1993-94 and 1994-95, 169 third-year students at the University of Kentucky College of Medicine were randomly assigned to two one-month rotations on general medicine inpatient wards. At the end of each rotation, the students confidentially evaluated the attending physician and the supervising resident (different for each rotation) with whom they had worked. Data were collected for 62 attending physicians and 89 residents. The authors analyzed the influences of the "best" and "worst" clinical instructors (those rated in the top and the bottom 20% by all students with whom they had worked over the two years) on "excellent" medical students (the 52 students whose USMLE I scores were in the top 30% of their class). RESULTS: Using regression approaches from the general linear model, the authors found that independent predictors of internal medicine residency choice for excellent medical students were exposure to highly rated internal medicine attendings (p = .02) and residents (p = .03). Nine of 29 (30%) of the excellent students who worked with a "best" medicine clinical instructor chose an internal medicine residency, while none of the 23 excellent medical students who did not work with a "best" medicine clinical instructor did so. The authors found no correlation in students' ratings of their pairs of attendings and residents, suggesting that rater bias did not explain the results. CONCLUSION: Better medical students who work with the best internal medicine attending physicians and residents in their internal medicine clerkship are more likely to choose an internal medicine residency.     

The educational value of community preceptorships in surgery

Increasing class size provided the impetus to send students on the core surgery course at the Medical University of South Carolina College of Medicine into the community hospitals with members of the clinical faculty. Each student was assigned to a surgeon and accompanied this preceptor on rounds, in the operating room, and in the office. To determine whether the students' learning was affected by being outside the university, the authors looked at the experience from 1977 to 1986 with 683 surgery students who took community preceptorships and 696 surgery students who took only university-based rotations. The two groups were compared in regard to age, sex, basic science grade-point average, class rank at the end of the first two years in medical school, ward evaluations, grades on departmental final examinations, and National Board of Medical Examiners "mini-examination" scores and Part II surgery scores. No differences were found. Choices of specialty for the first postgraduate year and evaluations of program directors were reviewed for 1982, 1985, and 1986, and were similar for all three years. The preceptorship program has been popular with students, who stated that they valued the one-to-one relationship with surgeons who liked to teach. The program has relieved pressure on the university hospital system and provided a good learning experience for students.     

Evaluations by three graduating classes of a required community health project.

The authors analyzed seniors' evaluations of the first three years of an intensive community health project at the Bowman Gray School of Medicine of Wake Forest University in 1988-89, 1989-90, and 1990-91. The project was designed to provide a public health perspective by having the students select, study, and propose solutions to a community health problem. Of 285 seniors, 240 (84%) completed evaluation questionnaires, using a five-point scale. The students' perceptions of the value of the project became steadily more favorable with each subsequent class; the classes of 1990 and 1991 rated the value of the project as being greater than that of most other experiences in their medical education. The project was more positively evaluated by the 106 responding students (44%) who planned to enter primary care specialties. The students who invested more time in the project also perceived its value to be greater.