Smoking among young doctors in Hong Kong: a message to medical educators

A survey was conducted using a self-administered questionnaire to examine the smoking habits, attitudes and practices of 151 doctors in their pre-registration year. The response rate was 88%. Over 80% of the respondents had never smoked. Less than 7% of the men smoked daily and none of the women smoked. Despite a very low smoking rate among the respondents, there were shortcomings in attitudes and practices. The study demonstrated that even in a place like Hong Kong, where the social climate on smoking is already changing in a healthy direction, significant deficiencies in our graduates can still arise if teaching on smoking and its control is undertaken in an uncoordinated manner. We argue that a specific course on the important aspects of smoking and health should be introduced into all undergraduate curricula. This is of special importance in countries where smoking is one the increase and where governmental actions on smoking control are inadequate in comparison with the marketing efforts of powerful multinational tobacco companies. Considering the magnitude of smoking as a global health problem, it is the very least that medical educators should do in combating this pandemic.     

An investigation of the attitudes of medical students to physically disabled people

A study was carried out to investigate the change in attitudes towards physically disabled people of a group of fifty-eight medical students during the first 3 years of their course. The students attended a newly established medical school which has developed a curriculum without the traditional division into preclinical and clinical years and where contact with patients occurs from the first year. Results demonstrated that, as expected, at the start of the course the attitudes of females towards disabled people were more positive than those of males. Also, a significant change in attitudes was found after 3 years, both males and females demonstrating more positive attitudes toward physical disability. The differences between males and females were maintained. The relationship between these students' attitudes and their behaviour was discussed and proposals for further research to investigate this are outlined.     

Psychiatry as compared to other career choices: a survey of medical students in Hong Kong

A questionnaire was administered to two groups of medical students, one preclinical and the other clinical, to assess their career choices, opinions of six specialties (including internal medicine, general practice, obstetrics and gynaecology, paediatrics and psychiatry as well as surgery) and anxieties about psychiatry. It was found that both groups of students conceptualized clinicians according to stereotypes which were modified but not abated by clinical exposure. Although the clinical students compared to preclinical students attributed more positive personality traits to psychiatrists, students interested in taking up careers in psychiatry were few in both groups. Compared to the preclinical class, clinical students were less worried about disturbed patients and emotional involvement with patients, but were more concerned about their deficiency in knowledge and skills relevant to psychiatry.     

Attitudes of medical students to medical ethics in their curriculum

One hundred and one students at different levels of their medical education were surveyed as to their views about inclusion of medical ethics in their curriculum. The results showed that 88% of the students feel that medical ethics has a place in their curriculum, and 84% rated medical ethics to be of High to Critical Importance to good medical care. They tended to read infrequently about medical ethics, which they would like integrated at all levels of the curriculum, particularly the clinical years. The more senior students were less sensitive to ethical issues. The students mentioned only dramatic issues in their accounts of encounters with cases involving ethical issues. It is felt that a wide gap is left in the education of these students if medical ethics is not included in a positive way in their curriculum.     

'Exercise medicine': the knowledge and beliefs of final-year medical students in the United Kingdom

It is becoming increasingly important that all doctors should have a good understanding of all the medical aspects of exercise. A questionnaire survey of final-year, British, medical students has demonstrated widespread acceptance that regular exercise is conducive to good health. Nevertheless, there were important deficiencies in the students' knowledge of the physiology of exercise and of physical training, and in their knowledge of the prevention and management of sports injuries. It is recommended that undergraduate education (and examinations) should put a greater emphasis on the medical aspects of exercise.     

Attitudes of men and women medical students to psychiatry

The attitudes of men and women medical students to psychiatry were compared using an attitude scale, before they began their psychiatry training. Major differences between the sexes were obtained, with the women students consistently displaying more positive attitudes to many aspects of psychiatry. The implications in terms of teaching and recruitment are considered.     

Career attitudes of preclinical medical students to the medical specialties

This study set out to investigate the attitudes of preclinical medical students to various specialties. It specifically aimed to measure a range of attitudes to nine medical specialties, by nearly 200 students. Multivariate analysis showed that the scale has various interpretable dimensions which measured such things as the way the specialty is taught in medical school, the recognized efficacy of treatment, type of patients, etc. Univariate analysis revealed numerous significant differences between the subjects' perceptions of the different specialties. It was concluded that the questionnaire provided a reliable, robust and valid instrument for the measurement of medical student attitudes to any or all specialties and may be particularly useful for research in this field.     

Preclinical teachers and preclinical students

A survey in 1974 in Manchester University medical school of the preclinical teachers showed that they thought that the motives of students in studying medicine were not what they should have been. Medically qualified and non-medically qualified teachers agreed about the importance of nine suggested motives, but there were highly significant differences between the two groups about the motives they felt to be present in students. The non-medically qualified were very much more likely to see students as concerned with the financial and social rewards of medicine, and more likely to doubt students' desires to be professionally competent or to help individuals. Some anecdotal evidence possibly throws light on these findings, which may have serious implications for teaching as non-medically qualified staff make up an increasing proportion of preclinical teachers.     

Stress and vulnerability in medical students

One hundred and forty Hong Kong Chinese students were surveyed early in the second year of their medical education (year 2), and compared with 138 students surveyed prior to beginning their first year of medical school and with 74 non-medical university students in their second year. In year 2 students, distress as reflected in their scores on anxiety and depression self-report scales was high, and these students reported greater utilization of health professional services as compared with the other two groups. In year 2 students, concerns related to the medical school environment and curriculum, and whether one has the endurance and ability to be successful were significant correlates with depression and anxiety. Loss of opportunity to maintain social and recreational sources of gratification correlated with anxiety. There was no difference between the sexes with regard to the development of anxiety and depression symptoms. Academically less successful students reported somewhat higher levels of depressive ideation and symptomatology. Trait anxiety correlated with the development of distress, while optimism protected against the development of distress. Active coping styles and positive reinterpretation as a coping strategy correlated negatively with distress, while wishful thinking correlated positively with distress. These findings emphasize the need for greater attention to the psychological well-being of doctors-in-training, in Hong Kong as in the Western world. These findings should be further explored in longitudinal studies, and may be helpful in designing intervention and support programmes for vulnerable students.     

Introducing first-year students to medical school: experiences at the Faculty of Medicine of Erasmus University, Rotterdam, The Netherlands

A system, in which more advanced students provide guidance to small groups of first-year students with respect to the educational programme, problems students may encounter in studying medicine and with respect to the living circumstances associated with going to medical school, and which has been operating for 14 years, is described. Each group consists of ten first-year students and two advanced students, called mentors, and meets about once every fortnight to discuss questions that come up among the first-year students. The mentors receive some professional training in the field of group psychology.
This system has now operated for 14 years, and therefore may be regarded as evidence that it meets real needs of students entering medical school.     

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.     

Developing medical student competence in lifelong learning: the contract learning approach

How contract learning may be used in the introduction to clinical medicine is described, with the goal to develop and enhance self-directed learning skills and attitudes of first- and second-year medical students. Essential tasks associated with successful self-directed learning are cited, and the contract method is described as a means for providing medical students with the opportunity to practise these tasks in the study of gerontology. The procedures followed in the implementation of the contract learning method are described, and its impacts on both need and motivation to continue learning about ageing and skills in directing independent learning projects are analysed and discussed. In addition, the implications of early preparation for doctor's lifelong learning are discussed.     

Upstairs, downstairs: Medical students in their first clinical year and their previous experience of work in hospitals

In a study of Edinburgh students in their first clinical year it was found that a sizeable proportion had had some prior experience of hospital life and work from vacation jobs--such as being porters, auxiliary nurses and so on. Students' retrospective accounts of such experience are reported. The most salient aspect of hospitals seen from this vantage point concerned the division of labour between grades of staff, and the hierarchical organization of hospital personnel. Students saw the experience primarily as a chance to see medicine 'from the other side'. It is suggested that such experiences can be drawn on in the teaching of sociology to undergraduate students.     

The professional attitudes of Nigerian first year medical students

In a study of the development of professional attitudes in medical students, a modified version of the Medical Attitudes Inventory ( Harris, 1974 ) was administered to 141 male and female first year medical students in Lagos, Nigeria. The results show that the students have well-defined attitudes on certain issues and are divided on others. The findings are discussed in terms of their implications for medical education, attitude research and durability of students' attitudes in and beyond medical school. The influence of contemporary social factors on student professional attitudes is also considered. The instrument has sufficient psychometric attributes to warrant further use.     

Voluntary attachments of preclinical medical students to rural practitioners in Queensland

This study evaluates the attachment of preclinical medical students to rural general practitioners in Queensland. The expectations of participating students were assessed before the experience, and compared with their realizations. Perceptions of their own clinical skills, and the type of medicine they want to practise were assessed both before and after.
Doctors taking part felt stimulated by the experience, and confimed that the presence of a student is readily accepted by patients, and causes minimal practice disruption. Students saw this attachment as providing motivation for their further studies, and relevance to their preclinical work. Clinical sophistication would not appear to be necessary for considerable benefit to be derived from the experience.     

Attitudes of Ugandan medical students toward 'straight' and 'modified' ECT

In third world countries, limited resources of anaesthetists and resuscitation facilities mean that electroconvulsive therapy (ECT) is usually given 'straight'(i.e. without anaesthetic and muscle relaxant). This study compared the attitudes of Ugandan medical students towards ECT given straight and ECT administered with muscle relaxant and general anaesthesia (i.e.'modified' ECT). Results confirmed the clinical impression that students regarded straight ECT as an inhumane method of treatment. However, whilst this was a major factor influencing students' preference for modified ECT as a treatment for themselves or for a close friend, it was relatively unimportant in determining their choice of ECT technique for a patient. Convenience of administration was the main criterion applied by students when deciding whether they would prefer to administer straight or modified ECT to a patient. Implications for medical education and the development of professional attitudes are discussed.