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.     

Medical students'' attitudes to psychiatry in Chile

There is controversy about the influence of psychiatric clerkships on medical students' attitudes to psychiatry. In general, studies in developed countries have found a short-lasting improvement in attitudes to psychiatry after a psychiatric clerkship. The present study was designed to measure changes in medical students' attitudes following a psychiatric clerkship in a developing country. Medical students from the Faculty of Medicine, University of Chile were interviewed before and after a psychiatric clerkship using a translation into Spanish of an attitude-to-psychiatry questionnaire used previously in the UK. The results were similar to those reported from developed countries. There was a marked early improvement in students' attitudes following their psychiatric clerkship which gradually faded over 3 years. There is scope for improvement in psychiatric undergraduate medical teaching in Chile and this might help to make more lasting improvements in attitudes to psychiatry among medical students.     

Students'' attitudes towards psychiatry

Using a reliable measure, a self-administered questionnaire (ATP), and adequate numbers of students, this study demonstrates the negative effects of general medical/surgical training and the positive effect of the psychiatry clerkship on students' reported attitudes towards psychiatry. A negative view of psychiatry at the beginning of the clerkship may make students reluctant to improve their interview skills but is otherwise unimportant in determining their reactions and performance in the clerkship. Medical students' interest in psychiatry as a career increases during the psychiatry clerkship but this merely offsets the decline in interest that occurs at other stages during the clinical training. Much of the attitudinal change that occurs during the psychiatry clerkship is maintained into the pre-registration year but the housemen recorded a significant negative change on the items concerning efficacy of psychiatric treatment and attitudes towards psychiatric patients. Additional training by psychiatrists during the pre-registration year might increase the motivation of young doctors to detect and treat psychiatric illness which they will encounter in all branches of medicine.     

The contribution of general practice to medical education: expectations and fulfilment

The aim of this study was to discover what students expected to learn during their fourth-year general practice attachment, to compare this with their GP tutors' expectations and to determine the extent to which the students' expectations were fulfilled. Questionnaires were used to gather this information; students completed them on the first and last days of the 4-week attachment and tutors shortly after the attachment. Students and their tutors had the highest expectations of the course in helping to raise awareness of the psychological and social aspects of ill health and develop clinical decision-making and management skills. At the end of the course students thought that they had gained most in these areas. Both students and tutors had lower expectations of the course helping to develop physical examination and practical skills and to improve knowledge in certain clinical areas. These were also rated lowest in terms of fulfillment. This study was carried out at a time when it is being suggested that more undergraduate teaching should take place in general practice and that this could include the teaching of practical skills and clinical subjects traditionally associated with hospital-based teaching. The results suggest that the expectations of students and GP tutors would need to be modified, as well as extra resources provided, if there is to be a shift in teaching towards the community.     

A skills programme for preclinical medical students

An education programme in which preclinical medical students are introduced to common procedural skills is described. This programme is presented by a multidisciplinary health care team using short lectures, demonstrations, mannequin practice, and, in selected instances, practice on class-mate volunteers. The programme was evaluated by the students immediately following the presentation and for one class during their clinical activities one year later. The students' support for this programme was generally enthusiastic and remained undiminished upon reflection 12 months later.     

Hopes and concerns of a first-year medical school class

Summary. To assess the hopes and concerns of first-year medical students, the 1991 Oregon Health Sciences University (OHSU) Medical School class was surveyed during orientation. Using qualitative research methods, student responses were grouped into general categories. The most common ‘hopes’ were to provide personal care and develop relationships with patients, to attain self-fulfilment, and to enjoy the personal challenge and variety of medicine. Common ‘concerns’ were family issues, outside intervention into medicine, and loss of self. The hopes and concerns of this class revolve primarily around personal issues, rather than issues relating to their local community or to society. This information may be useful in student counselling and curriculum development. Further research is necessary to evaluate changes in this class's attitudes over time. The methodology of this study may be useful in the evaluation of the attitudes of subsequent first-year medical school classes at OHSU, and at other institutions.     

The anxieties of new clinical students

The specific anxieties of 74 medical students beginning their clinical training were assessed by means of a questionnaire at the start of the clinical introductory course at St Mary's Hospital Medical School, London. Situations differed in the amount of anxiety that they engendered, and students also differed in the number of situations that they found anxiety producing. Students particularly reported that interactions with senior staff on ward rounds were anxiety provoking. The same questionnaire was also distributed to 52 teaching hospital doctors who were asked to complete the questionnaire as they thought the students had done. Compared with students, the doctors considered more situations to be anxiety provoking, and they differed in their rank ordering of the situations. Doctors tended to overestimate anxiety concerning communication problems, and to underestimate anxiety concerning routine clinical tasks such as phlebotomy.     

Changes in attitudes towards psychiatry among medical students: correlation of attitude shift with academic performance

This study investigates the changes in attitudes to psychiatry and level of psychiatric knowledge among medical students before and after formal teaching on psychiatry. Teaching led to the development of more favourable attitudes (particularly among women) towards psychiatry, but doubt remained after teaching about the 'scientific' status of the discipline. Initial attitudes did not relate to academic performance but, those developed after teaching showed a significant positive correlation with it.     

Choosing a career in general practice: the influence of medical schools

Summary. This paper reviews the literature on career choice to investigate the undergraduate influences on the preference of Australian graduates for a career in general practice. Although isolation of influencing factors is difficult, admission criteria and undergraduate curricula may influence career preference. As the institutional environment of medical schools is weighted towards scientific research and specialized medicine, medical students may be socialized into choosing non-generalist careers. Medical schools should consider broadening selection criteria and curriculum exposure to produce graduates with a broad range of career interests.     

Medical students' experiences with and perceptions of chronic illness prior to medical school

Summary. Concerns have been expressed about the failure of the medical curriculum to address the health-care needs of the chronically ill. It has been shown in the literature that medical students develop cynicism and negative feelings towards chronic illness as they progress through their training, perhaps as a result of the attitudes and frustrations of their teachers. What has been inadequately addressed are the experiences with and perceptions about chronic illness that medical students have before entering medical school. Some recommendations are made for curriculum changes based on the findings reported.     

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.     

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.     

Students' written reports as an essential part of a casebased learning programme in anatomy

Summary. This paper reports on second-year medical students' views and performance on the written reports for the cases that were studied in a case-based learning programme in anatomy at the University of Otago in 1988. The mean marks for the reports for the three main categories of student entry are presented. Differential performance on the written reports relative to the case-based component of the examination held at the end of the year has been determined for each student in the class and ranked in order. The proportions of students falling in the top and bottom quartiles for the class are given. The data taken together indicate that with an intensive programme of case-based learning in 1988, optimal performance in the written reports was reached at an early stage by the graduates whereas the two undergraduate categories improved their performance towards the end of the programme.     

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 perspectives of women and men medical students

In spite of the increasing number of women medical students, in many specialties the number of women actually working as doctors still lags behind the number of men working in the same profession. To define factors contributing to this discrepancy 646 medical students at the Vrije Universiteit in Amsterdam were surveyed. A questionnaire was used to obtain information about the difference between women and men medical students concerning their outlook on a future career as combined with domestic responsibilities. The questionnaire covered the items motives and career preference, barriers to reaching the profession of first choice, career planning and the combination of domestic responsibilities and a medical career. The results of this survey indicate that there are still important differences between women and men students in career perspectives. These differences need attention from medical students as well as teaching staff.     

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.     

Child and adolescent psychiatry in the undergraduate medical curriculum

The preliminary findings of a prospective controlled investigation to evaluate the effects of teaching child and adolescent psychiatry to medical students are presented. The results confirmed that the combined teaching of child and adolescent psychiatry, psychiatry and paediatrics led to significant changes as assessed using a multiple choice questionnaire and an attitude questionnaire. Students who had received the combined teaching acquired greater knowledge and more positive attitudes. Caution is warranted when interpreting the results, however, due to the multiplicity of factors affecting outcome: the absence of any measure of the acquisition of clinical skills; no attempt to determine separate or interactive effects of psychiatry and paediatric teaching; and no measure of stability of the changes over time.     

Enhancing the psychological health of medical students: the student well-being committee

Summary. Medical schools' emphasis on technical excellence is sometimes at the expense of social and emotional development. This paper describes a programme, orchestrated by a vital Well-Being Committee, that involves students in a wide range of activities to enhance social and emotional well-being. The primary prevention of emotional impairment is the goal.     

Experiences with a method for obtaining feedback on a medical curriculum undergoing change

Summary. Successful innovation and change in the way medical students are prepared are notoriously difficult. The relationship between the administrative structures of the medical school and its teaching hospitals, other responsibilities of its teachers and administrators, and the intricacies of the curriculum as a system of interrelated components, mean that any real change has wide repercussions. An opportunity for evaluation of a curriculum undergoing change was presented at the University of New South Wales, when the Faculty of Medicine introduced a new 6-year medical curriculum in 1988. The change was made to address a number of problems experienced with the old 5-year curriculum. The Course Evaluation Committee was in a unique position to conduct an ongoing evaluation of the new curriculum, year by year, as it was being introduced. A method for obtaining feedback from both staff and students on a medical curriculum undergoing change, is described. While some sample results are presented, the paper concentrates on the advantages and disadvantages of, and our experiences with, this method. Advantages include the specificity and timing of the information collected, and the high response rate. One disadvantage was the repeated use of the same cohort of students. Some staff still perceived the evaluation process as a threat, or were sceptical about the value and validity of student feedback. Whether staff acknowledged ownership of the new curriculum also affected the use of feedback.