Medical school and the process of disillusionment

A pilot study of the 1970 graduating class of Yale Medical School revealed that a group of medical students could be defined who seemed particularly dissatisfied with themselves and their profession ( Schwartz & Slaby, 1971 ). For the most part, these medical students differed from their peers in that they contemplated an alternative career in the arts or letters and, while they retained many of the values of their colleagues, they differed from them in such a way as to convey the impression that they were more uncertain about their identity.
The study dealt with these medical students at the point in their career at which they were about to become doctors. It seemed appropriate, as part of our larger study, in which we are attempting to follow changing values and patterns of behaviour among various groups of professionals and professional students ( Slaby & Schwartz, 1971 ), to collect data on medical students during each of the 4 years of medical school. It was our purpose to determine whether the group of uncertain students comprised those students who had been in conflict about being at medical school and about their future role in medicine since their entrance into medical school, or whether the process of disenchantment evolved during the course of medical training. We explored if this process affected susceptible students during their clinical or pre-clinical years, and report some of the manifestations of this disaffection.     

RURAL ORIGIN MEDICAL STUDENTS: HOW DO THEY COPE WITH THE MEDICAL SCHOOL ENVIRONMENT?

Australia suffers from a well documented shortage of rural medical practitioners. In an attempt to increase recruitment, it has emerged that rural origin medical students are more than twice as likely as their urban colleagues to become rural practitioners. This has led to a wide range of programs aimed at increasing the number of rural students who apply for and gain entry into medical school. But how do rural students cope with the medical school environment? This paper was based on the results of a survey of senior medical students and looked at how rural students’ fare with the medical school environment compared to their urban counterparts. It was concluded that government initiatives currently supporting rural medical students must be continued into the future and continuously evaluated to ensure that rural students have a positive learning experience in preparation for future rural practice.     

Medical school entrance and career plans of Malaysian medical students

This study investigates the reasons for entry to medicine and the career perspectives of phase III medical students of the Universiti Sains Malaysia (USM). The majority of the students were Malays from low socio-economic backgrounds who entered medical school after completing a 2–year matriculation course. An interest in medicine and helping people were the two main stated reasons for entry to medical school. A group of students wishing to work in private practice was identified. In comparison to the rest of the study body, students in the group were: not well prepared to enter medical school; dissatisfied with the course; and subject to family influences. A desire for monetary gain motivated their choice of medicine as a career. Overall, 13% of the students wished to change career because they were dissatisfied with their experience of medicine as undergraduates.
The study did not find a significant difference in career intentions between female and male medical students. However, women were less likely to seek entrance into private practice or pursue formal postgraduate education. The choice of surgery as a career was confined to men. About 90% of the students had already decided on their future specialty. Four well-established specialties were their most popular choices. The gender of the students had no significant influences of the decision to continue into postgraduate education. The proportion of female students who wished to marry doctors was significantly higher than for male students.     

‘You put up a certain attitude’: a 6‐year qualitative study of emotional socialisation

Context

Emotions play a central role in the professional development of doctors; however, research into how students are socialised to deal with emotions throughout medical school is still lacking.

Objectives

This study aimed to gain a better understanding of the emotional socialisation of medical students (e.g. how they learn to express and respond to emotions evoked in clinical practice in the process of becoming a doctor).

Methods

In this longitudinal study, 12 medical students participated in annual, individual, semi‐structured interviews, capturing the full 6‐year medical school period. We carried out a thematic analysis, which was iterative and inductive.

Results

The socialisation of emotion in the process of becoming a doctor happens in a complex interplay between student and context. We identified two modes of emotional socialisation (e.g. explicit and implicit teaching about emotions), the latter including how the people observed by students express their emotions and how they respond to the emotions expressed by students. Although the main message conveyed to students still seemed one about hiding or suppressing emotion, we found that students were able to identify and build upon the emotional expression and responses they observed in positive role models and managed to create their own opportunities to express their emotions. We found large differences between students in how they perceived, presented and developed themselves.

Conclusions

Students differ in how they respond to and what they need from their environment and thus may benefit from tailored supervision in learning how to experience, express and respond to emotion. Providing students with real and authentic responsibility for patients and allowing them time and opportunity to talk about emotion might help them to create an emotional space.     

'Part of the team': professional identity and social exclusivity in medical students

Medical Education 2011: 45 : 1220–1229 Objectives Medical students must develop not only their professional identity but also inclusive social attitudes for effective medical practice in the future. This study explores the elements that contribute to medical students’ sense of professional identity and investigates the concept of social exclusivity and how this might relate to students’ development of their identity as medical professionals. Methods The study is based on qualitative data gathered in telephone interviews with 13 medical students enrolled in Years 1 or 3 at an undergraduate medical school at a university in Australia. The questions were open‐ended and asked students about their experiences in medical school, sense of identity and social connections. Results Two main components contributed to a strong sense of professional identity in medical students: professional inclusivity and social exclusivity. Students experienced professional inclusivity when they attended clinical placements and when they were treated as future medical professionals by lecturers, doctors and patients. Social exclusivity was demonstrated by participants’ perceptions of themselves as socially separate from non‐medical students and isolated from students in other disciplines. Students described a sense of peer unity and a shared sense of identity as medical students within the medical school. Conclusions It is important to understand how students develop their sense of identity as medical professionals and the ways in which medical education and clinical placements can influence this professional identity. Although this study noted a very strong sense of social exclusivity in its findings, there were also high levels of intra‐discipline inclusivity. These results suggest that there is a reciprocal and reinforcing relationship between student experiences of professional inclusivity and social exclusivity that creates a defined sense of professional identity.     

"I'm too used to it": a longitudinal qualitative study of third year female medical students' experiences of gendered encounters in medical education

Although the number of women entering medical school has been steadily rising in the U.S.A., female medical students continue to report instances of sexual harassment and gender discrimination. The full spectrum of such experiences and their effect on the professional identity formation of female students over time remains largely unknown. To investigate these experiences, we interviewed 12 third year female medical students at a private New England medical school over several points during the 2006-2007 academic year. Using theoretical frameworks of gender performance and the centrality of student-patient and student-supervisor relationships, we were better able to understand how female medical students interpret the role of 'woman doctor' and the effect of negative and positive gendered interactions on the evolution of their professional identity. We found that participants quickly learned how to confront and respond to inappropriate behavior from male patients and found interactions with female patients and supervisors particularly rewarding. However, they did not feel equipped to respond to the unprofessional behavior of male supervisors, resulting in feelings of guilt and resignation over time that such events would be a part of their professional identity. The rapid acculturation to unprofessional behavior and resignation described by participants has implications for not only professional identity formation of female students but specialty choices and issues of future physician workforce.     

The development of self-regulated learning during the pre-clinical stage of medical school: a comparison between a lecture-based and a problem-based curriculum

Society expects physicians to always improve their competencies and to be up to date with developments in their field. Therefore, an important aim of medical schools is to educate future medical doctors to become self-regulated, lifelong learners. However, it is unclear if medical students become better self-regulated learners during the pre-clinical stage of medical school, and whether students develop self-regulated learning skills differently, dependent on the educational approach of their medical school. In a cross-sectional design, we investigated the development of 384 medical students’ self-regulated learning skills with the use of the Self-Regulation of Learning Self-Report Scale. Next, we compared this development in students who enrolled in two distinct medical curricula: a problem-based curriculum and a lectured-based curriculum. Analysis showed that more skills decreased than increased during the pre-clinical stage of medical school, and that the difference between the curricula was mainly caused by a decrease in the skill evaluation in the lecture-based curriculum. These findings seem to suggest that, irrespective of the curriculum, self-regulated learning skills do not develop during medical school.     

The short-term stability of student ratings of instruction in medical school

The purpose of this study was to assess the degree of consistency in student ratings of teacher effectiveness during the first year of medical school. Student ratings of teaching effectiveness represent a commonly used source of information that enters into the academic decision-making process. In medical school, student evaluations often represent a major source of information that is used in promotion and tenure decisions. It is essential that the precision of such ratings be ascertained so that decision-makers will know how much confidence to place in this source of information on teaching effectiveness. In this study, each member of a first-year medical school class was randomly assigned a two-digit identification number at the beginning of the spring semester, 1986. As the semester progressed students were asked to evaluate each full-time teacher in three major courses. Multiple instructors were utilized in each course (n = 10). Each teacher was evaluated immediately after lectures during the first (T1) and second (T2) halves of the course. Students evaluated the teacher a third time (T3) as part of the end-of-semester overall course evaluation. The teachers were evaluated on a short eight-item Likert-type scale that identified several key indicators of effective teaching. Students attached their anonymous identification numbers to individual ratings so that their responses could be matched in the analysis. The results indicate that medical students are only moderately consistent in the extent to which they evaluate teachers. This inconsistency varied by course and by instructors within courses.(ABSTRACT TRUNCATED AT 250 WORDS)     

The pursuit of medical knowledge and the potential consequences of the hidden curriculum

This study explores how preclinical medical students experience particular elements of their training, specifically their pursuit for medical knowledge and how this may impact their attributes as well as their relations with those outside of the realm of medicine. Ten first-year and 10 second-year students of a US medical school were interviewed regarding their experiences with and perceptions of their medical training. The students reported a cognitive and emotional distance from non-medical students that appears to be accentuated not only by their strenuous academic responsibilities but also elements of the hidden curriculum nested within medical training. Furthermore, students discuss experiencing disapproval, mistrust, and negative judgment toward laypersons thereby suggesting that this distancing may lend to deleterious effects on students' ability and willingness to connect with others. A Parsonian lens is utilized to examine the notion of a 'Knowledge Gap' as well as aspects of the hidden curriculum in medical education and their role in professionalizing medical students.     

Smoothing Out Transitions: How Pedagogy Influences Medical Students’ Achievement of Self-regulated Learning Goals

Medical school is an academic and developmental path toward a professional life demanding self-regulation and self-education. Thus, many medical schools include in their goals for medical student education their graduates' ability to self-assess and self-regulate their education upon graduation and throughout their professional lives. This study explores links between medical students' use of self-regulated learning as it relates to motivation, autonomy, and control, and how these influenced their experiences in medical school. Subjects were medical students in two distinct medical school environments, “Problem-based learning” and “Traditional.” PBL students described a rough transition into medical school, but once they felt comfortable with the autonomy and control PBL gave them, they embraced the independence and responsibility. They found themselves motivated to learning for learning's sake, and able to channel their motivation into effective transitions from the classrooms into the clerkships. Traditional students had a rougher transition from the classrooms to the clerkships. In the first two years they relied on faculty to direct and control learning, and they channeled their motivation toward achieving the highest grade. In the clerkships, they found faculty expected them to be more independent and self-directed than they felt prepared to be, and they struggled to assume responsibility for their learning. Self-regulated learning can help smooth out the transitions through medical school by preparing first and second year students for expectations in the third and fourth years, which can then maximize learning in the clinical milieu, and prepare medical students for a lifetime of learning.     

Correlations of knowledge and preference of medical students for a specialty career: a case-study of youth health care

Background  

Medical students develop interest in a specialty career during medical school based on knowledge and clinical experience of different specialties. How valid this knowledge is and how this knowledge relates to the development of preference for a specialty is not known. We studied their "subjective" knowledge of a specialty (students' reported knowledge) with "objective" knowledge of it (students actual knowledge as compared to reports of specialists) and their preference for this specialty at different stages of education, and used youth health care as a case study.     

Other worlds and other lives: A study of occupational therapy student perceptions of cultural difference

The research described in this article was a study of 22 first year occupational therapy students at the beginning of their educational programme, ie. Bachelor of Health Science (Occupational Therapy) at the Auckland Institute of Technology. The research design was qualitative with a phenomenological orientation and utilised a semi-structured interview format. This ‘snapshot’ of occupational therapy students at the beginning of their education constitutes part of a larger, longitudinal study done in conjunction with the school of occupational therapy at the University of British Columbia, Canada. The findings from this phase of the research indicated that students' perceptions of themselves as people influenced their perceptions of cultural difference. Perhaps not surprisingly, prior learning in the shape of work experiences, friendships and travel appeared to be significant influences on the students' perceptions of individuals from differing cultural backgrounds to themselves. There is a need for occupational therapy educators to acknowledge and value the life experiences and skills of their students at entry to the programme. Similarly, issues of culture, cultural difference, race and ethnicity need to be dealt with in the context of a coherent curriculum model with context specific features. Recommendations arising from this research relate to greater articulation of the issues outlined above to students, as well as clear statements regarding the value orientation of the school/department in relation to cultural difference. This is necessary as, in the absence of this information, students are only able to work from a largely assumptive basis. The most important recommendation is that this longitudinal study continue so that more detailed data can be gathered over time that will assist in the development of a deeper understanding of how students develop knowledge and skills in working with individuals who are culturally different over he duration of their educational programme.     

Identity,identification and medical education: why should we care?

Context Medical education is as much about the development of a professional identity as it is about knowledge learning. Professional identities are contested and accepted through the synergistic internal–external process of identification that is constituted in and through language and artefacts within specific institutional sites. The ways in which medical students develop their professional identity and subsequently conceptualise their multiple identities has important implications for their own well‐being, as well as for the relationships they form with fellow workers and patients. Objectives This paper aims to provide an overview of some current thinking about identity and identification with the aim of highlighting some of the core underlying processes that have relevance for medical educationists and researchers. These processes include aspects that occur within embodied individuals (e.g. the development of multiple identities and how these are conceptualised), processes specifically to do with interactional aspects of identity (e.g. how identities are constructed and co‐constructed through talk) and institutional processes of identity (e.g. the influence of patterns of behaviour within specific hierarchical settings). Implications Developing a systematic understanding into the processes through which medical students develop their identities will facilitate the development of educational strategies, placing medical students’ identification at the core of medical education. Conclusions Understanding the process through which we develop our identities has profound implications for medical education and entails that we adopt and develop new methods of collecting and analysing data. Embracing this challenge will provide better insights into how we might develop students’ learning experiences, facilitating their development of a doctor identity that is more in line with desired policy requirements. Medical Education 2010: 44 : 40–49     

Development of an interest in a career in public health during medical school

OBJECTIVES: In The Netherlands, approximately 12% of medical graduates spend their professional life in public health, but it is the authors' belief that few of them become interested in such a career during medical school. The aim of this study was to investigate students' development of interest in a career in a public health specialty during medical school. METHODS: A written questionnaire was completed by students of all years at a Dutch medical school in 2002 (n=1371) and 2003 (n=1293). Students indicated their interest in a career in 37 Dutch medical specialties. Three public health specialties were distinguished and compared with the least popular specialty, the most popular specialty and with the average interest over all specialties. RESULTS: Interest in a career in occupational health and social insurance health was low throughout medical school. However, almost 15% of students indicated a high level of interest in youth health care in the first year of medical school, which is over twice as many as for the average specialty. This percentage decreased dramatically during medical school. At graduation, all three public health specialties had interest figures well below the average. CONCLUSIONS: Students have little interest in careers in public health. However, given that approximately 12% of medical graduates spend their professional life in public health, the factors that influence career preferences should be investigated. Targeted measures may yield more primary career preference in this direction. Reasons for the loss of interest in youth health care need to be investigated.     

Tolerance for ambiguity among medical students: implications for their selection, training and practice

The practice of medicine has always been characterized by uncertainty. Yet, attempts to study tolerance for uncertainty in medicine have been few, and limited to its influence on specialty preferences and test-ordering behavior. In particular, studies have not investigated how the process of socialization into the medical profession affects tolerance for uncertainty. Based on the assumption that uncertainty and ambiguity are related concepts, a modified version of a tolerance for ambiguity scale was used to study Johns Hopkins medical students' (N = 386) tolerance for ambiguity (TFA) through 4 yr of medical school. In addition, using alcoholism as an example of a clinically ambiguous condition, the association between students' tolerance for ambiguity and their perceived role in diagnosing and treating alcoholism was also investigated. Results indicate that tolerance for ambiguity (1) does not change throughout medical school, (2) is lower among men, whites and students who are younger when they begin medical school, (3) is higher among prospective psychiatrists than surgeons, and (4) is lower among students who do not feel responsible for diagnosing and treating alcoholism. These findings suggest that tolerance for ambiguity may, indeed, affect practitioners' career choices and performance and that selection of medical students may be more important than medical training per se in influencing students' tolerance for ambiguity. If medical schools admitted students who possess a high tolerance for ambiguity, quality of care for ambiguous conditions might improve, imbalances in physician supply and practice patterns might be reduced, and the increasing ambiguity in medical practice might be better acknowledge and accepted.     

Critical review: medical students’ motivation after failure

About 10 % of students in each years’ entrants to medical school will encounter academic failure at some stage in their programme. The usual approach to supporting these students is to offer them short term remedial study programmes that often enhance approaches to study that are orientated towards avoiding failure. In this critical review I will summarise the current theories about student motivation that are most relevant to this group of students and describe how they are enhanced or not by various contextual factors that medical students experience during their programme. I will conclude by suggesting ways in which support programmes for students who have encountered academic failure might be better designed and researched in the future.     

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.     

Increasing the pool of qualified minority medical school applicants: premedical training at historically black colleges and universities.

Historically black colleges and universities have educated significant numbers of black students preparing for careers in medicine. These institutions have the potential to make even greater contributions to the pool of black medical school applicants and ultimately to the supply of black physicians. The Division of Disadvantaged Assistance, Bureau of Health Professions, Health Resources and Services Administration within the Public Health Service, commissioned a study of the curriculums and other factors related to premedical education. The study was conducted at the historically black colleges and universities that graduate a large number of students who gain admission to medical school, and the historically black colleges and universities whose students are less successful in gaining admission to medical school. Nine historically black colleges and universities participated in a self-assessment of their undergraduate premedical curriculums. The findings from schools with higher acceptance rates were compared with those of schools with lower acceptance rates to identify factors contributing to the production of significant numbers of successful medical school applicants. Comparisons of data on these schools revealed several important factors that may be related to differences in acceptance rates: Those schools that devoted greater effort to premedical training (for example, advising students about how to prepare for medical school, curriculum development, maintaining premedical or pre-health professions offices and clubs--the staff of these offices provide students with information on medical or other health professions schools--to identify and recruit students) tended to have higher acceptance rates.(ABSTRACT TRUNCATED AT 250 WORDS)