Generation X arrives at medical school to find changing expectations, growing pressures.

Students entering medical school today face a health care system that is vastly different from the one new students experienced in the 1970s and 1980s. Michael OReilly interviewed five first-year students from the University of Western Ontario to learn about the hopes and dreams of medicine's next generation and the pressures facing these students. The Class of '98 doesn't appear intimidated by the cutbacks practising physicians are facing. As one student put it, these students won't be yearning for the "good old days" because "we don't have any good old days to remember."     

宿州市中职学生对抗生素的认知和使用现状调查

目的:了解中职学生对抗生素的认知和使用现状,分析滥用抗生素的相关因素,为开展抗生素健康教育工作提供科学依据。方法:采用整群抽样的方法,对宿州市2所中职学校的在校学生进行问卷调查,调查内容包括专业和年级等基本情况、对抗生素的认知情况、抗生素的使用情况及凭处方购买抗生素的实施情况。通过对认知评分和各项指标百分率的比较,分析2所学校学生对抗生素认知和使用行为方面的差异。结果:回收有效问卷4462份,其中医学生2543份,非医学生1919份。医学生对抗生素的认知评分为(44.1±5.4)分,明显高于非医学生的(42.0±4.6)分(P<0.01)。4462名学生中常备抗生素者高达3621人(81.2%);症状相似时自行服用抗生素的医学生有1015人(40.0%),非医学生有666人(34.7%);使用抗生素前会认真阅读说明书的医学生有1144人(45.0%),非医学生有943人(49.1%)。仅有701名(27.6%)医学生和276名(14.4%)非医学生知道国家规定社会药房必须配备执业药师;1568名(61.7%)医学生和1063名(55.4%)非医学生表示到药房购买抗生素从没被要求出示处方。2组学生在凭处方购买抗生素的规定实施方面差异均有统计学意义(P<0.01)。结论:中职学校的学生对抗生素整体认知不高,且滥用抗生素的现象较为普遍,医学生与非医学生对抗生素的认知差异可以归于相关知识差异。     

Fear of ostracism still silences some gay MDs, students.

"Coming out" remains a very major decision for a gay or lesbian medical student. Canadian students interviewed for this article say they have feared being ostracized by their peers or encountering bias among older faculty members. A recent survey by the US-based Gay and Lesbian Medical Association found that 59% of gay and lesbian physician and medical student respondents have experienced job-related discrimination because of their sexuality. However, other gay/lesbian physicians and students are finding that their coming out is being greeted with tolerance, acceptance and understanding.     

A pilot study of medical student 'abuse'. Student perceptions of mistreatment and misconduct in medical school

A pilot survey of one third-year medical school class was carried out to explore student perceptions of mistreatment and professional misconduct in medical school training. Students were asked to rate the frequency and cite sources of mistreatment and misconduct among classmates, faculty, residents, and interns. They were also asked to assess the effects of such episodes on their physical health, emotional well-being, social and family life, and attitudes toward becoming a physician. The results indicate that students perceive mistreatment (particularly verbal abuse and unfair tactics) to be pervasive and professional misconduct all too common. As many as three fourths of the students report having become more cynical about academic life and the medical profession as a result of these episodes. Two thirds feel they are worse off than their peers in other professions. More than a third have considered dropping out of medical school and one fourth report they would have chosen a different profession had they known in advance about the extent of mistreatment they would experience. Rather than dismiss these problems as isolated events, we need to examine this issue more closely.     

Medical student's access to information and resources for the residency selection process

In the study reported here, the authors analyzed senior medical students' attitudes regarding the availability of information and resources pertaining to the residency selection process. Results of a nationwide survey of students showed that when the students had access to information from medical professionals (that is, faculty members, deans, house staff physicians), they felt they had greater access to information than did students who made greater use of other sources (official directories, classmates and the "grapevine"). Furthermore, the findings suggest that greater availability of information from medical professionals was related to higher levels of overall satisfaction with the residency match. While no evidence is presented that demonstrates that medical school faculty members and administrators were unwilling to devote attention to any particular group of students, the data suggest that these professionals provided information regarding the residency selection process more often to medical students at high-prestige schools, students who chose high-prestige specialties, and students who perceived themselves as having high class rank than to other students. Also, students in publicly supported schools felt the cost of travel for interviews to be more burdensome than did the students in private schools.     

Medical educators' views on medical education reform

To determine whether medical educators perceive a need for change in medical student education, we analyzed data from a 1989 survey of 1369 respondents from all US schools of allopathic medicine. Except for basic sciences faculty, a majority of educators stated that "fundamental changes" are needed in medical student education in the United States. Nearly three fourths of deans and associated deans reported the need for "fundamental changes" or "thorough reform." At least 79% of educators voiced support for six specific reforms, such as rewarding teaching excellence and increasing clinical education in ambulatory and community settings. While slight majorities supported reducing class size and centralizing governance, substantial proportions stated that they would "work against" such reforms. Most educators reported that a broad base of support within the school would be essential for change. The survey suggests a restlessness among the leaders of medical education.     

U of T Medical School uses multistep strategy to prevent sexual harassment.

The University of Toronto medical school is using a multistep strategy in an attempt to prevent sexual harassment among students and faculty members. A driving force behind the program is Dr. Miriam Rossi, who was recently appointed associate dean of student affairs. As well, the dean of medicine sent a notice to faculty members explaining that there will be zero tolerance "for any behaviour that can be construed to be sexual harassment."     

Simulated surgical workshops enhance medical school students’ preparation for clinical rotation

Background

A major focus of the medical school curriculum is to ensure medical students are well prepared prior to entering clinical rotations, which includes the compulsory surgical rotation.

Aims

The objective of this research was to design and formally evaluate a set of real-life surgical workshops aimed at better preparing medical students for their clinical rotation in surgery. These workshops would be incorporated into the pre-clinical medical school curriculum.

Method

Dedicated surgical workshops were introduced into the preclinical component of the Bachelor of Medicine/Bachelor of Surgery (MBBS) program at our University in 2009. These workshops encompassed training in the clinical skills needed in the perioperative and wider hospital setting. A survey comprising of eight to nine ranked questions (utilising a five-point Likert Scale) as well as three short answer questions was administered to the medical students after they completed their compulsory surgical clinical rotation.

Results

The overall response rate to the survey evaluating the surgical workshops was 79% (123/155). The mean of the ranked questions ranged from 4.05 to 4.89 which indicated that the students found the workshops useful. When evaluating the short answer questions (via topic coding), additional information was provided that supported and explained the survey findings and also included suggestions for improvements.

Conclusion

The findings of the medical student survey demonstrated the value of incorporating dedicated preparatory surgical workshops in the medical school pre-clinical curriculum. However, further research is warranted to determine if this inclusion translated into improved student performance during the clinical surgical rotation.     

Do students'' attitudes toward women change during medical school?

BACKGROUND: Medical school has historically reinforced traditional views of women. This cohort study follows implementation of a revitalized curriculum and examines students' attitudes toward women on entry into an Ontario medical school, and 3 years later. METHODS: Of the 75 students entering first year at Queen's University medical school 70 completed the initial survey in September 1994 and 54 were resurveyed in May 1997. First-year students at 2 other Ontario medical schools were also surveyed in 1994, and these 166 respondents formed a comparison group. Changes in responses to statements about sex-role stereotypes, willingness to control decision-making of female patients, and conceptualization of women as "other" or "abnormal" because they are women were examined. Responses from the comparison group were used to indicate whether the Queen's group was representative. RESULTS: Attitudinal differences between the primary group and the comparison group were not significant. After 3 years of medical education students were somewhat less accepting of sex-role stereotypes and less controlling in the doctor-patient encounter. They continued, however, to equate adults with men and to see women as "not adult" or "other." Female students began and remained somewhat more open-minded in all areas studied. INTERPRETATION: A predicted trend toward conservatism was not seen as students became older, more aware and closer to completion of medical training, although they continued to equate adults with male and to see women as "other." Findings may validate new curricular approaches and increased attention to gender issues in the academic environment.     

Substance abuse by medical students and doctors

The doctors are vulnerable to substance abuse/addiction due to their ready accessibility to the substances of abuse. There is higher percentage use of alcohol, tranquillisers and psychedelics among medical students, and dependence rates are 5% for medical students and 3% for doctors. Majority of the substance-abusing doctors are graduates, belong to medicine speciality (21%) and majority of them prescribe drugs to themselves (37%). The consultants experience more substance related complications, despite having late age of onset of alcohol and substance dependence, less number of concomitant substance abuse and less career handicap. Stress (situational, personal and professional), medical student abuse and family history of alcoholism are the major risk factors. Despite paucity of studies in Indian population, substance use is reported between 32.5% to as high as 81.2% among medical students, intems and house physicians. In spite of the treatment dilemmas, the physicians do respond favourably to treatment. These findings have implications in planning preventive and interventional strategies for this professional group.     

医学生在儿童期受虐待及其危险行为的调查分析

目的了解医学生在儿童期被虐待发生情况及其影响因素,旨在采取针对性措施保护和促进儿童的健康成长。方法采用自填式问卷,按照统一方式对某医学院本科一年级、二年级和三年级的学生进行回顾性调查及分析。结果本研究共发放问卷490份,有效答卷为485份,应答率为98.97%。在被调查的485名学生中,有459人（男：282,女：177）表示受过不同类型和不同程度的虐待,占总调查人数的94.64%;其中253人曾有过不同类型和不同程度的危险行为,占儿童期遭受过虐待人数的55.1%。结论儿童被虐待现象常被忽略,现实生活中不同的儿童被虐待方式有不同的发生特点与负面影响因素,对儿童的健康成长极为不利,应引起家长和社会的高度重视。     

Evaluating medical school graduates of a reduced course program: a preliminary report

The performance of 32 medical school graduates who had pursued a reduced course load ("extended program") for one or more years during medical school was examined during the first postgraduate year (PGY-1) of training. Those with academic problems as undergraduates performed at only a slightly lower than average level, while those who had extended their curricula to pursue personal or extracurricular interests tended to perform at a better than average level in the PGY-1 residency. Graduates with significant emotional disorders in medical school who pursued a reduced course load had a high (35 percent) dropout rate during the residency that occurred despite expert psychiatric care and substantial support during medical school and the residency. The authors suggest that extended programs may be useful for students seeking personal enrichment and for some with academic problems but that they do not seem particularly helpful to students with major emotional disturbances.     

Survivors of sexual abuse: clinical, lifestyle and reproductive consequences

BACKGROUND: In recent years, an increase in the prevalence of sexual abuse of women has been reported in Canada and elsewhere. However, there are few empirical data on the extent of the problem in Canadian aboriginal populations. The authors investigated the presence of a reported history of sexual abuse and other health determinants in a sample of women attending a community health centre with a substantial aboriginal population. This allowed determination of whether reported sexual abuse and its associated demographic and health-related effects were different for aboriginal and non-aboriginal women. METHODS: A sample of 1696 women was selected from women attending a community health centre in a predominantly low-income inner-city area of Winnipeg for a cross-sectional survey designed to study the association between sexual behavior and cervical infections. The survey was conducted between November 1992 and March 1995 and involved a clinical examination, laboratory tests and an interviewer-administered questionnaire. A substudy was conducted among 1003 women who were asked 2 questions about sexual abuse. RESULTS: The overall response rate for the main study was 87%. Of the 1003 women who were asked the questions about sexual abuse, 843 (84.0%) responded. Among the respondents, 368 (43.6%) were aboriginal. Overall, 308 (36.5%) of the respondents reported having been sexually abused, 74.0% of the incidents having occurred during childhood. The prevalence was higher among aboriginal women than among non-aboriginal women (44.8% v. 30.1%, p < 0.001). Women who had been sexually abused were younger when they first had sexual intercourse, they had multiple partners, and they had a history of sexually transmitted diseases. In addition, non-aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have been separated or divorced, unemployed and multiparous and to have used an intrauterine device rather than oral contraceptives. Aboriginal women who had been sexually abused were more likely than those who had not been abused to have had abnormal Papanicolaou smears. The proportion of smokers was higher among the abused women than among the non-abused women in both ethnic groups. INTERPRETATION: A history of sexual abuse was associated with other clinical, lifestyle and reproductive factors. This suggests that sexual abuse may be associated with subsequent health behaviors, beyond specific physical and psychosocial disorders. Aboriginal and non-aboriginal women who have suffered sexual abuse showed substantial differences in their subsequent health and health-related behaviours.     

银川市某中学学生因病缺课情况调查分析

目的了解学生健康及影响学生生活的疾病发生情况。方法根据技术规范要求,整群抽取全体在校学生进行监测。结果通过调查,影响学生缺课前三位的疾病是感冒、胃肠道疾病、外伤(其构成分别为76·30%、8·15%、4·07%),且高二年级学生因病缺课率(54·48%)较其它两个年级学生高。结论九中学生因各种疾病影响学生生活常见疾病的发生情况还比较严重,需引起预防医学工作者及学校、教师、学生、家长的重视。     

The British Columbia Positive Women''s Survey: a detailed profile of 110 HIV-infected women

OBJECTIVE: To describe the health, social environment, medical care received and satisfaction with medical care of HIV-infected women in British Columbia. DESIGN: Self-administered 75-item questionnaire distributed by mail or in person between March 1994 and February 1996 through community AIDS organizations and physicians' offices. SETTING: British Columbia. PARTICIPANTS: A total of 110 HIV-positive women. OUTCOME MEASURES: Sociodemographic data, risk factors for HIV infection, details about HIV testing, health status and medical treatment, use of health care services, degree of satisfaction with medical care and psychosocial stressors. RESULTS: Most of the women surveyed were aged 25 to 39 years (70.0%), were Canadian born (76.4%) and were white (80.9%). Over one-third did not complete high school, and half had an annual household income of less than $20,000. Of the 110 women 51.8% had children, who were HIV-positive in 12.3% of cases. The most frequently reported risk factor for HIV infection was sex with a man (49.1%); 19.1% reported both sex with a man and injection drug use, and 12.7% reported injection drug use only. Seventy-five women indicated that they had become infected through sex with a man, with or without injection drug use. Of these, 65 indicated whether or not this was the result of sexual assault or rape; 8 (12.3%) answered affirmatively. Of the 81 women who responded to the question regarding prior sexual assault or abuse, 43 (53.1%) reported being sexually assaulted as an adult, 35 (43.2%) reported being sexually abused as a child, and 22 (27.2%) reported being sexually abused or assaulted both as a child and as an adult. Women who were sexually abused as a child were more likely than those who were not abused as a child to have injection drug use as a risk factor (54.3% v. 7.5%). Menstrual cycle changes were reported by 70.1% of the respondents. Most women stated that they had not received adequate pre- or post-test counselling, and 47.0% were not satisfied with their doctor's care. Psychosocial concerns identified to be of greatest importance were financial problems, lack of intimacy or satisfying sexual relationship, and fear of rejection or discrimination. CONCLUSION: Several important concerns for HIV-positive women were identified, including dissatisfaction with medical care, fear of discrimination, violence and abuse, and poverty.     

Obstetric patients' assessment of medical students' role in their care

Obstetric patients at the Medical Center Hospital of Vermont who received care from medical students during a clinical clerkship rated the skills and assessed the roles of students in their care. The distribution method for the questionnaire selected for patients with favorable attitudes toward medical student care. The students' skills and attitudes were generally ranked high, with lower ratings given for the "ability to answer questions" and "preparation to participate in care." Eight-three percent felt the student improved their care in the hospital, primarily in a variety of supportive ways. Although generalizations to all patients are limited by the sampling design of the study, such information should prove valuable in explaining the role of medical students to patients entering teaching hospitals and encouraging patients to accept students in their care.     

深圳市中小学生吸烟行为及影响因素的调查研究

目的 通过对深圳市中小学生吸烟行为及影响因素的调查，为探讨适合深圳市中小学生特点的控制吸烟方案提供依据。方法采用整群随机抽样的方法，选取深圳市10所中小学校学生共5000名，用统一的调查表进行问卷调查。结果中学生吸烟率比小学生吸烟率高，尝试第1次吸烟以小学阶段占比例最高(50％)，尝试吸烟后仍想吸则以中学阶段占比例最高(85．4％)。在中、小学生吸烟者中，尝试戒烟成功的只占34．9％，表示会复吸烟的占25．6％，认为促使自己吸烟影响最大的主要是朋友、同学、父亲，大多数在无聊、朋友聚会和心情烦闷时吸烟；没有参加过预防吸烟活动的占78．0％，其中认为学校或班级没有组织过预防吸烟活动的占52．5％。结论学生吸烟行为与心理发育、周围环境密切相关，他们需要适宜的控烟健康教育，目前学校的控烟健康教育有待完善。     

A controlled experiment with a medical student honor system

In 1984 the student body at a midwestern medical school created an honor code and student honor council which supplemented the school's proctoring system. In consideration of recommending that the proctoring system be replaced by an honor system, the authors conducted a controlled experiment in which one trimester's behavioral science midterm and final examinations were unproctored and the midterm and final examinations in physiology and neuroscience were proctored. Using anonymous questionnaires, the authors discovered that significantly more students cheated and observed others cheating in behavioral science than in physiology or neuroscience examinations. Of 17 students who observed cheating, only two reported it, and they did so without providing the offenders' names.     

Patterns of fractures in accidental and non-accidental injury in children: a comparative study

The incidence and pattern of fractures in children who had been abused were compared with those of fractures sustained by children of similar ages in whom abuse had been excluded. From 1976 to 1982 there were 35 children with fractures resulting from child abuse, and all were aged under 5. Of the 826 children in the control group, seen from January to June 1981, 85% were aged over 5. Abused children were much more likely to have multiple fractures (p less than 0.001) and bruising of the head and neck (p less than 0.001). Fractures of the ribs were common in children who had been abused, and their presence, in the absence of major chest trauma, strongly suggested that abuse was occurring. Injuries to the long bones were invariably spiral or oblique fractures or subperiosteal new bone formation--both "gripping or twisting" injuries. Spiral fracture of the humeral shaft was significantly more common (p less than 0.001) in the group of abused children. Classic metaphyseal chip fractures were uncommon. One child in eight aged under 18 months who sustains a fracture may be a victim of child abuse.     

Mental disorders in medical students at the University of the West Indies,Trinidad and Tobago. Audit at a doctor's practice

A series of 32 consecutive students from one medical school presenting for psychiatric treatment over a two-year period between September 1997 and August 1999 is described. The author treated 31 of these students, representing 288 visits and 312 hours. On the basis of retrospective case note reviews, the author presents demographic data, the year of medical school in which the illness began, DSM IV diagnoses, treatment modalities, time absent from University as a result of mental illness and major stressors. Of the 32 subjects, 50% were male, with ages ranging from 20 to 34 years (mean 24.9 years). Ninety-four per cent were single, and 78% were Trinidadians. Thirty-one per cent were Trinidad and Tobago National Scholars. This finding achieved statistical significance. Seventy-two per cent presented during their clinical training. The most common source of referral was from members of the Faculty of Medical Sciences (31%). Relationship issues were the most commonly identified stressors in 31% of the subjects. Mood disorders and anxiety disorders were present in 59% of the students. Pharmacotherapy was used in 75% of the students. The majority (53%) of medical students with mental disorders were absent from university for less than one month. At follow-up in July 2001, 26 (81%) of the students had graduated, three (9%) were still in medical school and three (9%) had withdrawn from medical school as a result of mental illness. The study is limited in that only those seeking assistance from one doctor's practice are described. The findings would be further explored in longitudinal studies.