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.     

Comparing millennial and generation X medical students at one medical school.

PURPOSE: Two main generational cohorts comprising students enrolled in medical schools today are Generation Xers (born 1965-1980) and Millennial students (born 1981-1999). A subset is Cuspars (born 1975-1980), who share traits with both generations. Population theorists ascribe different personal characteristics, attitudes, and preferences to each group. The authors examined whether selected characteristics describing Generation X and Millennial students were quantifiable using a personality measure. Differences among Generation X, Millennial, and Cuspar medical students were investigated. METHOD: Eight hundred and nine medical students (399 females and 410 males) who matriculated between 1989-94 and 2001-04 at the Northeastern Ohio Universities College of Medicine completed the 16 Personality Factor Questionnaire (16PF). Differences in responses to the 16PF among the three generations were analyzed using multivariate analysis of variance (MANOVA). RESULTS: Analyses showed significant differences for Generation X versus Millennial students on 10 of the 16 personality factors. Millennial students scored significantly higher than Generation X students on factors including Rule-Consciousness, Emotional Stability, and Perfectionism; Generation X students scored higher than Millennials on Self-Reliance. Millennials also were significantly different from Generation Xers on several other factors. Significant differences were noted among Cuspars, Generation Xers, and Millennials. CONCLUSIONS: The 16PF is a useful tool to examine differences among these groups and to help understand the factors that constitute their personalities. Given differences among the generational groups, the authors forecast possible educational implications for medical school academic affairs and student services, and suggest areas for future research.     

Predictive validity of a house-officer selection process at one medical school

This study explored the rank list generated by a process of evaluating applicants for a surgery residency; the process is a revision of an older process (pre-1982) used for that purpose. The study's aim was to learn whether the new process is more predictive of residents' performances in their first year than was the process it replaced and whether the rough rankings computed directly from ratings of applicants are more predictive than the final rankings determined in a meeting by the department faculty, who modify the rough rankings. The 1982-1986 rankings and performances of 32 first-year residents at the University of North Carolina at Chapel Hill School of Medicine were studied and compared with the rankings and performances of 77 applicants from 1976 and 1978-1979 under the previous system. Correlation analyses revealed that for the applicants studied, the rough rankings in the new and the previous systems were equally predictive of performances as measured by rating scales, but that the new system was more predictive of performances on the surgery in-training examination. However, all correlations were small. Finally, the rough rankings obtained under the new system were more predictive of the residents' later performances than were the faculty's final rankings.     

Medical students and abortion: reconciling personal beliefs and professional roles at one medical school.

A survey was used from 1983 through 1990 in a required first-year course, Ethics and Medical Care, at The Johns Hopkins University School of Medicine, to explore where students drew the line about moral issues. Starting in 1988, a similar questionnaire was administered to each class of fourth-year medical students. This report summarizes the students' attitudes--reported anonymously in both surveys--regarding circumstances under which they would perform or refer for an abortion. Attitudes towards abortion changed little in four years. Comfort levels with patient referral were greatest when the life of the mother was threatened and in the case of rape. Students' attitudes correlated most strongly with personal beliefs about when a fetus was considered a human life and less so with students' genders. The first-year survey results were shared with the students in the course's annual sessions on abortion in order to aid them in understanding the assumptions underlying ethical dilemmas surrounding abortion and to make visible the class's moral pluralism on the subject. The survey also helped them determine their tolerance, if any, for patients' views or actions that conflicted with their personal moral stances.     

Test security in examinations that use standardized-patient cases at one medical school

The use of performance-based examinations consisting of standardized-patient (SP) cases has increased greatly in recent years. These examinations are typically long and thus require the presentation of the same SP cases to several consecutive examinee groups. Consequently, concerns have arisen about the potential for violations of test security whereby students who were tested early in the examination period pass on information to students tested later. These concerns are addressed using data from the SP-based examinations administered to five classes (1986-1990) of senior medical students at Southern Illinois University School of Medicine. Because of the length of the examinations, each class was randomly divided into five groups and the examination was administered to one group at a time, requiring three days of testing time per group and three weeks of testing time per class. The results showed no consistent, systematic changes in case means across the five groups tested at different times throughout the examination period, and thus provide no evidence of serious, widespread violations of test security.     

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.     

Influence of uncertainty about a specialty's administrative status on students' specialty choices at a Florida medical school

At the University of South Florida College of Medicine, there was a statistically significant drop in the number of 1990 graduates entering family practice residencies compared with the numbers entering during the previous decade. A retrospective analysis was carried out to determine what factors could have produced such a change and what specialties benefitted. The only factor identified was an administrative policy change that threatened the departmental status of the family medicine unit. Psychiatry was the only specialty choice that showed significant increases. The findings of this study suggest that medical students' selection of family practice as a specialty choice is detrimentally influenced by uncertainty about the family medicine unit's departmental status, and that family medicine may be competing with psychiatry for students' interest.     

Single case design: A critique of methodology and analysis of recent trends

Following a brief discussion of the history of the development and use of single cases studies, an overview of the single case design in contemporary outcome research is offered. This overview encompasses varieties of single case design, methods of data analysis, and pitfalls and problems with single case methodology. An analysis of current trends in single case design, based on publications in two leading behavioural journals, highlights a move toward alternating treatment designs and the growth of cognitive measures in single case studies. It is concluded that while single case designs are not necessarily the design of choice in all circumstances they are a fundamental research strategy in outcome research.     

Faculty expectations and primary care residents' perceptions concerning residents' growth in competence at one medical school.

The authors studied at one school both the developing confidence of primary care residents and the expectations of both internal medicine and specialty faculty members regarding the abilities of the residents. From 1980 to 1988, residents in the study institution's program in internal medicine primary care completed self-assessments concerning their diagnostic and management skills in primary care and several specialties at the start of their training and at the ends of their first, second, and third years. In 1988, the authors elicited the expectations of the primary care and specialty faculties regarding the levels of competence that residents should achieve in the specialties by the end of their third year. When the faculty assessments were compared, the specialists were found to ascribe greater levels of autonomy to residents. The authors conclude that involving residents and faculty members from various disciplines in developing expectations and evaluation criteria can enhance faculty members' perceptions of residents' clinical competence and residents' achievement of it.     

Medical students' exposure to pharmaceutical industry marketing: a survey at one U.S. medical school.

PURPOSE: While much is known about the interactions between the pharmaceutical industry and physicians, very little is known about pharmaceutical marketing directed toward medical students. This study sought to characterize the extent and forms of medical students' exposure to pharmaceutical industry marketing. METHOD: In 2001-02, an anonymous, 17-item questionnaire was distributed to 165 preclinical and 116 clinical students at the University of Minnesota Medical School-Twin Cities. The main outcome measures were the number and forms of exposures to pharmaceutical industry marketing reported by medical students and whether students had discussed these exposures with teachers or advisors. Preclinical and clinical students were compared using chi(2) analysis (p < .05). RESULTS: One hundred fourteen (69.1%) preclinical students and 107 (92.2%) clinical students responded. Nearly all students reported at least one exposure to pharmaceutical industry marketing. Seventy-six (71.7%) clinical students compared to 38 (33.3%) preclinical students recalled over 20 exposures (p < .005). Clinical students were more likely to have received a free meal (p < .01), textbook (p < .005), pocket text (p < .005), or trinket (p < .005) than were their preclinical colleagues. Most students (68.2%) had not discussed pharmaceutical marketing with an instructor or advisor; 59 (55.7%) clinical students as compared to 87 (80.6%) preclinical students recalled no such discussion (p < .005). CONCLUSION: Medical students have extensive exposure to pharmaceutical industry marketing during their early years of training. Given existing evidence that such exposure influences physicians' practice and prescribing patterns, the authors propose that medical school curricula include formal instruction to prepare students to critically assess these contacts.     

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.     

Initial career choices of medical school honors graduates in the early 1970s and 1980s

To investigate the changes over time in the attractiveness of a number of medical specialties as careers, the author analyzed the initial career pathways of students who graduated with honors in 1972, 1973, 1982, and 1983 from nine of the most prestigious American medical schools. The data were analyzed to discern career selection differences among the total population studied, between the men and women, and between the graduates of public and private institutions. Internal medicine showed statistically significant declines in its attractiveness to the students in all the categories but remained overrepresented as a career choice by honors students compared with its attractiveness to medical students in general for the years studied. Radiology was chosen by an increasing percentage of the honors students in the 1980s, but mostly by students from private medical schools. The men who were honors graduates in the 1980s chose surgery fields more often, while women honors graduates tended to enter pediatrics and obstetrics-gynecology. These data indicate that the career choices of honors graduates in the early 1980s more closely mirrored the career choices of all students entering medical specialty fields and do not reveal gross imbalances. Of the primary care disciplines, only internal medicine attracted fewer honors graduates in the 1980s.     

The relationship between residents' characteristics, their stress experiences, and their psychosocial adjustment at one medical school

Empirical research focused on the stressful aspects of residency training has largely ignored the interactions between residents' psychosocial and demographic characteristics, stressful experiences, emotional responsivity, and coping styles. This article presents the results of a questionnaire, completed by 165 residents, that consisted of the Profile of Mood States, the Hassles Scale, the Ways of Coping Questionnaire, and a series of questions regarding demographic data, social support system features, and residency stress factors. The residents reported that time demands and indebtedness were the major sources of stress in their residency programs. Social support variables were significantly related to the degrees to which the residents successfully coped with daily stress factors. While the women residents reported higher stress levels than did the men, they did not report higher levels of emotional distress. Finally, the lengths of time residents had spent in training were significantly related to the levels of their mood disturbances and daily hassles.     

The entry of African-American students into US medical schools: an evaluation of recent trends.

A need to reassess US medical schools'' admission of African-American students exists based on recent challenges to affirmative action. The Association of American Medical Colleges (AMMC) provided US medical school enrollment data and characteristics. Measures of enrollment were constructed for each medical school and aggregated by ownership type and state. After peaking at 1311 students in 1994, African-American medical school matriculation decreased by 8.7% by 1996. This decline was disproportionately generated by public medical schools. However, it was not limited to institutions that are located in states where anti-affirmative action policies have been implemented. Several schools were consistently successful (e.g., UCLA, Case Western, and Robert Wood Johnson) or unsuccessful (e.g., Texas Tech and Texas A&M) in enrolling African-American students. Recent gains in the enrollment of African-American students are being reversed, particularly at public institutions. Implications exist, particularly for the health of poor and underserved communities that are more likely to be cared for by such students during their careers as physicians.