Impact of desire to work in underserved communities on selection of specialty among fourth-year medical students

OBJECTIVE: The objective of this study was to explore the specific factors that influence medical student's choice of primary care as a specialty. Special attention is given to the influence of desire to work in underserved communities on selection of a specialty. DESIGN AND SETTINGS: A web-based survey of factors affecting choice of specialty was completed by 668 fourth-year students from 32 medical schools. RESULTS: Students interested in primary care reported an increased likelihood of working with underserved populations when compared with other specialties. The independent impact of both student's social compassion attitudes and values, and subjective and reinforcing influences on the selection of primary care, when compared with all other specialties, was strong. Personal practice-oriented considerations showed an independent negative impact on the selection of primary care when compared with surgery and support specialties. Financial considerations strongly influence the selection of support specialties. Medical training experiences showed an independent influence on the selection of surgery over primary care. CONCLUSION: The need for primary care physicians and specialists in underserved communities is considerable. Addressing health disparities in underserved communities requires a concerted effort to increase the availability of primary care providers in these communities. This study observed that primary care practice or specialty selection by medical students is influenced by individual values and subjective external influences other than predicted by medical training alone. This observation necessitates a closer determination of strategies required to ensure an increase in the number of primary care physicians serving underserved communities.     

Experiences promoting healthcare career interest among high-school students from underserved communities

Promoting early interest in healthcare careers among youth from underserved areas is one promising strategy for addressing the health professional shortage in such communities, Most career choice studies try to predict outcomes using such traditional measures as grades and test scores, This study examines experiences influencing healthcare career interest among high-school students participating in health professions introductory programs in underserved communities. The opinions of parents and teachers regarding students' motivations are also considered. Seven focus groups (N=51) were conducted in one rural and two largely minority urban communities in New York State designated as health professional shortage areas. Qualitative data analysis involved a theory-driven, immersion and crystallization approach following the experiential learning model. Constructive experiences with the healthcare system, family role-modeling and support, interactive health-related school activities, the media, inspirational and accessible school staff, and strategic community partnerships, among other factors, facilitated student interest in health professions. Findings suggest that underserved and disenfranchised community environments still pose challenges for furthering healthcare career interest among youth.     

Exploring obstacles to and opportunities for professional success among ethnic minority medical students.

PURPOSE: To explore the barriers and facilitators experienced by ethnic minority medical students in achieving personal and professional success. METHOD: In 2002 and 2003, 43 minority medical students participated in one of six two-hour focus groups located in Philadelphia, Pa; Kansas City, Mo; Baltimore, Md; Miami, Fl; New York, NY; and Los Angeles, Calif. Focus groups consisted of an average of seven (range 5-10) individuals. Eighty-eight percent were of black/African descent, 10% were Hispanic, and 2% were Asian/Pacific Islanders. Students discussed their views of personal and professional success, including opportunities and obstacles, and completed a brief demographic survey. Discussions were audiotaped, transcribed verbatim, and reviewed for thematic content in a three-stage independent review/adjudication process. RESULTS: All 748 comments were grouped into themes relating to definitions of success (35%) and to perceived facilitators (25%) or inhibitors (40%) of success. Participants strove to achieve professional/academic status, financial security, and quality of life. In so doing, participants identified facilitators of success, including support systems, professional exposure, financial aid, and personal characteristics. Lack of financial and social support, challenges with standardized tests, experiences with racial stereotyping and discrimination, and self-imposed barriers were among inhibitors to success. CONCLUSIONS: The opportunities for and barriers to academic success identified by minority students should be heeded by educators and administrators who develop programs and policies to recruit minority medical students and to ensure their professional development. To enhance the institutional climate for diversity, programs that improve cultural awareness and reduce biases among all students, faculty, staff, and administrators are needed.     

Self-care in medical education: effectiveness of health-habits interventions for first-year medical students.

PURPOSE: To examine changes in health habits (sleep, alcohol, and exercise) and the effects of an educational intervention promoting self-care on the emotional and academic adjustment of first-year medical students. METHOD: Fifty-four medical students completed questionnaires that assessed various health habits, alcohol use, depression severity, and areas of life satisfaction at the beginning of the semester, at mid-term, and at finals. Approximately half of the students received written feedback or participated in an educational discussion group at mid-term. RESULTS: The students demonstrated significant changes in health habits, with increases in alcohol consumption and decreases in exercise and socialization. The changes in health habits were predictive of both emotional and academic adjustment, with students who decreased in positive health habits, particularly socialization, being more depressed at finals. The feedback and educational interventions influenced some sleep and exercise behaviors, but the groups did not differ in overall emotional or academic adjustment. CONCLUSIONS: First-year medical students show significant changes in health habits as they adjust to medical school. An educational intervention demonstrated promising effects in changing these patterns, but self-care needs to be further elaborated to address the specific challenges associated with acute adjustment as well as with long-term stressors.     

加强医学生的人文教育

医学生是未来医学科研和临床工作的主力军，社会的进步要求医学生不仅需要精湛的专业技能还应从医学、社会、道德和伦理等不同角度去思考问题，树立以人为本以病人为中心的高尚医德，具备良好的与人沟通的能力，深入的了解服务对象的需求，以帮助患者走出身心困境。要达到这一目标，单纯的专业教育是远远不够的，必须同时加强人文教育，这是社会发     

Ethics education for Canadian medical students

This study was designed to determine the nature, extent, and quality of medical ethics education for students in Canadian medical schools. In 1989, a questionnaire that used primarily open-ended questions was sent to all 16 Canadian medical schools; they all responded. Significant findings include the following: 15 of the 16 schools provided some ethics education (with wide-ranging objectives); the amounts of time alloted for such instruction ranged from ten and a half hours to 45 hours (per degree, not per year), with no discernible pattern in the distribution of hours across the years; most teaching was case-based and issue-oriented; most instructors were physicians; and almost all the schools conducted assessments of students using a pass-fail standard.     

e-meducation.org: an open access medical education web portal

Background

Internet can serve in opening the door to a brand new world of high quality medical information. However, the chaotic size of data available in the WWW is often misleading. We sought to provide the world medical community with a web portal that may be used as a clearinghouse providing the outlet for dissemination of high quality WWW educational products.

Methods

Directories of the relevant WWW resources have been compiled and others are being currently under development to cover most medical fields. A custom-built medical search engine was created. Really Simple Syndication (RSS) feeds and video sharing services were reviewed for their quality and were presented along with case-based educational presentations through a user-friendly web portal interface. A directory of guidelines database is currently under development.

Results

The educational portal "e-meducation" available at http://www.e-meducation.org/ has been launched in December 2006 and at the moment, provides links to more than 800 educational web-pages, more than 2100 clinical practice guidelines, 32 news feeds, and 14 educational videos. The web site also hosts 40 case-based presentations and a custom medical search engine.

Conclusion

Based on the incorporation of simple and tested educational strategies such as case based instruction and interactive learning, e-meducation.org aims to become a prototype platform that offers a more convenient interface to existing products, resources and medical contents.     

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.     

Caring for medical students as patients: access to services and care-seeking practices of 1,027 students at nine medical schools. Collaborative Research Group on Medical Student Healthcare.

PURPOSE: The personal health care of medical students is an important but neglected issue in medical education. Preliminary work suggests that medical student-patients experience special barriers to health care services and report problematic care-seeking practices that merit further inquiry. METHOD: A self-report questionnaire was piloted, revised, and distributed to students at nine medical schools in 1996-97. The survey included questions regarding access to health services, care-seeking practices, and demographic information. RESULTS: A total of 1,027 students participated (52% response rate). Ninety percent reported needing care for various health concerns. Fifty-seven percent did not seek care at times, in part due to training demands, and 48% had encountered difficulties in obtaining care. A majority had received treatment at their training institutions, and students commonly pursued informal or "curbside" care from medical colleagues. Almost all participants (96%) were insured. Differences in responses were associated with level of training, gender, and medical school. CONCLUSION: Medical schools shoulder the responsibility not only of educating but also of providing health services for their students. Students encounter barriers to care and engage in problematic care-seeking practices. Greater attention to issues surrounding medical student health may benefit students and their future patients.     

医学生手术学课程教学中的素质教育

人文素质教育是改变人的思维结构的教育,学生的人文素质教育实施状态,直接关系到人才培养质量的高低,直接关系到人才强国战略实施的成败,直接关系到国家核心竞争力的强弱,是国家全局和民族未来发展的大事[1]。如何才能将专业课程的知识教育与人文素质教育有机结合起来,避免只教书不育人的现象,是教育改革的一项重要内容[2]。     

Anatomy in medical education: Perceptions of undergraduate medical students

AimThe best method to teach anatomy is widely debated. A shift away from cadaveric dissection in UK medical schools towards newer approaches has taken place without adequate evaluation of their suitability. The impact of this on future anatomical and surgical competencies is unclear. We assessed student perceptions to different methods of anatomy teaching.MethodsAll 2nd year students at Leeds School of Medicine were invited to complete a matrix-grid questionnaire. Participants were asked to score six methods of anatomy teaching (dissection; prosection; lectures; models; PC software packages; living & radiological anatomy) using a 5-point Likert-type scale on the ability to achieve nine learning objectives. Kruskal–Wallis and Mann–Whitney analyses suitable for non-parametric data were used to evaluate differences in scores between teaching methods.Results170 students (71%) responded to the survey. Overall, dissection was the single highest scored method, followed by prosection. Newer approaches such as models, computer software packages and living & radiological anatomy scored comparatively worse. The most suitable method for achieving individual learning objectives was variable with dissection perceived as most suitable for four out of nine objectives.ConclusionsCadaveric dissection is a favourable approach for achieving important learning objectives in the field of anatomy. Further evaluation of teaching methods is required prior to changes being made in the curricula of UK medical schools.     

Managed care education: what medical students are telling us.

PURPOSE: To examine graduating medical students' perceptions of the adequacy of instruction in managed care and in 11 curricular content areas identified by experts as a necessary part of managed care education. This study sought to determine whether medical students perceived these content areas as relevant to managed care and to evaluate the extent to which students' perceptions of the adequacy of instruction varied as a function of managed care penetration in the locations of their respective medical schools. METHOD: Data from the Association of American Medical Colleges' 1999 Medical School Graduation Questionnaire (GQ) were analyzed. Students' ratings of adequacy of instruction were summarized. Correlations between ratings of instruction in managed care and 11 related content areas were calculated, as well as correlations between managed care penetration in the locations of the students' schools and the proportion of students rating instruction as inadequate. RESULTS: A majority of 1999 medical school graduates (60%) rated instruction in managed care as inadequate; other content areas to which majorities of graduates gave inadequate ratings were practice management (72%), quality assurance (57%), medical care cost control (57%), and cost-effective medical practice (56%). Ratings in these four content areas were highly correlated with ratings of instruction in managed care. The correlation between managed care penetration and rating of instruction in managed care was statistically significant (r = -.37); correlations between managed care penetration and instruction in the other content areas were not. CONCLUSIONS: On the 1999 GQ, a majority of medical students responded that they felt they had not received adequate instruction in managed care. Further, the responses suggest that these medical students defined managed care in terms of managing costs, rather than managing health care, or developing population-based approaches to the delivery of health care.     

Third year medical students perceptions towards learning communication skills: implications for medical education

Objective

To analyze students’ perceptions towards learning communication skills pre-and-post training in a Communication and Clinical Skills Course (CCSC) at a Portuguese Medical School.

Methods

Content analysis was used to describe and systematically analyze the content written by students (n = 215 from a total of 229) in an open-ended survey. In addition, content analysis association rules were used to identify meaning units.

Results

Students’ pre-training definitions of communication skills were not specific; their post-training definitions were more precise and elaborated. Students perceived communications skills in Medicine as important (61%), but recommended that teaching methodologies (52%) be restructured. There appeared to be no connection between criticism of teaching skills performance and perceptions of the other aspects of the course.

Conclusion

Students’ experiences at CCSC are associated with their perceptions of communications skills learning. Content analysis associations indicated that these perceptions are influenced by context.

Practice implications

Improvement of curricula, teaching and assessment methods, and investment in faculty development are likely to foster positive perceptions towards learning communication skills in these students.     

医学教学中加强对医学生医患沟通能力的培养

医患沟通教育是当代医学生的必修课,良好的医患沟通是降低医患纠纷的重要手段。培养适合当代社会需求、具有良好沟通能力的高素质医学人才是医学院校的根本目标。本文阐述了医学教育中加强医患沟通能力培养的重要性和必要性,提出了培养医学生医患沟通能力的建议,为减少医患纠纷,构建和谐医患关系打下了良好基础。     

The public hospital mission at Seattle's Harborview Medical Center: high-quality care for the underserved and excellence in medical education.

United States public hospitals and medical schools commonly enter into partnerships that serve the patient care, education, and research missions of both institutions. Harborview Medical Center, the county hospital in Seattle, Washington, and the University of Washington School of Medicine (UWSOM) have enjoyed a long affiliation that began at the medical school's founding 60 years ago. A formal agreement in 1967 turned over responsibility for all Harborview operations to UWSOM at a time when Harborview's facilities had fallen into serious disrepair and public hospitals were closing across the United States. All faculty and staff based at Harborview are employed by the University of Washington. By the mid-1970s a revitalization was underway at Harborview. The Medic One paramedic program drew national acclaim for pioneering prehospital emergency cardiac care, and the trauma and burn centers grew rapidly to meet specialized intensive care needs of the Pacific Northwest. Today, the success of the trauma, specialty surgery, and rehabilitation services have allowed Harborview to consistently maintain a positive operating margin while caring for the county's uninsured and indigent patients ($98 million in charity care in 2005). The hospital also offers nationally recognized residency programs and supports nationally and internationally acclaimed research. Harborview faces significant challenges for the future, including rapid growth of the indigent patient load, continually changing expectations for physician training, and growing cost pressures.     

Three domains of competency in global health education: recommendations for all medical students.

In the setting of world population growth and migration, global health issues have an increasing impact on domestic conditions and our medical practitioners. The authors ask: What exactly constitutes global health, and how much do U.S. and Canadian medical students or practitioners need to know about it? To address this topic, the authors convened an American Society for Tropical Medicine and Hygiene Committee on Medical Education, sought input from the Global Health Education Consortium, and surveyed members of the American Committee on Clinical Tropical Medicine and Travelers' Health for educational priorities within the tropical medicine field. The information gained from these sources has been distilled into three domains of global health competency that the authors propose each medical school curriculum should try to achieve for all students: global burden of disease, traveler's medicine, and immigrant health. The authors present here the rationale for altering curricula to include these three topics as a starting point for discussion among medical educators.