Medical student indebtedness and the propensity to enter academic medicine

This paper considers the potential impact of medical school indebtedness and other variables on the propensity of US doctors to enter academic medicine. Probit models provide some evidence that indebtedness reduces the likelihood that physicians will choose academic medicine as their primary activity. Nevertheless, the magnitude of this effect is not large. As indebtedness may be endogenous, the probits are rerun using an instrumental variables approach. These estimates imply that over time indebtedness may have an important impact on the propensity of physicians to enter academic medicine.     

Medical student attitudes to risk taking and self-perceived influence on medical practice

CONTEXT: Little has been published on medical student risk-taking attitudes and behaviours and whether students think these attributes will affect how they treat patients. OBJECTIVES: Our aims were to assess for an association between risk-taking attitudes and behaviours, such as problematic substance use, self-reported risky behaviours, and self-reported accidents, and to test for an association between risk-taking attitudes and student perceptions of the influence of these attitudes on future clinical practice. METHODS: Three consecutive classes of Year 2 medical students (n=315) completed a self-administered, 29-item questionnaire. Risk-taking attitudes were evaluated using a 6-question, risk-taking scale adapted from the Jackson Personality Inventory (JPI). RESULTS: A significant positive correlation was demonstrated between risk-taking attitudes (JPI) and problematic substance use (r=0.34; P<0.01), self-reported risky behaviours (r=0.47; P<0.01), and self-reported accidents (r=0.33; P<0.01). Students who did not think their attitudes toward risk would affect their clinical decision making scored significantly higher on our measure of risk-taking attitudes (t306=-4.60; P<0.01). Students who did not think that their drinking, drug taking or sexual behaviour would affect how they counselled patients on these matters scored significantly higher on our measure of problematic substance use (t307=-2.51; P=0.01). CONCLUSIONS: Although risk-taking attitudes have been associated with significant differences in clinical decision making among doctors, in our sample students with high risk-taking attitudes and behaviours were significantly less likely than their colleagues to think their attitudes would affect their clinical practice. Implications for medical education are discussed.     

Comparison of medical and non–medical student attitudes to social issues in medicine

A 63-item questionnaire on attitudes to psychosocial issues in medicine was administered to final-year students in the Faculties of Medicine ( n = 104), Pharmacy ( n = 57) and Arts and Social Sciences ( n = 75) of the University of Benin. The responses given were analysed by the summation and Cornell scalogram techniques for content and intensity. On aggregate, the pharmacy students scored significantly higher than their medical and arts/social science counterparts ( P < 0.001). The advantage over medical students was on only one subscale: paramedical cooperation. The scores of the pharmacy and arts/social science groups were significantly lower than those of medical students on the social factors sub-scale. On issues that threaten to diminish the traditional role and status of the medical profession (e.g. paramedical cooperation and government intervention), the attitude of medical students was either unenthusiastic or clearly resentful. However, they shared the same orientation as the other groups towards matters which did not challenge the prerogatives of medical doctors (e.g. preventive medicine and doctor–patient relationship). It is suggested that measures be adopted to raise the level of awareness of non-health professionals vis-à-vis the non-biological antecedents of disease and also to bridge the gap in attitudes among groups in the health care team.     

Alcohol education and the medical student

The development of a more sophisticated aetiological model ofalcohol abuse and dependence has certain advantages when itcomes to teaching medical students about the subject. The moveaway from a simplistic, unicausal model of disease coincideswith more sophisticated notions of disease in medicine in generaland alcoholism in particular can now be seen as a paradigm formany disorders. While the new model implicitly recognises theimportant role of non-medical professionals in the detectionand management of alcohol-related problems, the protean manifestationsof alcohol in general and specialised medical settings demandsthat tomorrow's doctors have an appropriately sophisticatedmodel of the disorder and the abilities and skills necessaryfor its detection and management.     

Instruction on death and dying for the medical student

With instruction on death and dying beginning to be included in the curricula of many medical schools and the likelihood that this development will spread, it is timely to examine the best ways in which the subject can be taught. The most important need at this stage is the creation of objectives. Nine objectives have been briefly outlined which have either been reported on by teachers in the field or which seem to be pertinent to death education. The focus on objectives rests on the premise that the format and content of courses will follow largely from the goals that are selected. Questions of who should teach death and dying, when it should be taught and what format should be used, are discussed.     

Challenges to rural medical education: a student perspective

ABSTRACT: The key feature of the Greater Murray Clinical School model is the attachment of students to patients. Students follow their patients through the health care system, in contrast to the standard approach where students are attached to doctors or speciality based clinical units. The patient/student coupling occurs at the primary care level, which mostly but not exclusively will occur in the GP's office. Students anchor their knowledge by seeing the natural progression of common illnesses, the impact of behavioural aspects on health and disease, and by experiencing continuity of care. Along their path they develop good problem solving skills and learn to understand the health care system they will become part of. The main obstacle in teaching a medical undergraduate curriculum in a rural setting is that large geographical distances separate students, teachers and resources. Consequently, information technology will play an important role in terms of delivery of the GMCS curriculum. Moreover, there is potential for flow-on benefits to the community following integration of new information technology into the local health infrastructure.