Medical students as patients: implications of their dual role as explored in a vignette-based survey study of 1027 medical students at nine medical schools

Objective

Medical students experience a range of mental and physical illnesses during training and may encounter significant barriers in seeking health care. Little is known about the issues surrounding the dual role as both learner and patient when a medical student seeks care at his or her training institution.

Method

A confidential survey examining medical students' health care needs, practices, and concerns was administered at 9 US medical schools. One part of the survey focused on responses to 4 medical student–patient vignettes. The vignettes systematically varied preexisting student vs preexisting patient status before assuming a medical student–patient role, and the vignettes also varied illness situations that were more vs less stigmatizing. Responses were analyzed using χ² and multivariate analysis of variance tests.

Results

A total of 1027 students participated. We found that students were more likely to accept the dual role as medical student–patient in vignettes depicting a preexisting patient role than a preexisting student role. Students sought to avoid the dual role as student-patient in the context of stigmatizing health concerns. Women students were more likely than men to reject the dual role in all cases.

Conclusion

Medical students appear to be sensitive to the conflicts that may be associated with the dual role as both medical student and patient when seeking care at their training institution. Our data suggest the importance of substantive efforts to promote the health, interests, and well-being of medical student–patients.     

Reasons for risk-reducing mastectomy versus MRI-screening in a cohort of women at high hereditary risk of breast cancer

Objective

To determine the reasons that motivate women in a cohort of women under intensive surveillance for breast cancer to undergo risk-reducing mastectomy (RRM).

Patients and methods

Women with a BRCA1 or BRCA2 mutation who were enrolled in an MRI-based breast screening study were eligible to participate in this survey. A self-administered questionnaire was given to women who did, and who did not terminate annual MRI-based surveillance in order to undergo RRM. The questionnaire included information on family history, risk perception and satisfaction with screening. In addition, women were asked to provide the principal reason for their choice of having preventive surgery or not, and were asked about their satisfaction with this choice.

Results

246 women without breast cancer participated in the study. Of these, 39 women (16%) elected to have RRM at some point after initiating screening. Although women who had a mother or sister with breast cancer were more likely to opt for RRM than were women with no affected first-degree relative (21% versus 10%) this did not reach statistical significance. Women who perceived their breast cancer risk to be greater than 50% were more likely to opt for RRM than were women who estimated their risk to be less than 50% (19% versus 6%). Fear of cancer was the most common reason cited for choosing to have RRM (38% of respondents) followed by having had a previous cancer, (25%), then concern over their children (16%).

Conclusion

Among women with a BRCA mutation who are enrolled in an MRI-based screening program, a high perception of personal breast cancer risk and a history of breast cancer in a first-degree relative are predictors of the decision to have RRM.     

Scientific and ethical concerns regarding engineering human longevity

The goal of biogerontological research is to elucidate the biological factors underlying adverse age-related changes in structure and function of molecules, cells, tissues, and organisms. In spite of the considerable progress achieved so far, it is still too early to predict what strategies will be both safe and effective at preventing, delaying, or reversing these changes in humans, and whether such strategies will also increase longevity.     

Interval between clinical presentation of necrotizing enterocolitis and bowel perforation in neonates

Objective  

To define the interval between clinical presentation of necrotizing enterocolitis (NEC) and bowel perforation in neonates.