D. Daniel Hunt

Frequency and effect of negative comments ("badmouthing") on medical students' career choices.

BACKGROUND: Some call it “medical bigotry,” and others describe it as the “hidden curriculum,” but, by any name, the superficial and demeaning comments that students hear about particular career choices are thought to play a major role in discouraging the selection of primary care careers. This paper explores the frequency and effect of “badmouthing” on career choice with the hypothesis that it is more frequently heard about primary care disciplines but has relatively little influence on actual career choice. METHOD: In 1993, 129 (79%) of the 163 University of Washington School of Medicine graduates responded to a two-page questionnaire about badmouthing. This information was used to refine the questionnaire. In 1994, 1,447 graduating students from nine medical schools were surveyed with the revised questionnaire. The schools were chosen to represent schools that had high, medium, and low proportions of students going into primary care careers. RESULTS: A total of 1,114 questionnaires were returned, for a response rate of 77%. Badmouthing was heard frequently (76% of the responding students) and often occurred as early as the first and second years of medical school. The students heard badmouthing about their career choices most frequently when they selected surgery (91%) and family medicine (87%) and least frequently when they chose pediatrics (57%), p < .001. The students reported that the influence on career choice was low in general, but 186 students (17% of all respondents) did report altering their choices based on badmouthing. CONCLUSION: Primary care fields and non-primary care fields were equally affected by career changes due to badmouthing. This study indicates that badmouthing, while pervasive across all disciplines and an unattractive aspect of the educational experience, cannot alone account for the low proportion of graduates choosing primary care careers.

From concept to culture: the WWAMI program at the University of Washington School of Medicine.

Shortages of primary care physicians have historically affected rural areas more severely than urban and suburban areas. In 1970, the University of Washington School of Medicine (UWSOM) administrators and faculty initiated a four-state, community-based program to increase the number of generalist physicians throughout a predominantly rural and underserved region in the U.S. Northwest. The program developed regional medical education for three neighboring states that lacked their own medical schools, and encouraged physicians in training to practice in the region. Now serving five Northwest states (Washington, Wyoming, Alaska, Montana, and Idaho), the WWAMI program has solidified and expanded throughout its 30-year history. Factors important to success include widespread participation in and ownership of the program by the participating physicians, faculty, institutions, legislatures, and associations; partnership among constituents; educational equivalency among training sites; and development of an educational continuum with recruitment and/or training at multiple levels, including K-12, undergraduate, graduate training, residency, and practice. The programs positive influences on the UWSOM have included historically early attention to primary care and community-based clinical training and development of an ethic of closely monitored innovation. The use of new information technologies promises to further expand the ability to organize and offer medical education in the WWAMI region.

Clinical behaviors and skills that faculty from 12 institutions judged were essential for medical students to acquire

This paper describes a 1988–1989 collaborative mail survey of faculty opinion about clinical behaviors and skills that students should be expected to demonstrate prior to graduation from undergraduate medical school (hereafter called “exit objectives”). Selected faculty from 12 American and Canadian medical schools indicated whether each of 77 objectives was essential for every student to know or demonstrate prior to graduation; useful but not essential at the undergraduate level; or not applicable to their undergraduate program. Their responses provide a glimpse into faculty expectations regarding some of the exit behaviours and skills they deemed essential. Forty-two percent (32) of the 77 objectives were regarded as essential by 75% or more of the faculty members who responded. Essential objectives involved conducting organ system examinations, formulating problems and hypotheses, and gathering fundamental interview, physical, and screening examination data, including emergency examinations of the airway and circulatory systems. Other essential objectives involved collaboration and communication, demonstrating concern for legal and ethical values, and keeping abreast of current information within the discipline. Exit objectives related to the diagnosis and management of specific conditions were regarded as useful but not essential at the undergraduate level. Implications for medical education are discussed.

The relationship of male transsexual typology to psychosocial adjustment

In a search to uncover variables predictive of psychosocial adjustment of male transsexuals, this study examined features which have been empirically linked to characteristics of male transsexual typology. Data from 25 male transsexual volunteers were examined by means of multiple regression analysis to determine whether symptoms of introversion, depression, or tension, as well as adjustment to work and gender reorientation could be linked to the typological variables of androphilia, gynephilia, cross-gender fetishism, feminine gender identity in childhood, and age of onset of transsexualism. Valid and reliable scales measuring the typological variables of erotic partner preference (androphilia and gynephilia), cross-gender fantasy in association with sexual arousal (cross-gender fetishism), and degree of feminine gender identity in childhood were used. Results indicate a significant relationship between social gender reorientation and the feature of androphilia and between work adjustment and gynephilia. This differential adaptation is explained in terms of the different course that transsexualism takes within each typological subgroup. These findings offer evidence as to why some transsexuals may more readily adopt a female gender identity than others. There was no relationship found between the typological features and those variables measuring psychological disturbance.

Types of problem students encountered by clinical teachers on clerkships

Summary. The teachers who play the all‐important role of enabling students to learn on clinical clerkships must balance the two essential skills of being a good role model and maintaining objectivity in order to identify students with a variety of problems. This study describes the findings of a survey that identifies both the type of the problems that most bother teachers and the relative frequency of those problems. Non‐cognitive problems (poor interpersonal skills and non‐assertive, shy students) were identified by teachers as being seen at the same relative frequency but posing greater difficulty than cognitive problems (poor integration skills, disorganization, poor fund of knowledge, etc.). A variety of the types of interventions to these problems are discussed.

A follow-up study of the characteristics of dean's letters.

Purpose To assess the content and quality of deans letters since the publication of guidelines recommended by the Association of American Medical Colleges (AAMC) in 1989. Method In 1998, the deans letter writers at all 124 U.S. medical schools were surveyed. The questionnaire incorporated items from two previous surveys (1981 and 1992). In addition, samples of deans letters (n = 451) from all U.S. medical schools for the graduating class of 1998 were rated based on the AAMCs guidelines. Results The response rate of the 1998 survey (66%) was lower than those of the two previous surveys (87% for 1992 and 85% for 1981). Schools that prepared letters that followed the AAMCs guidelines were somewhat more likely to have responded. According to the letter writers in 1998, close to 300,000 letters (approximately 1,050,000 pages total) were sent to residency directors, at an estimated cost of

Cognitive correlates of biologic sex and gender identity in transsexualism

26,000 per school. A total of 65% of schools produced adequate deans letters based on the 1989 AAMCs guidelines, compared with 55% in 1992. Many schools were organizing the deans letter in more readable formats, and more schools provided information that allowed for a comparison of students within the same school. Conclusion The improvements in deans letters are encouraging, but ten years after the AAMCs guidelines, 35% of U.S. schools still produce unacceptable letters. With the addition of the electronic submission of information, it is time to review further improvements to the deans letter.

Screening for depression in a primary care setting in Vietnam

Twenty-two individuals seeking sex-change surgery and diagnosed as transsexual by a Gender Identity Research Team underwent extensive neuropsychological and cognitive testing prior to surgery. On the Wechsler Adult Intelligence Scale transsexuals performed in congruence with their biologic sex rather than gender identity. In contrast, on a measure of conceptual styles, transsexuals performed in congruence with their gender identity. The MMPI did not provide evidence of a major psychopathological process.

Evaluating clinical skills in an undergraduate medical education curriculum

A Vietnamese Depression Scale (VDS) was developed in 1982 in the United States and has been used as a screening tool for depression and as the basis for a standardized interview to assess depression in the Vietnamese refugee populations. In this current study, the VDS was used in Ho Chi Minh City, Vietnam, to assess depression in patients who were already diagnosed with depression by Vietnamese psychiatrists and in patients presenting at a local primary care clinic. Of the 177 primary care clinic patients, 8.4% met the criteria for clinical depression based on the VDS. Results indicate a higher risk for depression among married and/or less than high school educated individuals. Discrepancies were found between the depression diagnosis by Vietnamese psychiatrists and VDS screening results. Among the participants interviewed who met the VDS criteria for depression, culture-specific phrases such as “desperate,” “going crazy,” and “low spirited and bored” were highly associated with symptoms of depression.

Transsexualism: a standardized psychosocial rating format for the evaluation of results of sex reassignment surgery.

The University of Washington School of Medicine conducted a series of internal surveys to investigate senior students’ capabilities with respect to clinical skills and behaviors. The surveys examined faculty opinion regarding essential clinical skills and sought their estimates of potential problem areas. They also identified those clinical skills and behaviors on which students reported whether they had ever been expected to demonstrate proficiency. Three questions were addressed: (a) What behaviors and skills should all undergraduate medical students in this institution be expected to demonstrate before graduation? (b) Do senior medical students at this institution appear to be learning skills that faculty believe are essential? (c) How should skills that are considered essential by the institutions faculty be evaluated? This approach to institutional self‐study is presented as a model for determining how a medical school that does not have a comprehensive performance‐based evaluation system can determ...