Erica Frank

Physical activity habits of doctors and medical students influence their counselling practices

Doctors are well positioned to provide physical activity (PA) counselling to patients. They are a respected source of health-related information and can provide continuing preventive counselling feedback and follow-up; they may have ethical obligations to prescribe PA. Several barriers to PA counselling exist, including insufficient training and motivation of doctors and improvable, personal PA habits. Rates of exercise counselling by doctors remain low; only 34% of US adults report exercise counselling at their last medical visit. In view of this gap, one of the US health objectives for 2010 is increasing the proportion of patients appropriately counselled about health behaviours, including exercise/PA. Research shows that clinical providers who themselves act on the advice they give provide better counselling and motivation of their patients to adopt such health advice. In summary, there is compelling evidence that the health of doctors matters and that doctors’ own PA practices influence their clinical attitudes towards PA. Medical schools need to increase the proportion of students adopting and maintaining regular PA habits to increase the rates and quality of future PA counselling delivered by doctors.

Changes in U.S. Medical Students’ Specialty Interests over the Course of Medical School

Studies have examined factors affecting medical students’ specialty choice, but little research exists on stability of these specialty interests. To describe patterns of change in specialty interests during medical school and examine associations between specialty change patterns and gender, desire for a high-prestige career, and interest in prevention. Medical students (Class of 2003) at 15 representative US schools were invited to complete surveys during freshman orientation, entry to wards, and senior year. This analysis used data from 942 students who completed all 3 surveys. In addition to a number of other items, students were asked to choose the 1 specialty they were most interested in pursuing. The most common specialty choices among freshman students were pediatrics (20%) and surgery (18%); least common choices were psychiatry and preventive medicine (1% each). General internal medicine was the initial specialty choice for 8%. Most students changed their specialty choices, regardless of initial interest. Only 30% of those initially interested in primary care (PC) remained interested at all 3 time points, compared to 68% of those initially interested in non-PC. Female versus male students were more commonly interested in PC at all 3 time points. Senior students interested in non-PC specialties were more likely to desire a high-prestige career (48%) than those interested in PC (31%). Medical students may benefit from more intensive introduction to some specialties earlier in pre-medical and medical education. In addition, increasing the prestige of PC fields may shape the physician workforce.BackgroundStudies have examined factors affecting medical students’ specialty choice, but little research exists on stability of these specialty interests.ObjectiveTo describe patterns of change in specialty interests during medical school and examine associations between specialty change patterns and gender, desire for a high-prestige career, and interest in prevention.DesignMedical students (Class of 2003) at 15 representative US schools were invited to complete surveys during freshman orientation, entry to wards, and senior year.ParticipantsThis analysis used data from 942 students who completed all 3 surveys.MeasurementsIn addition to a number of other items, students were asked to choose the 1 specialty they were most interested in pursuing.ResultsThe most common specialty choices among freshman students were pediatrics (20%) and surgery (18%); least common choices were psychiatry and preventive medicine (1% each). General internal medicine was the initial specialty choice for 8%. Most students changed their specialty choices, regardless of initial interest. Only 30% of those initially interested in primary care (PC) remained interested at all 3 time points, compared to 68% of those initially interested in non-PC. Female versus male students were more commonly interested in PC at all 3 time points. Senior students interested in non-PC specialties were more likely to desire a high-prestige career (48%) than those interested in PC (31%).ConclusionsMedical students may benefit from more intensive introduction to some specialties earlier in pre-medical and medical education. In addition, increasing the prestige of PC fields may shape the physician workforce.

Stress and depressive symptoms/dysphoria among US medical students: results from a large, nationally representative survey.

This study determined rates and correlates of stress, depressive symptoms/dysphoria, and suicidal thoughts among US medical students. Data were obtained from a large-scale survey conducted at 16 representative medical schools. Students completed questionnaires during first-year orientation (n= 1846), at the time of transition to clinical rotations (n= 1630), and during the fourth year (n= 1469). Students entering the wards reported greater stress, more bad mental health days, and greater depressive feelings than first-year students, with fourth-year students reporting intermediate stress levels. The number of days of bad mental health in the past month, stress experienced in the past 12 months, and perceptions about the medical schools system for coping were independently associated with suicidal thoughts, which were reported by 9% of fourth-year students. Medical schools should undertake efforts to assist students’ coping because a substantial proportion of students experience meaningful levels of stress, depressive symptoms (especially around the time of transitioning to clinical care rotations), and suicidal thoughts.

Alcohol consumption and alcohol counselling behaviour among US medical students: cohort study

Objective To determine which factors affect alcohol counselling practices among medical students. Design Cohort study. Setting Nationally representative medical schools (n=16) in the United States. Participants Medical students who graduated in 2003. Interventions Questionnaires were completed (response rate 83%) at the start of students’ first year (n=1846/2080), entrance to wards (typically during the third year of training) (n=1630/1982), and their final (fourth) year (n=1469/1901). Main outcome measures Previously validated questions on alcohol consumption and counselling. Results 78% (3777/4847) of medical students reported drinking in the past month, and a third (1668/ 4847) drank excessively; these proportions changed little over time. The proportion of those who believed alcohol counselling was highly relevant to care of patients was higher at entrance to wards (61%; 919/1516) than in final year students (46%; 606/1329). Although students intending to enter primary care were more likely to believe alcohol counselling was highly relevant, only 28% of final year students (391/1393) reported usually or always talking to their general medical patients about their alcohol consumption. Excessive drinkers were somewhat less likely than others to counsel patients or to think it relevant to do so. In multivariate models, extensive training in alcohol counselling doubled the frequency of reporting that alcohol counselling would be clinically relevant (odds ratio 2.3, 95% confidence interval 1.6 to 3.3) and of reporting doing counselling (2.2, 1.5 to 3.3). Conclusions Excessive drinking and binge drinking among US medical students is common, though somewhat less prevalent than among comparably aged adults in the US general population. Few students usually discussed alcohol use with patients, but greater training and confidence about alcohol counselling predicted both practising and believing in the relevance of alcohol counselling. Medical schools should consider routinely training students to screen and counsel patients for alcohol misuse and consider discouraging excessive drinking.

Caring for medical students as patients: Access to services and care- seeking practices of 1,027 students at nine medical schools

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.

The association between physicians’ and patients’ preventive health practices

Background: Although much has been written about the potential power of the association between physicians’ personal health practices and those of their patients, objective studies of this relationship are lacking. We investigated this association using objectively measured health care indicators. Methods: We assessed 8 indicators of quality of health care (screening and vaccination practices) for primary care physicians (n = 1488) and their adult patients (n = 1 886 791) in Israel’s largest health maintenance organization; the physicians were also patients in this health care system. Results: For all 8 indicators, patients whose physicians were compliant with the preventive practices were more likely (p < 0.05) to also have undergone these preventive measures than patients with noncompliant physicians. We also found that more similar preventive practices showed somewhat stronger relations. For example, among patients whose physician had received the influenza vaccine, 49.1% of eligible patients received flu vaccines compared with 43.2% of patients whose physicians did not receive the vaccine (5.9% absolute difference, 13.7% relative difference). This is twice the relative difference (7.2%) shown for pneumococcal vaccine–eligible patients of influenza-vaccinated versus nonvaccinated physicians (60.9% v. 56.8%). When we examined the rates of unrelated practices, we found that, for example, mammography rates were identical for patients whose physicians did and did not receive the influenza vaccine. Interpretation: We found a consistent, positive relation between physicians’ and patients’ preventive health practices. Objectively establishing this healthy doctor–healthy patient relation should encourage prevention-oriented health care systems to better support and evaluate the effects on patients of improving the physical health of medical students and physicians.

Personal and clinical exercise-related attitudes and behaviors of freshmen U.S. medical students.

Abstract To determine personal and clinical exercise-related attitudes and behaviors of freshmen U.S. medical students, we surveyed 1,906 entering freshman medical students (response rate = 87%; average age = 24 years) in 17 U. S. medical schools. Students reported a median of 45 min/day of exercise, 80 min/week each of mild and moderate exercise, and 100 min/week of strenuous exercise. Nearly all students (97.6%) engaged in some moderate or vigorous exercise in a typical week. Sixty-four percent complied with U. S. Department of Health and Human Services exercise recommendations. Most freshmen (79%) believed it would be highly relevant to their future practices to counsel patients about exercise; predictors included intention to provide primary care, excellent health, prevention emphasis by their personal physician, and performing more strenuous exercise.

Methodologic Concerns in Defining Lesbian for Health Research

A recent report from the Institute of Medicine recommends more methodologic and substantive research on the health of lesbians. This study addresses one methodologic topic identified in the Institute of Medicine report and by a subsequent scientific workshop on lesbian health: the definition and assessment of sexual orientation among women. Data are from the Women Physicians’ Health Study, a questionnaire-based U.S. probability sample survey (N = 4,501). The two items on sexual orientation (current self-identity and current sexual behavior) had a high response rate (96%), and cross-tabulation of responses indicated several combinations of identity and behavior. Three conceptually different definitions of “lesbian” are compared on the basis of (1) identity only, (2) sexual behavior only, and (3) both identity and sexual behavior. Suggestions and cautions are given to researchers who will add items on sexual orientation to new or ongoing research on women’s health.

Significance of Authorship Position: An Open-Ended International Assessment

Introduction:The International Committee of Medical Journal Editors (ICMJE) does not recommend guidelines on authorship position, despite its important role in academic promotion. To identify perceptions of authorship position, the authors performed the first study of authorship position using only open-ended questioning. Methods:Articles with at least 3 authors were selected from the top 10 cited and 20 other medical journals. The first, last, and 1 author in-between were selected and asked to identify contributions of first and last authors listed in medical journal articles. The responses were analyzed for differences between perceptions of first versus last authorship. Results:Respondents were more likely to report ICMJE criteria being fulfilled by first authors; however, only 1.1% identified all 3 ICMJE conditions of authorship for either author. ICMJE criteria were no more likely identified by authors of high-impact versus low-impact journals. Significant differences existed between the understandings of appropriate roles for first- versus last-listed authors. First-listed authors were viewed at least 7 times more likely to be involved in study conduct, manuscript writing, have a major study contribution and perform the majority of the work involved. Last-listed authors were at least 7 times more likely to be viewed as having a minor or no contribution to the study, provide funding, be a laboratory head/mentor, hold a senior position and supervise/oversee the study. Conclusions:ICMJE authorship criteria were poorly identified by respondents in this open-ended, international sampling of medical journal authors. Although ICMJE criteria are ideally met by all authors, this does not seem to be well understood or accepted.

Mental health concerns among Canadian physicians: results from the 2007-2008 Canadian Physician Health Study

OBJECTIVE In light of prior reports on the prevalence of stress, depression, and other mental health problems among physicians in training and practice, we examined the mental health concerns of Canadian physicians using data from the 2007-2008 Canadian Physician Health Study. METHODS Among 3213 respondents, 5 variables (depressive symptoms during the past year, anhedonia in the past year, mental health concerns making it difficult to handle ones workload in the past month, problems with work-life balance, and poor awareness of resources for mental health problems) were examined in relation to sex, specialty, practice type (solo practice vs group or other practice settings), and practice setting (inner city, urban/suburban, or rural/small town/remote). RESULTS Nearly one quarter of physicians reported a 2-week period of depressed mood, and depression was more common among female physicians and general practitioners/family physicians. Anhedonia was reported by one fifth; anesthesiologists were most likely to report anhedonia, followed by general practitioners/family physicians. More than one quarter reported mental health concerns making it difficult to handle their workload, which was more common among female physicians and general practitioners/family physicians and psychiatrists. Nearly one quarter reported poor work-life balance. Lack of familiarity with mental health resources was problematic, which was more prominent among female physicians and specialists outside of general practice/family medicine or psychiatry. CONCLUSIONS Mental health concerns are relatively common among Canadian physicians. Training programs and programmatic/policy enhancements should redouble efforts to address depression and other mental health concerns among physicians for the benefit of the workforce and patients served by Canadian physicians.