Frederick S. Sierles

Relationship Between Specialty Choice and Medical Student Temperament and Character Assessed With Cloninger Inventory

Background: Multiple variables affect medical specialty choice, including temperament, sociodemographic factors, and personal experiences. Many studies address specific variables for specific specialties, but few assess the relative impact of each factor. Purpose: To identify the relative influence of temperament in choosing a specialty. Methods: A sociodemographic and personal experiences questionnaire and a 240-question temperament and character inventory was distributed to 682 medical students. Their scores for 6 medical specialties were examined using analyses of variance, multivariate analyses of variance, and discriminant analysis. Results: Students choosing surgery, emergency medicine, and obstetrics and gynecology were higher on novelty seeking than other students. Future surgeons were lower in harm avoidance and reward dependence (RD) than the others. Students choosing primary care specialties, emergency medicine, and obstetrics and gynecology were all high on RD; with pediatrics being highest. Students differed from college students, the women differed from the men, and the Asian Americans differed from the other groups. Conclusion: The implications of these findings are discussed for career counseling and future research.

Educational Objectives for a Junior Psychiatry Clerkship

Explicit instructional objectives have become essential in medical education and have been developed nationally for students in surgery, gynecology, and pediatric clerkships. The authors describe the rationale for and process of developing psychiatry clerkship objectives, first at the Medical College of Pennsylvania (MCP) and then by the Association of Directors of Medical Student Education in Psychiatry. Faculty interviews about the development of psychiatry clerkship objectives at MCP illustrate the objectives’ positive educational impact.

Changes in medical students' exposure to and attitudes about drug company interactions from 2003 to 2012: a multi-institutional follow-up survey.

Purpose To ascertain whether changes occurred in medical student exposure to and attitudes about drug company interactions from 2003–2012, which factors influence exposure and attitudes, and whether exposure and attitudes influence future plans to interact with drug companies. Method In 2012, the authors surveyed 1,269 third-year students at eight U.S. medical schools. Items explored student exposure to, attitudes toward, and future plans regarding drug company interactions. The authors compared 2012 survey data with their 2003 survey data from third-year students at the same schools. Results The 2012 response rate was 68.2% (866/1,269). Compared with 2003, in 2012, students were significantly less frequently exposed to interactions (1.6/month versus 4.1/month, P < .001), less likely to feel entitled to gifts (41.8% versus 80.3%, P < .001), and more apt to feel gifts could influence them (44.3% versus 31.2%, P < .001). In 2012, 545/839 students (65.0%) reported private outpatient offices were the main location of exposure to pharmaceutical representatives, despite spending only 18.4% of their clerkship–rotation time there. In 2012, 310/703 students (44.1%) were unaware their schools had rules restricting interactions, and 467/837 (55.8%) planned to interact with pharmaceutical representatives during residency. Conclusions Students in 2012 had less exposure to drug company interactions and were more likely to have skeptical attitudes than students in 2003. These changes are consistent with national organizations’ recommendations to limit and teach about these interactions. Continued efforts to study and influence students’ and physician role models’ exposures to and attitudes about drug companies are warranted.

Relationships Between Drug Company Representatives and Medical Students: Medical School Policies and Attitudes of Student Affairs Deans and Third-Year Medical Students

ObjectivesThe authors sought to ascertain the details of medical school policies about relationships between drug companies and medical students as well as student affairs deans’ attitudes about these interactions.MethodsIn 2005, the authors surveyed deans and student affairs deans at all U.S. medical schools and asked whether their schools had a policy about relationships between drug companies and medical students. They asked deans at schools with policies to summarize them, queried student affairs deans regarding their attitudes about gifts, and compared their attitudes with those of students who were studied previously.ResultsIndependently of each other, 114 out of 126 deans (90.5%) and 114 out of 126 student affairs deans (90.5%) responded (identical numbers are not misprints). Ten schools had a policy regarding relationships between medical students and drug company representatives. Student affairs deans were much more likely than students to perceive that gifts were inappropriate.ConclusionThese 2005 policies show trends meriting review by current medical schools in considering how to comply with the 2008 Association of American Medical Colleges recommendations about relationships between drug companies and medical students or physicians.

Review of Geri Fox’s Saying Goodbye: A Stimulus Videotape Centering on Her Conversations with Simon Fox, Her Late Father

We know with certainty that people will die. This might seem an unusual way to begin a medical education article, but it is worth noting this well-understood aspect of the life cycle in light of modern medicine’s apparent educational difficulties with accepting this premise [1]. Indeed, as medical interventions have become increasingly advanced and successful, many have argued that physicians are ironically also increasingly poorly equipped to grapple with the powerful feelings that develop when their patients or their patients’ family members die [2]. In this sense, one could argue that a fundamental aspect of medical practice has changed. Doctors were perhaps once comfortable with helping families to process these losses, but there is increasing evidence that today’s younger physicians are not well prepared to face these issues with their parents [3]. Nevertheless, families still turn to their doctors for guidance during these difficult transitions. For this reason, there is a great need for efficient and thoughtful instructional tools to help faculty in teaching these important topics. And beyond teaching about these issues, faculty members themselves will become increasingly aware of and skilled in conveying the importance of this life transition. Given that not every person who dies receives palliative or hospice care, many family members present to their general doctors with simple or complex grief after losing a relative and they are subsequently referred for some kind of counseling. Within the medical profession, psychiatrists are among the physicians called upon in these circumstances. Training programs have struggled with how best to convey the normal grieving that occurs when a family member dies [3]. This challenge may in fact be a reflection of the same advances in medicine that have largely moved these issues outside of the scope of most medical practices, but regardless of the reasons, examples of normal grief are hard to come by in psychiatric training curricula [4]. This lacuna is unfortunate given the clear need for psychiatrists to be comfortable understanding simple and complex grief and to have in mind how best to care for patients who are suffering from these challenges. With these challenges in mind, Geri Fox, M.D., created an instructional video of her interactions with her much-loved father during his last days. The IRB at the University of Illinois Medical School, Chicago, exempted (minimal risk) Dr. Fox’s film. Dr. Fox has called this 38-min film Saying Goodbye [5]. Beyond the emotional difficulties that creating such a video could understandably kindle, Dr. Fox’s attention to salient moments during this normal but heartwrenching part of the life cycle offers students and faculty a scaffolding to discuss how best to understand the complex feelings that a dying elderly parent can engender in his or her offspring. Although it is not the purpose of this article to laud the film for its artistic merit, it is not possible to comment on the film’s usefulness without first at least mentioning the care and expertise that Dr. Fox displays in creating and selecting teaching moments throughout the video as she and her father converse. In order to best appreciate the utility of the film itself, some background about Dr. Fox’s father and the reasons for his increasing and mortal infirmity are necessary. * Steven Schlozman sschlozman@partners.org

Should Psychiatrists Teach the Physical Examination to Medical Students? A Case Report and National Survey

In the first-year course at UHS/The Chicago Medical School, the teaching of the physical examination by a senior psychiatrist was rated highly compared to teaching by internists and surgeons. A national survey identified seventy-one psychiatrists at thirteen schools teaching the basic physical examination. These schools had more graduates that chose residencies in psychiatry than did those schools where such teaching did not occur. For several reasons, including better working relationships with medical colleagues and role modelling for future psychiatrists, we recommend that some psychiatrists at all schools teach the physical examination to neophyte students.