G. Christian Jernstedt

Fostering Professionalism in Medical Education

Increasing attention has been focused on developing professionalism in medical school graduates. Unfortunately, the culture of academic medical centers and the behaviors that faculty model are often incongruent with our image of professionalism. The need for improved role modeling, better assessment of student behavior, and focused faculty development is reviewed. We propose that the incentive structure be adjusted to reward professional behavior in both students and faculty. The third-year medicine clerkship provides an ideal opportunity for clinician-educators to play a leading role in evaluating, rewarding, and ultimately fostering professionalism in medical school graduates.

Understanding and improving medical student specialty choice: a synthesis of the literature using decision theory as a referent.

Background: As emphasis in medicine has shifted to increasing the number of physicians who choose primary care specialties, many studies of medical specialty choice have been conducted. Although researchers have approached the topic in a number of ways, most approaches have tended to focus on narrow elements of the choice, such as the effect of programs or curricula. A more comprehensive approach is possible by fitting the process to a preexisting broad theoretical framework. Summary: This synthesis of the literature examines specialty choice from the perspective of decision theory--with its aims of understanding how decisions are made, providing information about the quality of decisions, and improving the decision-making process. Conclusion: This approach has the potential to not only help deconstruct the process of decision making regarding specialty choice but also uncover information about the best ways to help medical students learn to make wise decisions.

A Longitudinal Study of Determinants of Career Satisfaction in Medical Students

Abstract: Context: There is evidence of significant career dissatisfaction among practicing physicians and those considering medicine as a profession. Most research on career satisfaction has examined practicing physicians. This study was undertaken to look at determinants of satisfaction in those at the earliest stage of their medical careers — medical students. Methods: As part of a larger study, students comprising one class at the University of Washington School of Medicine were surveyed three times over the course of their medical education. For the present study we examined measures specifically related to determinants of career satisfaction. Findings: Over time, students’ sense of the importance of most measured determinants of satisfaction showed significant change, the majority of which were in the direction of decreased importance. However, most of the change was relative. That is, factors that students considered to be most important at the start of medical school continued to be most important throughout the educational experience and those factors students considered to be least important at Year 1 continued to be least important at Years 2 and 4. Discussion: These findings have implications for medical education, a time when students are forming expectations that will impact their career satisfaction. In addition to information on career satisfaction, students should understand the professional values of medicine, their own values and expectations, current practice patterns, economics, and the role of advocacy.

The Affective Impact of Field Experience Education on College Students.

Field experience education encompasses a wealth of undergraduate curricular opportunities, including cooperative education, internships, adventure learning, and study abroad. Studies of field experiences may be organized according to three stages of the experiential process: selection factors prior to the experience, immediate change due to the experience, and the persistence of change following the experience. Compared to traditional campus activities, field experiences appear to have some significant affective impact on college students. However, a knowledge of experimental design techniques makes obvious the need for a major revision of the manner in which field experiences have been evaluated.

Commonality Analysis: Partitioning Variance for Multivariate Prediction

Commonality analysis partitions the proportion of explained variance in the dependent variable or variables that is accounted for by the independent variables. Both variances unique to independent variables and variances common to sets of independent variables are obtained. An algorithm is described for computing these variance components for both the single and multiple dependent variable case. An associated program selects the proper procedure, multiple regression or canonical correlation, and provides a table of all variance components.

Teaching children about health: an example of secondary gain in an academic-community partnership.

CONTEXT The Partners in Health Education (PHE) program is an elective that pairs first and second year medical students with local classroom teachers to promote health messages to students in kindergarten through grade eight. Designed with the primary goal of helping medical students improve their communication skills through the process of teaching children about health, the PHE program has secondary goals of supporting community teachers in their efforts to promote health and of teaching children about health and the prevention of disease and injury. This report contains the results of the assessment of program impact on the school children. METHODS A total of 327 elementary grade students in 14 experimental classrooms and 13 comparison classrooms comprised the participants for the study. Students were individually interviewed twice over an eight-week period using a structured interview form designed to capture self-report information about health and healthy living. Repeated measures analysis of variance was conducted. The effect of interest in each case was the treatment x time interaction. RESULTS There were significant treatment x time interactions for several measures of childrens reported knowledge and attitudes about health. DISCUSSION Although designed primarily to help medical students improve their communication skills, the PHE program produced a secondary gain such that elementary students in participating classrooms reported learning more about health than did students in comparison classrooms. Programs such as PHE can provide ways to meet the goal of helping children become empowered to take charge of their own health and to make healthy choices.

LECTURES AND TEXTUAL MATERIALS AS SOURCES OF INFORMATION FOR LEARNING

Undergraduates were given material to be learned from a lecture, a transcript of the lecture, or a written text based on the lecture. Performance on a multiple-choice examination 1 wk. after original learning was the criterion. Predictor variables were sampled from the person, environment, and behavior domains of influence. A coordinated sequence of multivariate procedures was applied to the data. Differences in the person and behavior domains were associated with differences in criterion performance; differences in environment were not. Enhanced learning from text and lecture was associated with high motivation, high ability, extended studying, active studying, and with encountering a preferred performance measure. Study activities were interpreted as catalyst for both motivation and ability.

Health Behavior Research and Medical Training

Despite rapid advances in the technology of the health sciences and in understanding of the basic biology of diseases at the molecular level, most of the disease processes that in the postantibiotic age cause disability and death have behavioral roots. The statistics concerning behavioral risk factors noted in youth are particularly alarming. For example, among American high school students, 73.9% indicated that they had tried smoking by their senior year, while 24.7% admitted to smoking daily over the past month. Furthermore, 48% indicated that they had had at least one alcoholic drink within the past month. With regard to sex, 70% responded that they had had sexual intercourse by their senior year, with 18.5% reporting having had four or more sexual partners. As for suicide, 24% indicated that they had given serious consideration to the thought of suicide over the past year. Finally, 22% indicated that they had carried a weapon in the past month (Kann et al., 1995).