Jennifer S. Carrera

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.

Domestic Violence Against Married Women in Cambodia

We evaluate the effects of marital resources and early-life experiences on recent domestic violence and attitudes about wife abuse among 2,074 married Cambodian women. Household standard of living was negatively associated with physical domestic violence. Women with 8-13 fewer years of schooling than their husbands more often experienced physical and psychological domestic violence. Women with more living children more often experienced physical domestic violence and justified wife beating. Having surviving parents and siblings was not associated with domestic violence nor with attitudes about wife beating. Women reporting higher paternal schooling, urban childhood residence and domestic violence against their mothers had higher odds of experiencing physical and psychological domestic violence. Findings underscore the effects of marital resources and early-life experiences on domestic violence in Cambodia.

Political self-characterization of U.S. medical students.

BACKGROUNDThere have been no prior studies of the political self-characterization of U.S. physicians-in-training, and little is known about physicians’ political leanings or the critical relationship between medical issues and political orientations of physicians and physicians-in-training.METHODSAll medical students in the class of 2003 at 16 nationally representative U.S. schools were eligible to complete three questionnaire administrations (at freshman orientation, entrance to wards, and senior year).RESULTSAmong these medical students, 5% self-characterized as politically very conservative, 21% conservative, 33% moderate, 31% liberal, and 9% as very liberal.” Being male, white, Protestant, intending to specialize in Surgery or anesthesiology/pathology/radiology, or currently or previously being married significantly (P ≤ .001) increased the likelihood that a student self-identified as very conservative or conservative. Disagreement or strong disagreement with the statements, “I’m glad I chose to become a physician” and “Access to care is a fundamental human right,” were also both associated with being very conservative or conservative. Being more liberal was reported by blacks and Hispanics; those intending to become ob-gyns, psychiatrists, and pediatric subspecialists; and atheists, Jews, and adherents of eastern religions.CONCLUSIONSU.S. medical students are considerably more likely to be liberal than conservative and are more likely to be liberal than are other young U.S. adults. Future U.S. physicians may be more receptive to liberal messages than conservative ones, and their political orientation may profoundly affect their health system attitudes.

Factors affecting weight counseling attitudes and behaviors among U.S. medical students

Purpose To identify the factors associated with perceived relevance and reported frequency of weight counseling among medical students. Method The authors surveyed all medical students in the Class of 2003 at 16 U.S. medical schools during first-year orientation (1999), orientation to wards (2000–2001), and fourth year (2002–2003). Results Across the three time points, response rates were, respectively, 89% (1,846/2,080), 82% (1,630/1,982), and 77% (1,469/1,901); a total of 2,316 medical students participated. More than half of the students felt that weight counseling was highly relevant to their intended practice (respectively, 63% [1,149/1,812], 70% [1,050/1,509], and 54% [717/1,329]). Among fourth-year students, 25% (350/1,393) reported that they “usually–always” provided weight counseling to general medicine patients. Perceived relevance peaked at orientation to wards (odds ratio [OR] = 1.88), then declined to initial levels. Greater school support for health promotion was positively associated with high counseling frequency (OR = 1.06). Students interested in non-primary-care specialties were less likely than others to consider weight counseling highly relevant (OR = 0.59) or, in their fourth year, to provide it to patients (OR = 0.50). Finally, higher personal fruit/vegetable consumption and confidence that this intake would increase were positively associated with high perceived relevance (both OR = 1.07) and frequency of weight counseling (OR = 1.09 and 1.16, respectively). Conclusions The majority of medical students consider weight counseling relevant to their intended careers. Promoting healthy personal behaviors and encouraging acquisition of skills in weight management across all specialties would likely improve clinical practice.

BASICS INEQUALITY: Race and Access to Complete Plumbing Facilities in the United States

In light of 2014–2016 media coverage about the inadequate water and sanitation services for households in places like Flint and Detroit, Michigan and the Central Valley of California, this paper asks whether places with majority non-White residents in the United States disproportionately lack access to these most basic of services. Investigating this issue through the combined lenses of structural racism, environmental justice, and the human right to water and sanitation, we analyze U.S. Census American Community Survey household data at the county level. Our findings indicate strong White versus non-White racial effects at the national and county levels (R 2 = 0.0462, P

Learning amid controversy: Prostate cancer knowledge and screening practices among US medical students

Background. No studies have examined medical students’ recommendation and use of prostate-specific antigen (PSA) testing and digital rectal exam (DRE) to screen for prostate cancer. We hypothesized that students’ race and extent of training on these techniques would be associated with their administration of them. Methods. We analyzed multiinstitutional longitudinal data from a cohort of 2181 medical students in the class of 2003. We queried students’ health behavior, their knowledge of prostate cancer racial disparities, their frequency of performing a PSA test or a DRE on a man 50 years of age or older (senior year only), the perceived relevance of such services to their future practice, and their training on PSA and DRE. We examined predictors of students’ administering PSA and DRE tests to patients during the senior year and changes in the predictors over time. Results. Respectively, 27% and 34% of students reported using the PSA and DRE “usually/always” during their senior year. Black students reported administering the PSA test more often than did students of other races, but race was not a significant predictor of PSA screening after controlling for personal healthy behavior. High perceived relevance to future practice and extensive training on PSA were most strongly associated with administration of PSA. Conclusions. The association between healthy personal behavior and PSA administration confounded the association between race and PSA screening. These results may help explain differences in prostate cancer screening among physicians and help medical educators tailor their curricula on prostate cancer screening.

Research altruism as motivation for participation in community-centered environmental health research

Protection of human subjects in research typically focuses on extrinsic rather than intrinsic motivations for participation in research. Recent sociological literature on altruism suggests that multiple kinds of altruism exist and are grounded in a sense of connection to common humanity. We interviewed participants in eight community-centered research studies that sampled for endocrine disrupting compounds and that shared research findings with participants. The results of our analysis of participation in these studies indicate that altruistic motivations were commonly held. We found that these sentiments were tied to feeling a sense of connection to society broadly, a sense of connection to science, or a sense of connection with the community partner organization. We develop a new concept of banal altruism to address mundane practices that work towards promoting social benefits. Further, we offer that research altruism is a specific type of banal altruism that is a multi-faceted and important reason for which individuals choose to participate in community-centered research.