Özlem Sarıkaya

Exposure of medical students to pharmaceutical marketing in primary care settings: frequent and influential

It is known that interaction between pharmaceutical companies and medical professionals may lead to corruption of professional values, irrational use of medicine, and negative effects on the patient–physician relationship. Medical students frequently interact with pharmaceutical company representatives and increasingly accept their gifts. Considering the move toward early clinical encounters and community-based education, which expose students early to pharmaceutical representatives, the influence of those gifts is becoming a matter of concern. This study examines the frequency and influence of student exposure to drug marketing in primary care settings, as well as student perceptions of physician–pharmaceutical company relationships. This was a two-phase study consisting of qualitative research followed by a cross-sectional survey. Clinical experience logbooks of 280 second-year students in one school were analysed, and the themes that emerged were used to develop a survey that was administered to 308 third-year students from two medical schools. Survey results showed a 91.2% exposure to any type of marketing, and 56.8% of students were exposed to all classes of marketing methods studied. Deliberate targeting of students by pharmaceutical representatives, in particular, was correlated with being less sensitive to the negative effects of and having positive opinions about interactions with pharmaceutical companies. The vast majority of students are exposed to drug marketing in primary care settings, and may become more vulnerable to that strategy. Considering that medical students are vulnerable and are targeted deliberately by pharmaceutical companies, interventions aimed at developing skills in the rational use of medicines and in strategies for coping with drug marketing should be devised.

Exposing Nursing Students To the Marketing Methods of Pharmaceutical Companies

There is a strong association between reliance on the promotional activities of pharmaceutical companies and a generally less appropriate use of prescription drugs. Pharmaceutical companies direct some of their promotion towards health workers who do not have the authority to prescribe medicines, such as nurses in certain countries. The aim of this study was to determine the impact that exposure to the marketing methods of pharmaceutical companies has on judgments made by nursing students about health worker—pharmaceutical company relationships. A cross-sectional survey was carried out with 442 nursing students in Istanbul, Turkey. The exposure of students to the marketing methods of pharmaceutical companies, whether it be indirectly through observation or directly by first-hand experience, increases the probability that students will adopt rationales that underlie affirmative judgments of health worker—pharmaceutical company relationships. Based on the pervasiveness and ability of drug promotion to influence the perceptions of students, it is imperative that attempts be made to reduce its negative impact.

What do we know about the anxieties of new clinical students

Editor – The clinical phase of medical education is looked forward to by most medical students, although it can also be a process that generates anxiety. It is important to identify the situations that are connected with increased levels of anxiety among students; such information could make an important contribution to the preparedness for clinical training of both new students and teachers. A recent study, conducted at Marmara Medical School, Istanbul, aimed to determine which situations cause anxiety among new clinical medical students from their own and their teachers’ perspectives. Students’ perceived anxieties were assessed by means of a questionnaire, which was also given to the teachers involved in clinical training during the fourth year of medical education. Teachers were asked to complete the questionnaire as they thought the introductory students might have done. It was interesting to see that the teachers’ results produced a higher mean anxiety score than did the students’ results. Many of the items identified by the teachers as causing anxiety were related to communicating with patients. As a similar study has shown, the students themselves did not underline these items that much. Students, however, reported more anxiety around giving incorrect treatment, becoming infected by patients, inadvertently hurting patients and getting up early for ward rounds. The anxiety caused by these items was underestimated by teachers. We have seen that fear of making mistakes that might potentially harm patients is one of the principal sources of anxiety among health sciences students. Another result of this study was the finding that both teachers and students found the performance of some clinical skills to cause anxiety, such as cardiopulmonary resuscitation, rectal and ⁄ or vaginal examination and taking blood from patients. Anxiety levels and their sources change as students progress through medical education. We also know that stress is associated with poor performance, especially in clinical training. Marmara Medical School is currently involved in a process of change. This process is intended to deal with well known problems in medical education, such as a lack of effective integration between the preclinical and clinical phases, an overloaded curriculum and a lecture-based and teacher-centred approach. Many of the findings of our study arose from these problems. If sources of stress can be identified and targeted early, barriers to learning can be minimised. However, teachers first need to be aware of these sources and the fact that students may respond differently to clinical activities.

Minimizing missed opportunities: an approach to decrease the unmet need for family planning

Objectives The aim of the study was to determine the participants with unmet need and to show that family planning consultancy given to women and men attending the first-level health facilities would increase contraceptive usage and reduce unmet need for family planning. Methods All married women aged 15-49 years and men having wives of the same age group attending the health centers for any service other than family planning were included in the study. Among 2021 attendants, a total of 1701 participated in the study (84.2%). Participants were interviewed after they took the services for which they attended. At the end of the inquiries, all willing participants were referred to the family planning unit in the same building. Results The unmet need (need for any or more effective contraceptive methods) was 43.1%. All participants with unmet need were referred to the family planning unit in the same building and willing participants were given family planning services. Of the participants, 23.9% attended the family planning unit and 17.8% took services immediately at the time of the attendance. Conclusions Linking family planning services with other health services can be a cheap and practical way to reduce the unmet need.

Students Meeting with Caregivers of Cancer Patient: Results of an Experience-Based Learning Project

The communication between medical students and cancer caregivers, and the problems they have experienced as well as the outcomes for their professional development before starting clinical practice was assessed in the context of a student research project. Data were collected by questionnaires or by 20 to 40-min long interviews with cancer caregivers. Their communications with physicians, hearing the bad news, and health service satisfaction were questioned. Therefore, the caregivers trusted the professional approach of their physician. However, they expected more empathic communication in the process of diagnosis and therapy. Development of empathy and trust-based communication between patients and physicians and enhancement of the quality of devoted time to cancer patients and caregivers may have an effect on the course of disease. Interviewer students mentioned that they developed communication skills about difficult clinical tasks and in delivering bad news face to face to cancer caregivers before starting their clinical education.

Education For Healthcare In Disasters: An Imperative For Undergraduate Medical Education

Obsesif kompulsif bozukluk genellikle 2.3. on yilda ortaya cikan tekrarlayici, istenmeyen, sikinti yaratici dusunce, imaj ya da durtuler ve eslik eden davranislardir. Gec yasta baslayan olgular nadirdir. 71 yasindaki hasta sol tarafinda gucsuzluk nedeniyle klinigimize basvurdu. Norolojik muayene ile sol hemiparezi, minimal disfazi ve anozognozi saptandi. Kranyal manyetik rezonans goruntulemede, sagda orta serebral arter kortikal dali sulama alaninda orta temporal girus posterior kismi ile inferior parietal lobulde, lentikulostriat arter sulama alaninda internal kapsul, sag globus pallidus ve putamende infarkt alani ve sag internal karotid arterde (ICA) okluzyon saptandi. 15 gun sonra idrar bulasma korkusu, surekli banyo yapma, el yikama, uykusuzluk ve yogun sikinti hissi yakinmalari gelisti. Davranislarinin sacma oldugunun bilincindeydi, fakat engelleyemiyordu. Noropsikolojik testlerde basit dikkati hafif bozuktu. Vizuospasyal islev ve kontruksiyon yetileri de bozuk olarak degerlendirildi. Obsesif kompulsif bozukluk genelde erken yaslarda baslamaktadir. Biz bu olgu ile serebrovaskuler nedenlere sekonder gelisen ileri yas olgulara dikkat cekmek istedik.“Gereksinimlerin yerel kaynaklarin kapasitesini astigi durumlar” biciminde tanimlanan olagandisi durumlarin sikligi, cesitliligi ve yikiciligi, dunyada ve ulkemizde artis gostermektedir. Saglik sistemlerinin dogrudan yasadigi altyapi ve insan gucu kayiplarinin yani sira toplumun saglik hizmeti gereksiniminin artmasi, cok-disiplinli ve gonullu ekiplerle calisma zorunlulugu, yerine getirilmesi gereken gorevlerin coklugu ve cesitliligi gibi sorunlar, durumu daha da karmasiklastirmaktadir. Bu sorunlarla bas etmek icin en temel araclardan birisi, saglik calisanlarinin olagandisi durumlara yonelik olarak egitilmesidir. Ancak dunyada ve Turkiye’de olagandisi durumlara hazirlikli olma ve etkili yanit verme egitimi acisindan cok umutlu bir tablo oldugunu ileri surmek guctur. Cok sayida program uygulaniyor olsa da, programlar cogunlukla kurumlarin birbiriyle isbirligi yapmadan duzenledigi, icerik acisindan onemli eksikler tasiyan, hedef grup kapsayiciligi yetersiz ve farkli sektorlerden olagandisi durum calisanlarinin esgudumunu desteklemeyen niteliktedir. Bu calismada dunyada ve Turkiye’de saglik alaninda olagandisi durum egitimiyle ilgili durum gozden gecirilmekte ve gereksinimlerin tanimlanmasi amaclanmaktadir. Ayrica bir ornek olarak, mezuniyet oncesi tip egitimi icin cekirdek yeterlik hedefleri belirlenmekte ve bir program onerisi sunulmaktadir. Program onerisi hazirlanirken, egitim programlarinin etkililigini guvenceye almak amaciyla onerilen egitim programi gelistirme basamaklari izlenmistir. Bu amacla, cesitli yontemlerle egitsel gereksinimler belirlenmis; olagandisi durum tibbiyla ilgili temel kaynaklar incelenerek ogrenme hedefleri secilmis ve ogrenme hedeflerine uygun ogretme yontem ve teknikleri kararlastirilmistir.