Sidney Weissman

An Analysis of Changing Patterns of American Medical Student Career Selection of Psychiatry

Over the past ten years there has been a dramatic decrease in the number of students planning careers in psychiatry. The most widely held hypothesis is that encouraging medical students to pursue primary care careers has drawn them away from psychiatry. A survey questionnaire composed of 79 questions was distributed anonymously to the 995 senior medical students in the eight medical schools in Northern Illinois. Multiple correlations and a discriminate analysis were performed to identify those selecting psychiatric careers and those entering other specialties. The study confirms the decline of medical student interest in psychiatry; it offers data in support of the distinction between psychiatry-oriented medical students and their peers. The study distinguishes differing career patterns for men and women medical students. It does not provide support for the concept of primary care, especially family practice, drawing students away from psychiatry.

The need to teach a wider, more complex view of "evidence".

In ‘‘Teaching Medical Students Social Responsibility,’’ Faulkner and McCurdy outline a logical and classic approach to this important goal; however, it is an approach that is almost the reverse of what I have observed to be effective. They suggest starting with the creation of objectives, and perhaps faculty development, followed by the development of necessary didactics. They ‘‘believe that most medical students will take their lead from the faculty.’’ My experience is that students come to us with a high degree of social responsibility and our task is to avoid ‘‘teaching it out of them’’ by a curriculum sometimes characterized by factual overload and insensitivity to humanism. Rather than starting with objectives, I believe in starting with an activity and, in a later, iterative process, identifying the objectives, creating an appropriate evaluation system, and modifying the activity as needed. This belief has grown out of the development of our ‘‘POPS’’ (patient-oriented problem solving) system for teaching immunology and, more relevant to this subject, from my observations of the evolution of socially relevant projects at the University of Florida College of Medicine (UFCOM). The majority of UFCOM’s most effective socially relevant projects have been initiated and run by students. Three of these ongoing projects include:

Additional suggestions for facilitating professional identity formation.

Additional Suggestions for Facilitating Professional Identity Formation To the Editor: In the November 2014 issue, Cruess and colleagues propose that a critical element of medical education is to foster the formation of a professional identity. They assume because of the importance of a professional identity in our activities that we physicians all share a common definition of professional identity and essentially agree as to what it is. Because of the difficulty in operationalizing such a definition, the authors do not explicitly define in detail what a professional identity is. They note that this has been addressed historically by didactic education focused on defining professionalism and professional responsibility. They argue that the critical step in students attaining a professional identity may be through broad socialization experiences in varied clinical rotations in medical school and residency, not simply in didactics courses alone. For this reason, based on their understanding of the complexities of identity formation, they place the primary locus for a student’s integrating a professional identity on diverse clinical rotations interacting with medical professionals.

Multisource feedback: problems and potential.

Academic Medicine, Vol. 88, No. 8 / August 2013 1055 We agree that well-designed multisource feedback (MSF) surveys that include patient ratings and feedback should be part of formative assessment in graduate medical education and maintenance of certification (MOC). In fact, a number of validated instruments, most notably the family of patient surveys developed by the Consumer Assessment of Healthcare Providers and Systems program, already exist to help physicians improve care and are already included in several MOC programs as formative assessment tools to help physicians improve patient experience and quality in their own practices. With regard to peers and others, hospital-based physicians who recently participated in an MOC pilot study of an MSF instrument assessing teamwork rated the quality of the feedback highly, and specialists who chose a peer survey of communication skills for their MOC program also reported high satisfaction and utility with the experience.

Guidelines for the general psychiatry application process and for inter-residency transitions.

Selecting a psychiatry program is a seminal event. There is often not enough guidance about this process. The American Association of Directors of Psychiatric Residency Training (AADPRT) recognized that this was a high-stakes process and that there was the opportunity to provide input about the process and promoting fairness and consistency, which could help provide the best opportunity for applicants to select where they will train and for programs to accept trainees who are well qualified for what a program offers and will best fit into the learning environment. A workgroup created guidelines included herein for the application process to begin general psychiatry training and to transition from one program to another, including transfer from one General Psychiatry program into another and entry into Child and Adolescent Psychiatry Residencies as well as subspecialty fellowships in psychiatry.

From Immigrant to Practitioner: A Perspective

In this chapter, the author addresses the factors that may lead medical students to desire further medical education outside of their home country or where they have attended medical school and explores the process in which a medical student who is educated outside of the United States elects to obtain a medical residency in the United States and eventually pursue a medical career in the United States. The author also explores the current immigration processes available for an international medical graduate to enter the United States and the specific and varied immigration programs available to these students. The author reviews the steps the student must take to obtain a residency in the United States while concurrently elaborating on the medical organizations in the United States that the student must engage with in his or her quest for a residency. Finally, the author reviews the process of obtaining a medical position in the United States after completion of residency training and introduces the reader to the varied organizations that have an impact on medical practice. The unique adverse forces that may impact how IMGs are treated in obtaining post residency positions are also discussed.

More about who should oversee preparation of the dean's letter.

Academic Medicine, Vol. 87, No. 6 / June 2012 681 takes into account a student’s Step 1 score on the United States Medical Licensing Examination, third-year clerkship grades, research, leadership, and community service to create a score that we use to divide the class into quartiles anonymously. The quartile to which a student has been assigned then determines the key descriptor we give the student (outstanding, excellent, very good, and good) in the summary section of the MSPE. Committees involving faculty and leadership outside of student affairs are also good ways to make sure processes are followed and individual biases minimized. When there is a clear and fairly applied process, it matters less what office ultimately oversees the MSPE. The issue is not who, but how.