Susan L. Rattner

An empirical study of decline in empathy in medical school

Context  It has been reported that medical students become more cynical as they progress through medical school. This can lead to a decline in empathy. Empirical research to address this issue is scarce because the definition of empathy lacks clarity, and a tool to measure empathy specifically in medical students and doctors has been unavailable.

Attitudes toward physician-nurse collaboration: a cross-cultural study of male and female physicians and nurses in the United States and Mexico.

BACKGROUND Inter-professional collaboration between physicians and nurses, within and between cultures, can help contain cost and insure better patient outcomes. Attitude toward such collaboration is a function of the roles prescribed in the culture that guide professional behavior. OBJECTIVES The purpose of the study was to test three research hypotheses concerning attitudes toward physician-nurse collaboration across genders, disciplines, and cultures. METHOD The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered to 639 physicians and nurses in the United States (n = 267) and Mexico (n = 372). Attitude scores were compared by gender (men, women), discipline (physicians, nurses), and culture (United States, Mexico) by using a three-way factorial analysis of variance design. RESULTS Findings confirmed the first research hypothesis by demonstrating that both physicians and nurses in the United States would express more positive attitudes toward physician-nurse collaboration than their counterparts in Mexico. The second research hypothesis, positing that nurses as compared to physicians in both countries would express more positive attitudes toward physician-nurse collaboration, was also supported. The third research hypothesis that female physicians would express more positive attitudes toward physician-nurse collaboration than their male counterparts was not confirmed. CONCLUSIONS Collaborative education for medical and nursing students, particularly in cultures with a hierarchical model of inter-professional relationship, is needed to promote positive attitudes toward complementary roles of physicians and nurses. Faculty preparation for collaboration is necessary in such cultures before implementing collaborative education.

The Effect of Magnesium on Apatite Formation in Seeded Supersaturated Solutions at pH 7.4

The deposition of mineral apatite in skeletal tissues occurs in a physiological milieu relatively rich in magnesium ions. Wuthierl found that the ultrafilterable Mg level in extracellular cartilage fluid (0.8 mM) is comparable to that found in blood plasma. Although the effects of Mg on mineral dynamics in vivo are imperfectly understood, several past studies on synthetic systems have shown that a major way in which Mg may affect apatite formation in vivo is through altering precursor phase development. The lifetimes of amorphous calcium phosphate (ACP) and octacalcium phosphate (OCP), two known precursors to the formation of apatite in spontaneous precipitations, can be lengthened considerably by the presence of Mg in the reaction medium.2-5 In seeded reactions carried out at physiological pH, Nancollas and coworkers6,7 showed that Mg reduced the overall rate of reaction growth largely by stabilizing precursors to the final apatitic phase. The present study corroborates the previously published results on seeded systems. In addition, however, the findings reported here indicate that the seeded growth of apatite can be delayed by Mg even when solution conditions do not favor precursor development. Materials and methods.

Validity of faculty ratings of students' clinical competence in core clerkships in relation to scores on licensing examinations and Supervisors' ratings in residency.

Connections between assessment measures in medical school, residency, and practice need to be studied in order to ascertain the validity of such assessments in the continuum of medical education and physician training. Assuring the validity of students’ clinical competence ratings is especially important because these assessments are among the major components of the dean’s letter of evaluation and, as such, are used in the ranking of candidates for residency programs. Medical schools expend considerable time and effort in preparing a dean’s letter for each of their graduating students. It is based largely on the faculty’s assessment of the student’s academic and clinical performance. It should be one of the most important attachments to students’ applications for graduate medical education. Despite this, residency directors may not attach much importance to the dean’s letter, in part, perhaps, because they are uncertain that the information contained within it is valid for predicting performance during residency. Previous surveys have indicated that academic criteria such as U.S. Medical Licensing Examinations (USMLE) scores, membership in Alpha Omega Alpha (AOA), the medical honor society, and class rank were rated highly as selection variables by residency directors. More recently, performance during clinical clerkships has been cited as an important factor, particularly in the specialty for which the student is applying, and especially for the most competitive residencies. It is thus increasingly important to confirm the validity of clerkship evaluations to assure the credibility of the dean’s letter as a predictor of postgraduate performance. The dean’s letters of evaluation from Jefferson Medical College include a broad range of information (USMLE Step 1 score, secondand third-year class ranks, histogram of third-year written examination grades, clinical ratings, and excerpts from the narrative evaluations from the third-year clerkships). We have previously documented the validity of a calculated medical school class rank in predicting postgraduate performance. The purpose of this study was to examine the validity of faculty ratings of students’ clinical competences in six core clinical clerkships in relation to the students’ subsequent performances on medical licensing examinations and to program directors’ ratings of clinical performance in the first year of residency.

Attitudes toward physician-nurse alliance: comparisons of medical and nursing students.

No abstract available.

Factors influencing primary care physicians' choice to practice in medically underserved areas.

No abstract available.

Gender comparisons of income expectations in the USA at the beginning of medical school during the past 28 years.

This study was designed to investigate gender differences in the USA, in anticipated professional income. Participants were 5314 medical students (3880 men, 1434 women) who entered Jefferson Medical College between 1970 and 1997. The annual peak professional income estimated at the beginning of medical school was the dependent variable and gender within selected time periods was the independent variable. Results showed significant differences between men and women on their anticipated future incomes in different time periods. Women generally expected 23% less income than men. The effect size estimates of the differences were moderately high. The gender gap in income expectations was more pronounced for those who planned to pursue surgery than their counterparts who planned to practice family medicine or pediatrics. A unique feature of this study is that its outcomes could not be confounded by active factors such as experience, working hours, age and productivity. Findings suggest that social learning may contribute to gender gap in anticipated income.

A statewide system to track medical students' careers: the Pennsylvania model.

In 1994 the Commonwealth of Pennsylvania announced a statewide Generalist Physician Initiative (GPI) modeled after The Robert Wood Johnson Foundations GPI. Three-year grants totaling more than

Tuberculin positivity and patient contact in healthcare workers in the urban United States.

9 million were awarded to seven of Pennsylvanias medical schools, including two that had already received GPI grants from the foundation. Stimulated by these initiatives, the states six allopathic and two osteopathic medical schools decided to work together to develop a collaborative longitudinal tracking system to follow the careers of all their students from matriculation into their professional careers. This statewide data system, which includes information for more than 18,000 students and graduates beginning with the entering class of 1982, can be used to evaluate the impact of the Pennsylvania GPI, and it also yielded a local longitudinal tracking system for each medical school. This paper outlines the concept of the system, its technical implementation, and the corresponding implications for other medical schools considering the development of similar outcomes assessment systems.

Cross-sectional assessment of medical and nursing students' attitudes toward chronic illness at matriculation and graduation.

We performed tuberculin and anergy testing in 91 healthy volunteer employees from the patient transport and housekeeping units at an urban tertiary-care hospital, stratifying results by the risk factor of patient contact. Tuberculin positivity was highly prevalent in this group; patient contact was not a predictor of tuberculosis infection risk, and anergy was rare.