Western medical schools--a breed apart.

The 16 medical schools in the 13 western states are distinctive from their counterparts nationally in several ways: they are relatively young, enroll a small number of medical students, and tend to be strongly research oriented. The rise of these institutions since Abraham Flexner''s visit to all of the western schools in 1909 reflects a truly remarkable development.     

Do students' attitudes toward women change during medical school?

BACKGROUND: Medical school has historically reinforced traditional views of women. This cohort study follows implementation of a revitalized curriculum and examines students'' attitudes toward women on entry into an Ontario medical school, and 3 years later. METHODS: Of the 75 students entering first year at Queen''s University medical school 70 completed the initial survey in September 1994 and 54 were resurveyed in May 1997. First-year students at 2 other Ontario medical schools were also surveyed in 1994, and these 166 respondents formed a comparison group. Changes in responses to statements about sex-role stereotypes, willingness to control decision-making of female patients, and conceptualization of women as "other" or "abnormal" because they are women were examined. Responses from the comparison group were used to indicate whether the Queen''s group was representative. RESULTS: Attitudinal differences between the primary group and the comparison group were not significant. After 3 years of medical education students were somewhat less accepting of sex-role stereotypes and less controlling in the doctor-patient encounter. They continued, however, to equate adults with men and to see women as "not adult" or "other." Female students began and remained somewhat more open-minded in all areas studied. INTERPRETATION: A predicted trend toward conservatism was not seen as students became older, more aware and closer to completion of medical training, although they continued to equate adults with male and to see women as "other." Findings may validate new curricular approaches and increased attention to gender issues in the academic environment.     

Buffeted by harsh economic winds,medical schools turn a wary eye to the future

All parts of Canada''s health care system are facing fiscal pressures these days, but they are particularly great at Canada''s medical schools. However, Dr. David Hawkins of the Association of Canadian Medical Colleges is optimistic that all 16 of Canada''s medical schools will remain open, mainly because of the huge impact they have on health care in their local communities. “We don''t just turn out students — we raise the standard of health care in a whole community,” he says.     

Applications and Enrolments at the Western Medical Schools: A Study of Medical Matriculants for 1964

All applicants and those who subsequently enrolled for the 1964-65 session in the Western medical schools were studied with the hope that it would encourage a national registration of applicants. Seven hundred and sixty-four applicants completed 865 applications for 288 places in four schools. Although the principal factor in selecting medical students in all Western schools is pre-medical performance, 49 “good-quality” (academically of good standing and under 30 years of age) resident applicants were not accepted in their own provincial school, and 49 places were filled with “poor-quality” students.The loss of good applicants to the Western medical schools and the 20% overlap of each school''s applicant pool with that of other schools suggests that objective standards of quality must be developed, and that a regular annual national assessment of applicants should be conducted by the Association of Canadian Medical Colleges.     

Medical school applicants from ethnic minority groups: identifying if and when they are disadvantaged.

OBJECTIVE--To assess whether people from ethnic minority groups are less likely to be accepted at British medical schools, and to explore the mechanisms of disadvantage. DESIGN--Prospective study of a national cohort of medical school applicants. SETTING--All 28 medical schools in the United Kingdom. SUBJECTS--6901 subjects who had applied through the Universities'' Central Council on Admissions in 1990 to study medicine. MAIN OUTCOME MEASURES--Offers and acceptance at medical school by ethnic group. RESULTS--Applicants from ethnic minority groups constituted 26.3% of those applying to medical school. They were less likely to be accepted, partly because they were less well qualified and applied later. Nevertheless, taking educational and some other predictors into account, applicants from ethnic minority groups were 1.46 times (95% confidence interval 1.19 to 1.74) less likely to be accepted. Having a European surname predicted acceptance better than ethnic origin itself, implying direct discrimination rather than disadvantage secondary to other possible differences between white and non-white applicants. Applicants from ethnic minority groups fared significantly less well in 12 of the 28 British medical schools. Analysis of the selection process suggests that medical schools make fewer offers to such applicants than to others with equivalent estimated A level grades. CONCLUSIONS--People from ethnic minority groups applying to medical school are disadvantaged, principally because ethnic origin is assessed from a candidate''s surname; the disadvantage has diminished since 1986. For subjects applying before A level the mechanism is that less credit is given to referees'' estimates of A level grades. Selection would be fairer if (a) application forms were anonymous; (b) forms did not include estimates of A level grades; and (c) selection took place after A level results are known.     

提高临床实习教学质量的实践与体会

临床实习是医学生大学教育阶段的重要组成部分,是医学生向临床医生转型的过渡时期。临床实习质量的高低直接关系到医学生的培养质量。在实习期间培养出扎实的临床基本功、科学的临床思维和高尚的医德医风对于医学生而言是非常重要的。同时,临床实习教学也是医学院校及教学医院的工作重心。作为教学医院,我院多年来积极推进教学改革,不断探索提升临床实习质量的方法,部分科室率先开展了PBL等新的教学模式,并取得了卓越的成效。我院领导阶层也通过抓好教学准备、提升带教质量、严格实习考核等方面的工作,全面提升了临床实习教学质量,从而提高了医学生的综合素质,也为提高执业医师考试通过率打下了坚实的基础。     

Another Look at the Medical “Generation Gap”—Second Triennial Survey of Attitudes of Medical Students and Recent Graduates

A 1969 survey of attitudes held by medical students and recent graduates was repeated in 1972, using the same samples of respondents and adding a new freshman group. Findings from both surveys showed that a “generation gap” existed on many issues.Furthermore, a comparison of the two studies suggested that two kinds of attitude change are occurring simultaneously. On some issues, the next generation of physicians will probably continue to differ from their predecessors. Perhaps the primary thread woven through this cluster of attitudes is that today''s medical students and young physicians perceive themselves as members of a larger structure for providing health care.However, many of the students'' attitudes held early in their medical careers appear to have been modified in the process of becoming physicians. It appears that medical education continues to convey many traditional professional values to students, and it seems likely that tomorrow''s physicians will retain a core of those values.     

Audit of admission to medical school: I--Acceptances and rejects.

A prospective study of the process of application, selection, and admission to medical school was performed. St Mary''s Hospital Medical School received 1478 UCCA applications for admission in October 1981: 94 (6.4%) applicants entered St Mary''s in October 1981, 436 (29.5%) entered other medical schools, 176 (11.9%) read a subject other than medicine, and 772 (52.2%) did not enter university. The study included 12.6% of all applicants and 12.9% of all entrants to British medical schools in October 1981. Educational qualifications, demographic variables, type of schooling, family background, and the manner of application were examined in relation to overall selection. A level achievement was the major determinant of acceptance. O level achievement, early application, and medical parents had significant but smaller independent effects on the chance of acceptance. Social class, age, sex, and school type did not predict acceptance when corrected for academic and other factors. Few differences in personality, career preference, cultural interests or attitudes were found between those accepted and those rejected.     

Medical Students in Canadian Universities: Report of Statistics, 1963-64 and 1964-65

Recognizing Canada''s urgent need of physicians Canadian medical faculties have continued to increase first-year enrolment for the sixth successive year. Returns from the 12 medical schools showed that 1133 students began medical studies in 1964 compared with 1086 the previous year. Firstyear female students showed a decrease for the first time since 1959: 124 compared with 146 in 1963. Every tenth graduate is a woman; six years ago this ratio was one in 20. Loss of students from withdrawals and dismissals in 1963-64 occurred chiefly in the first year (9.2% as compared with 8.7% in 1962-63). Almost half of the loss in all four years of the course was for non-academic reasons. A decrease in American and a slight increase in Commonwealth and foreign first-year students was noted. Total foreign student enrolment continued to decline from a high of 485 in 1959-60 (13.7%) to 400 in 1964-65 (10.3%).     

Demonstrating social accountability in medical education

The author considers the University of Toronto''s Health, illness and the Community course for undergraduate medical students, described in this issue by Wasylenki and associates (see pages 379 to 383). Social accountability in medical education demands a community orientation and hence an emphasis on outreach. Medical schools should expand their clinical service to the community, provide community-based residency placements and offer continuing medical education in rural and regional centres. Accountability also requires community involvement in planning and implementing research projects. Placing students in a community setting as part of the curriculum is praiseworthy, but it is not sufficient to ensure social accountability. What is needed now is a more comprehensive acceptance by faculties of medicine of the mandate of community-centred learning, together with well-targeted funding for education and research initiatives.     

医学生早期教育阶段综合能力培养之探索

现代医学模式要求医务工作者必须是高素质的人才。基础医学教育阶段是医学生培养过程中的基础环节和重要阶段,与临床教学阶段相比,基础教育阶段更有利于学生综合能力培养和开展素质教育。医学生综合能力的培养在医学教育中具有重要的地位,它的实现要靠教育者在教育教学的各个环节中主动施行,积极探讨医学生综合能力培养的有效实施途径和方法。我们课题组根据多年从事医学生人才培养的教育教学经验,针对医学生早期教育阶段的心理、生理、环境、知识结构特点,围绕综合能力培养这个核心课题,强化创新性人才培养,系统有序地按学生学习时间和课程进行各种能力的逐一培养,从学习能力,思维能力,观察能力,动手能力,合作能力,分析问题和解决问题能力,判断是非能力,语言表达能力,写作能力,创新开拓能力等,探索医学生早期教育阶段综合能力培养模式。     

'Pals'. A medical student public service program.

We designed a public service and educational program to aid children and families coping with chronic illness and to augment medical student education. Medical students developed relationships with chronically ill children and families based on the Big Brother-Big Sister program model. In addition, students attended bimonthly seminars on childhood chronic illness and family dynamics. Medical students learned about the psychosocial aspects of illness through these relationships and reported that the program contributed to their sense of worth as caregivers. By fostering students'' innate altruism, medical schools may succeed in cultivating caring and humanism in their student physicians. We propose a model that encourages medical students to relate personally with patients and their families. A program such as this has the potential to nurture compassion in medical students, contribute to medical education, and provide support to patients and families.     

Undergraduate medical education.

Pressures from students and teachers, from professional bodies, and from changes in the way health care is delivered are all forcing a rethink of how medical students should be taught. These pressures may be more intense in London but are not confined to it. The recommendation the Tomlinson report advocates that has been generally welcomed is for more investment in primary care in London. General practitioners have much to teach medical schools about effective ways of learning, but incentives for teaching students in general practice are currently low, organising such teaching is difficult and needs resources, and resistance within traditional medical school hierarchies needs to be overcome. Likewise, students value learning within local communities, but the effort demanded of public health departments and community organisations is great at a time when they are under greater pressure than ever before. The arguments over research that favour concentration in four multifaculty schools are less clear cut for undergraduate education, where personal support for students is important. An immediate concern is that the effort demanded for reorganising along the lines suggested by Tomlinson will not leave medical schools much energy for innovating.     

Education and Eminence in British Medicine

The educational background of eminent members of the British medical profession was examined by recourse to Who''s Who. Substantial differences in background were found among the various medical specialties. Members of specialties enjoying high prestige within the profession—physicians, surgeons—were more likely than other members of the sample to have been to an English school as opposed to one in Scotland, Wales, or Northern Ireland, and to a headmasters'' conference school as opposed to a grammar school. Educational background was also found to relate to the aspect of the patient''s body on which specialists normally worked. Specialists coming from English headmasters'' conference schools were more likely than others to work on living bodies rather than dead bodies or parts of bodies, on the head rather than on the lower trunk, on male bodies rather than female bodies, and on the body''s surface rather than its inside.     

Jehovah's Witnesses leading education drive as hospitals adjust to no blood requests.

Jehovah''s Witness representatives have visited more than 10 Canadian medical schools and 200 hospitals in an attempt to educate future and practising physicians about nonblood medicine. The trend is becoming more popular since the advent of HIV, and there are now about 100 bloodless medicine and surgery centres around the world, including 52 in the US. However, a Jehovah''s Witness spokesman says Canada is "conspicuously absent" from the list of countries that offer bloodless-medicine programs.     

The Oslerian Tradition and Changing Medical Education: A Reappraisal

Although only 21 of Sir William Osler''s 45 years in academic medicine were spent in US medical schools (1884 to 1905), he played a major role in shaping modern medical education in this country. The integration of scholarship with patient care, together with the science and art of medicine, was central to Osler''s teaching and writing throughout his career. A classic generalist and a charismatic clinical teacher, he taught by example and was as concerned with the ideals of medicine as with its science and knowledge.Many changes have reshaped the content, process and concerns of American medical education since Osler''s time. Subspecialization and balkanization of medical education and practice have become dominant. Many of the important issues in medicine today do not fit neatly into the domain of any of the established specialties or medical organizations. There is now an urgent need to promote generalist attitudes in medicine, and the Oslerian tradition has much to offer in approaching today''s problems in medical education and practice.     

Autistic autobiography

Autism narratives are not just stories or histories, describing a given reality. They are creating the language in which to describe the experience of autism, and hence helping to forge the concepts in which to think autism. This paper focuses on a series of autobiographies that began with Grandin''s Emergence. These are often said to show us autism from the ‘inside’. The paper proposes that instead they are developing ways to describe experience for which there is little pre-existing language. Wittgenstein has many well-known aphorisms about how we understand other people directly, without inference. They condense what he had found in Wolfgang Köhler''s Gestalt Psychology. These phenomena of direct understanding what other people are doing are, Köhler wrote, ‘the common property and practice of mankind''. They are not the common property and practice of people with autism. Ordinary language is rich in age-old ways to describe what others are thinking, feeling and so forth. Köhler''s phenomena are the bedrock on which such language rests. There is no such discourse for autism, because Köhler''s phenomena are absent. But a new discourse is being made up right now, i.e. ways of talking for which the autobiographies serve as working prototypes.     

Requirements of British universities for higher medical degrees.

OBJECTIVE--To examine the requirements and opportunities for obtaining a doctor of medicine or master of surgery degree from a university in the United Kingdom other than the graduate''s own, particularly in the case of foreign graduates. DESIGN--Review of regulations governing the award of doctor of medicine and master of surgery degrees in British universities. SETTING--All 19 universities in the United Kingdom offering clinical courses. MAIN OUTCOME MEASURE--Availability of degrees to graduates of other universities. RESULTS--Opportunities for obtaining a degree differed widely among the medical schools, one university (Edinburgh) not admitting graduates of other universities in any circumstance. Of the remaining universities, none would consider a graduate who had not worked in the area where the medical school was located. CONCLUSION--The wide differences in opportunity among the medical schools may put some foreign graduates at a disadvantage compared with other graduates. This problem may become more severe as the number of graduates from the European Community who settle in Britain increases.     

Student perceptions of mistreatment and harassment during medical school. A survey of ten United States schools.

Senior students at 10 medical schools in the United States responded to a questionnaire that asked how often, if ever, they perceived themselves being mistreated or harassed during the course of their medical education. Results show that perceived mistreatment most often took the form of public humiliation (86.7%), although someone else taking credit for one''s work (53.5%), being threatened with unfair grades (34.8%), and threatened with physical harm (26.4%) were also reported. Students also reported high rates of sexual harassment (55%) and pervasive negative comments about entering a career in medicine (91%). Residents and attending physicians were cited most frequently as sources of this mistreatment. With the exception of more reports of sexual harassment from women students, perceived mistreatment did not differ significantly across variables such as age, sex, religion, marital status, or having a physician parent. Scores from the 10 schools also did not vary significantly, although the presence of a larger percentage of women in the class appeared to increase overall reports of mistreatment from both sexes.     

Factors Associated with Primary School Teachers’ Attitudes Towards the Inclusion of Students with Disabilities

Objective

Teachers'' attitudes toward inclusion are often based on the practical implementation of inclusive education rather than a specific ideology and understanding of inclusiveness. This study aimed to identify the factors associated with primary school teachers'' attitudes towards inclusion of students with all disabilities in regular schools.

Method

Seventy four primary school teachers participated in a cross-sectional survey conducted in Western Australia. Teachers'' attitudes and efficacy toward integration of students with disabilities were measured using the Opinions Relative to Integration of Students with Disabilities scale and Bandura''s Teacher Efficacy scale respectively.

Results

Four teacher attributes—age, gender, teaching self-efficacy and training collectively explained 42% of the variability in teachers'' attitude toward including students with disabilities.

Conclusion

The current study further contributes to the accumulation of knowledge that can unpack the complex pattern of factors that should be considered to promote positive attitudes towards inclusive schools.