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. (+info)
Do case studies mislead about the nature of reality?
This paper attempts a partial, critical look at the construction and use of case studies in ethics education. It argues that the authors and users of case studies are often insufficiently aware of the literary nature of these artefacts: this may lead to some confusion between fiction and reality. Issues of the nature of the genre, the fictional, story-constructing aspect of case studies, the nature of authorship, and the purposes and uses of case studies as "texts" are outlined and discussed. The paper concludes with some critical questions that can be applied to the construction and use of case studies in the light of the foregoing analysis. (+info)
Do studies of the nature of cases mislead about the reality of cases? A response to Pattison et al.
This article questions whether many are misled by current case studies. Three broad types of style of case study are described. A stark style, based on medical case studies, a fictionalised style in reaction, and a personal statement made in discussion groups by an original protagonist. Only the second type fits Pattison's category. Language remains an important issue, but to be examined as the case is lived in discussion rather than as a potentially reductionist study of the case as text. (+info)
The role of curriculum in influencing students to select generalist training: a 21-year longitudinal study.
To determine if specific curricula or backgrounds influence selection of generalist careers, the curricular choices of graduates of Mount Sinai School of Medicine between 1970 and 1990 were reviewed based on admission category. Students were divided into three groups: Group 1, those who started their first year of training at the School of Medicine; Group 2, those accepted with advanced standing into their third year of training from the Sophie Davis School of Biomedical Education, a five-year program developed to select and produce students likely to enter primary care fields; and Group 3, those accepted with advanced standing into the third year who spent the first two years at a foreign medical school. All three groups took the identical last two years of clinical training at the School of Medicine. These were no significant differences with respect to initial choice of generalist training programs among all three groups, with 46% of the total cohort selecting generalist training. Of those students who chose generalist programs, 58% in Group 1, 51% in Group 2, and 41% in Group 3 remained in these fields rather than progressing to fellowship training. This difference was significant only with respect to Group 3. However, when an analysis was performed among those students providing only primary care as compared to only specialty care, there were no significant differences. Analysis by gender revealed women to be more likely to select generalist fields and remain in these fields without taking specialty training (P < .0001). Differentiating characteristics with respect to choosing generalist fields were not related to either Part I or Part II scores on National Board Examinations or selection to AOA. However, with respect to those specific specialties considered quite competitive (general surgery, obstetrics and gynecology, and ophthalmology), total test scores on Part I and Part II were significantly higher than those of all other students. The analysis indicated that, despite the diverse characteristics of students entering the third year at the School of Medicine, no one group produced a statistically greater proportion of generalists positions than any other, and academic performance while in medical school did not have a significant influence on whether a student entered a generalist field. (+info)
Health sector reform in central and eastern Europe: the professional dimension.
The success or failure of health sector reform in the countries of Central and Eastern Europe depends, to a large extent, on their health care staff. Commentators have focused on the structures to be put in place, such as mechanisms of financing or changes in ownership of facilities, but less attention has been paid to the role and status of the different groups working in health care services. This paper draws on a study of trends in staffing and working conditions throughout the region. It identifies several key issues including the traditionally lower status and pay of health sector workers compared to the West, the credibility crisis of trade unions, and the under-developed roles of professional associations. In order to implement health sector reforms and to address the deteriorating health status of the population, the health sector workforce has to be restructured and training programmes reoriented towards primary care. Finally, the paper identifies emerging issues such as the erosion of 'workplace welfare' and its adverse effects upon a predominantly female health care workforce. (+info)
Health human resource development in rural China.
China has made significant progress in increasing the quantity of health workers in rural areas. Attention is shifting to improving the quality of health workers. This article documents several features of health workers in rural China. Many have not received formal training to a level implied by their rank and title, and there is no clear relationship between the skills of health workers and the functions they perform. Many better-qualified personnel have left lower level health facilities for more attractive employment in higher level and urban facilities. A system of professional licensing is currently being considered that will link educational requirements to employment and promotion. This article outlines some of the issues that should be taken into consideration in formulating this system. In particular, licensing may have unequal impacts on rich and poorer areas. This article argues that other regulatory measures will be necessary if licensing is to be an effective mechanism for controlling the quality of health workers, and contribute to the provision of affordable health services in both rich and poor areas. (+info)
The world economic crisis. Part 2. Health manpower out of balance.
As outlined in the first part of this article in the last issue of the journal, many countries are facing severe constraints on health expenditure at the same time as they are trying to work towards Health for All by the Year 2000. Health manpower needs to be planned to secure maximum benefits from the limited resources available. Many medical schools train more doctors than are needed because quotas on medical places are either non-existent or set too high. Medical training may be oriented to high-technology, curative care and produce doctors ill equipped to fulfil the role demanded of them in the primary health care approach. Educational courses for paramedics and nurses are often insufficient and inappropriate. Countries which have previously lost trained doctors to attractive posts abroad now face the prospect of a flood of doctors looking for work in their home countries, now that opportunities for work abroad are being reduced. Such countries will find it difficult to reverse the bias in policy towards medical professionals, despite the waste caused by unemployment and inappropriate training among doctors. With limited budgets, there is a need for countries to plan ahead. To do this they must find ways of estimating future effective demand. The future balance of staff can then be planned on the basis of resources available and the relative costs of deploying various categories of health staff. (+info)
Student loan debt does not predict female physicians' choice of primary care specialty.
OBJECTIVE: There has never been a conclusive test of whether there is a relation between ultimately choosing to be a primary care physician and one's amount of student loan debt at medical school graduation. DESIGN/SETTING/PARTICIPANTS: To test this question, we examined data from the Women Physicians' Health Study, a large, nationally representative, questionnaire-based study of 4,501 U.S. women physicians. MEASUREMENTS AND MAIN RESULTS: We found that the youngest physicians were more than five times as likely as the oldest to have had some student loan debt and far more likely to have had high debt levels (p <.0001). However, younger women physicians were also more likely to choose a primary care specialty (p <.002). There was no relation between being a primary care physician and amount of indebtedness (p =.77); this was true even when the results were adjusted for the physicians' decade of graduation and ethnicity (p =.79). CONCLUSIONS: Although there may be other reasons for reducing student loan debt, at least among U.S. women physicians, encouraging primary care as a specialty choice may not be a reason for doing so. (+info)