Enhancing the psychological health of medical students: the student well-being committee.

Medical schools' emphasis on technical excellence is sometimes at the expense of social and emotional development. This paper describes a programme, orchestrated by a vital Well-Being Committee, that involves students in a wide range of activities to enhance social and emotional well-being. The primary prevention of emotional impairment is the goal.

Surgeons' personalities: the influence of medical school.

Does medical school shape surgeons' personalities? This research retrospectively compares personality test results of 17 surgical and 44 non-surgical specialists trained at the same medical school. Fifty-five standardized personality measures at two developmental periods (the outset and the conclusion of medical school) revealed no pronounced differences between surgeons and other specialists. Interviews with 30 academic doctors (10 surgeons, 10 anaesthesiologists and 10 psychiatrists) explore the apparent discrepancy between personality tests scores and commonly held opinions that surgeons' personalities differ from other doctors.

Medical slang and its functions.

Medical slang is analyzed in the developmental perspective of the physician's career. More than 300 terms gathered by ethnographic methods are classified by social categories: (1) the setting--various types of hospitals and facilities, (2) the players--care-givers and care-receivers, (3) the social processes--patient admission, diagnosis, treatment and discharge, and (4) death and dying. Slang usage generally begins during the third year of medical school when students rotate among clinical services and peaks during the internship year. Male and female clinicians are similar in slang usage. Five psychosocial functions of medical slang are discussed.

Physicians' adjustment to retirement.

We address the questions, How do physicians adjust to and enjoy their retirement? What factors contribute to the well-being of retired physicians? A 60-item questionnaire mailed to 238 retired physicians in Los Angeles County with a 41.6% response rate assessed health, standard of living, relationships, activities, emotional difficulties, and general enjoyment. Health often improved after retirement, as did relationships with spouses and children. Standard of living was comfortable or better for most. Retired physicians engage in a wide range of interests and activities. Emotional difficulties are minimal and considerably reduced after retirement. Most physicians enjoy the freedom and activities of retirement and are happy. Fears of boredom and deterioration are unfounded.

The primary prevention of addiction in the physician.

A review of the literature suggests that the causes of addiction in the physician include: 1) a genetic component; 2) a dysfunctional family; 3) a college atmosphere where alcohol is part of the ritual of passage; 4) self-selection of a medical school career by introverts and over-achievers; 5) unrealistic expectations of medical school and a medical career; 6) the suppression of feelings and avoidance of intimacy in medicine; 7) the insensitivity of some faculty, amounting in some cases to abuse; and 8) the various other stresses of medical training, practice, and life. Primary prevention programs described in the literature include education about alcoholism and drug abuse, stress management skills education, encounter and discussion groups, workshops, and counseling. An important element in preventing addiction in the physician is the psychological ability to cope with the serious stresses which will inevitably be encountered. Suggestions are offered for a course that will improve the ability of students to cope with these stresses.

The impact of drug testing on the morale and well-being of mandatory participants.

The impact of drug testing on the morale of mandatory participants was assessed through interviews and questionnaire responses of 500 intercollegiate athletes required to participate in a urine testing program. Subjects varied widely in their experiences. Most were not greatly affected, but some were embarrassed, humiliated, upset, and anxious about being inaccurately identified as drug users. Others experienced positive benefits: new information, a novel and interesting conversation piece, and a socially acceptable way to refuse drugs offered in friendship. Some said that testing benefited their athletic performance and school work. A number of recommendations were made to humanize and improve the experience: a better orientation about what to expect, more effective educational sessions, a warmer, more comfortable testing setting, more reasonable drug testing objectives, and more rigorous testing standards.

Peer vs. parental influence in substance use among hispanic and Anglo children and adolescents.

The relative influence of peer and parental influence on youths' use of alcohol and other drugs is explored among 446 Anglo and Hispanic youths, ages 9-17. Current users and abstainers are similar in age and gender. Among both groups, parental influence is more profound than that of peers. However, substance users, compared to abstainers, are more influenced by peers. Level of marijuana use by youths' friends is the most reliable predictor of drug use. Youths having viable relationships with parents are less involved with drugs and less influenced by drug-oriented peers.

Primary prevention of emotional impairment among medical trainees.

An extensive literature on medical students' and physicians' emotional impairment indicates the need for primary preventive programs, but few have been reported. This paper describes a seminar for premedical students aimed at preventing their later disillusionment and distress as medical trainees by fostering realistic expectations and emotional exploration. The seminar consists of open-ended discussions between premedical students and medical trainees/practitioners about stress and coping at various career stages, a physician preceptor for each student, and emotionally expressive readings and videotapes. Course-end and follow-up evaluations found that both the students' realism about their careers and their personal well-being were markedly increased.

Drug testing effectiveness in identifying and preventing drug use.

The effectiveness of drug testing in identifying and preventing drug use was assessed by a study of intercollegiate athletes required to participate in a urine testing program. Five hundred athletes who underwent testing were contrasted with a comparison group of 124 athletes not tested. Results show that some drug-using athletes avoided detection. Although many reduced their drug usage, some continued in the same pattern as before; a few actually increased drug usage.

School performance, academic aspirations, and drug use among children and adolescents.

The relationship between drug use, school performance, and academic aspirations among 446 Anglo and Hispanic youths, age nine to seventeen, is explored. Two groups of subjects--current substance users and non-users--were interviewed. Subjects in each comparison group were similar in age, ethnicity, and gender. Overall results, consistent with prior research, indicate a significant relationship between current school performance, future educational aspirations, and drug use. No difference was noted between substance use groups on indicators of general interest in school work or probability of dropping out of school. Important differences in response patterns occurring with age, ethnicity, and gender were found.

Family composition, socioeconomic status, and adolescent substance use.

The hypothesis that deprivation in the form of parental absence and economic hardship causes youth substance use was tested in a study population consisting of two hundred sixty-two adolescents, ages 13 through 17, and one parent of each. No correlation between family composition and youth substance use was found. Two measures of socioeconomic status, family income and parents' subject rating, also revealed no correlation with youths' substance use behavior. However, when father's occupation was used to evaluate this relationship, significantly more abstainers were shown to have fathers who are professionals, and significantly more users had fathers occupying managerial or foreman-level positions; a possible explanation for this result is that occupation may somehow be related to parental style. The common sense assumption that parental absence and economic hardship are directly responsible for youth substance use is unsupported by our data.

Patterns of cigarette, alcohol, and other drug use among children and adolescents: a longitudinal study.

Findings are presented from an 18-month longitudinal study of substance use behavior among 400 children and adolescents, ages 9-17 at the first interviews. Patterns of use from two sequential interviews are reported. Descriptive results are presented as simple frequencies and cross-tabulated with demographic items (age, sex, ethnicity, and socio-economic status). Patterns of use over an 18-month period are examined for cigarettes, alcohol, marijuana/hashish, and other drugs. Four patterns are assessed for each of these substances--abstention at both the first and second interviews; abstention at the first, but not the second interview; use at the first interview, abstention at the second; and use at both interviews.

Drinking patterns and problems among female children and adolescents: a comparison of abstainers, past users, and current users.

The sociopsychological factors that underlie drinking behavior among 197 young girls, ages 9 through 17, are explored. Three groups-youthful abstainers, former users, and current users-were interviewed, as were their parents. These comparison groups are contrasted on 110 variables. The relative merits of four competing explanations of youthful drinking behavior-deprivation, personal deficiency, hedonistic peer culture, and family pathology-are assessed.

Patterns of substance use among children and youth: a longitudinal study.

This report presents a set of findings from a three wave 36 month longitudinal study on the use of cigarettes, alcohol, marijuana/hashish and other drugs by a population of children and adolescents ranging in age from 9 to 17 at the time of first interview. Gross differences in percentages of subjects reporting using substances across the three data collection intervals are found to be quite small. However, when these differences are examined in detail, it is found that a good deal of initiation of use by some subjects and curtailing of use by others stands behind the relatively small net changes in use from one interval to another. Escalation in substance use, from less mood altering to more mood altering substances, is found to exist, but to appear far less frequently than "initial" multiple drug use. Finally, "intensity" of use of one substance is found to be somewhat related to age and very strongly related to the use of other substances. Limitations of findings due to episodic rather than continuous monitoring of substance use are noted.

Generational continuity in the use of substances: the impact of parental substance use on adolescent substance use.

Two hundred sixty-two adolescents, ages 13 through 17, and one of the parents of each, interviewed separately, are compared with regard to their use of substances. Youthful subjects in each comparison group are similar in age, sex, ethnicity and socioeconomic status. Results show a variety of relationships between parental use of coffee, cigarettes, beer and wine, hard liquor and marijuana/hashish and adolescent use of such substances. Generally, parental use of these substances is moderately to strongly related to use by their children. The strongest relationships are found for coffee, mother's use of cigarettes, and father's use of hard liquor. All of these relationships are not linear. For example, fathers who are moderate drinkers of hard liquor are more likely to have adolescent children who are substance users. Two theories of intergenerational substance use are discussed.

The effect of marital status on stress in medical school.

Two competing explanations have been offered to explain why the unmarried experience greater stress--the protection/support hypothesis (emotional support from a spouse offsets daily tensions) and the selection hypothesis (the more emotionally mature individual marries). To assess these hypotheses, the authors compared the difference in stress levels between 61 married and unmarried students during the stressful years of medical school. Stress was measured each year by attrition rates, self-reports, and interviews with spouses. The stressors of medical school were more severe for the single students; moveover, stress levels of formerly single students declined after marriage. The authors believe these results affirm the protection/support hypothesis.

Back on the streets: therapeutic communities' impact upon drug users.

Relatively little is known about the efficacy of the therapeutic community as an intervention for drug abusers. The few published outcome studies vary widely in their conclusions; some claim extraordinary success while others cite much more modest results. This study reports the incidence of behavior changes (drug use, criminality, and unemployment) among 208 addicts, most of whom were White middle-class heroin users, both graduates and "splitees," who participated in one of two California therapeutic communities. One program lasted 3 months and the other 10-12 months. Follow-up interviews conducted 11-18 months after participants left the treatment setting found only nine individuals, 4.3% of the participants, who totally abstained from drugs. There was, however, a marked decrease from preintervention incidence of drug use, crime, and unemployment. The most impressive behavior changes occurred among those who participated in the long-term program, as contrasted with the shorter one, and among those who graduated, as compared with those who withdrew before program completion.