Medical students act as Big Brothers/Big Sisters to support human immunodeficiency virus-infected children's psychosocial needs.

OBJECTIVE: To address the special psychosocial and emotional needs and concerns of human immunodeficiency virus-infected children through a medical student-based Big Brother/Big Sister program. DESIGN: A telephone survey of 9 medical students who participated in the program in the last 4 years was undertaken to assess their experiences and feelings about the program. RESULTS: The experiences resulting from participation in the program were unanimously positive. The medical students stated that in no other medical setting were they able to develop a better understanding of the feelings and emotions of living with a terminal illness. The volunteers also believed that the program increased the benefits for the child and the medical student. CONCLUSIONS: Initial evaluation of the Big Brother/Big Sister program for human immunodeficiency virus-infected children suggests that it helped establish a strong, supportive relationship between the affected child and the medical student. A modified program in other medical schools may help to serve many other communities affected by the human immunodeficiency virus epidemic.

Contemporary medical students' quest for self-fulfillment through community service.

The author argues against the criticism that contemporary medical students, like most educated youth in our society, are self-centered moral relativists without a sense of social responsibility. He first frames his argument in terms of what Charles Taylor calls the three "malaises of modernity," namely, the rise of individualism, an emphasis on instrumental reasoning based on bureaucratic efficiency, and the loss of political action. He goes on to show how these malaises are manifested in the academic health center and their effect on the professional socialization of future physicians. Then, using John Evan's perspective of the need to shift from "supply-side" to "demand-side" thinking in the way today's medical students are trained and Hafferty and Frank's thesis that the most critical determinants of a physician's identity operate not within the formal curriculum but in a "hidden curriculum," he presents his own case of how Rush medical students, by participating in student-generated, voluntary projects--via the Rush Community Service Initiatives Program--are harnessing their individualism through commitment to serving the poor and disadvantaged. To show that the situation at Rush is not unique, the author also points to the impact that the Health of the Public and service-learning programs have been having both in academic health centers and in the communities being served. Finally, it is his contention that these community service experiences, given unconditionally to people in need, broaden the students' education by offering a population and community perspective of health and illness and, perhaps more important, bind them closer to society in both a moral and a political sense.

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.

Casualties of residency training: a national study of loss and attrition.

Little information is available on the number of physicians in training who leave their residency or otherwise drop out of the profession during these years. We report on a recently completed (1987) national survey of residency program directors documenting the number of people who withdraw or are dismissed from residency and their reasons for leaving.

The experience of mistreatment and abuse among medical students.

Concerns expressed by Silver regarding the possible existence of abuse of medical students have been confirmed with findings of verbal, physical and sexual abuse as well as unnecessary sleep deprivation and negative comments regarding the choice of a career in medicine.

Alcohol-use patterns through medical school. A longitudinal study of one class.

We describe the patterns of alcohol use of one medical school class assessed repeatedly over time from the first day of medical school to a point several months short of graduation. Although male students consistently drank more than their female counterparts during the preclinical years, the men reduced their alcohol intake during the clinical years to converge on the lower, more consistent intake rates of their female classmates. Over the four years of medical school, 11% of the students met criteria for excessive drinking for at least one six-month period and 18% were identified as alcohol abusers by Research Diagnostic Criteria during the first two years. More than half of the excessive drinkers met abuse criteria, whereas only one third of the alcohol abusers were also excessive drinkers. Alcohol abusers had better first-year grades and better overall scores on the National Board of Medical Examiners, part I, test than their classmates. The implications of these findings for designing and implementing alcoholism intervention/prevention programs in medical schools are discussed herein.

Alcohol use patterns of first-year medical students: II. Psychosocial characteristics associated with drinking level.

Psychosocial characteristics that identified first-year medical students who drank more or less alcohol than their peers were examined. Subjects were 116 freshman medical students (96% of one class) who completed questionnaires about alcohol use, mood, personality, social relationships, and parental alcohol abuse on the first day of school, and 106 (88% of the class) who responded to the same questionnaires in April of the first year. Heavier drinking students (i.e., the upper 25% of the sample) were more likely to be male and single, to have drunk heavily prior to medical school, to come from larger social networks which include fewer relatives, and to demonstrate a lower interpersonal orientation. Mood, academic performance, and parental alcohol abuse were not associated with drinking level. The heaviest drinkers in this sample appear to be precisely those individuals who are most impervious to peer or other social influences.

Personality indicators of psychosocial adjustment in first-year medical students.

One aspect of the Rush Medical College Longitudinal Study is concerned with the identification of personality traits that predict various kinds of psychosocial adjustments and impairments among medical students and physicians. Two orthogonal traits, masculinity and femininity, were selected for study as independent variables because of their implications for mental health and their relevance to the work of physicians. Ninety percent (N = 106) of a class of first-year medical students completed measures of masculinity and femininity during orientation and, 8 months later, completed a broad array of dependent measures of psychological well-being, interpersonal satisfaction, humanistic attitudes and alcohol consumption. Analyses of the data revealed strong and consistent main effects of masculinity on depression, confidence, pleasure capacity, extraversion, locus of control, neuroticism and interpersonal satisfaction. Femininity was associated with depression, pleasure capacity, extraversion, neuroticism, interpersonal satisfaction, concern for the opinion of others and humane attitudes toward patient care. Low femininity was also associated with high alcohol consumption. These results suggest that masculinity and femininity scores may help to identify at the outset medical students at risk for impairment, and that androgynous individuals (who are high in both masculinity and femininity) may be especially well-suited to assume the demanding and varied roles that physicians are called on to play.

Alcohol use patterns of first-year medical students: I. Development of shared norms.

Freshman medical students (96% of one class; n = 116) completed questionnaires on alcohol use at orientation, and again in April (n = 106) of that same year. Quantity/frequency and self-label ratings of alcohol use were employed to define normative ranges (in ethanol oz/wk). The confidentiality of student participants was protected. Males consumed five drinks per week over the summer and dropped to four per week during school; females consumed two drinks per week over both periods. Summertime and school year consumption rates were strongly correlated. Normative ranges of drinking converged from September to April, suggesting the emerging norms were the product of social experience with classmates. Class norms described a "cutpoint" separating acceptable range from excessive drinking (more than two drinks per day). The authors conclude that reliable "community norms" for medical students could be identified, the norms evolve over time, and they can be employed to determine the boundaries of acceptable drinking for research and screening purposes.

Medical student counseling: the Rush Medical College Adviser Program.

An adviser program has been instituted at Rush Medical College which utilizes specially selected and trained faculty members and provides comprehensive counseling with continuity of contact between adviser and student through the four years of medical school. In this paper, the authors describe the development of the program and the evaluations used to determine its efficacy. The authors conclude that the personal characteristics and time commitment of the advisers are of primary importance rather than their training discipline, that continuity of contact between student and adviser fosters the development of the most beneficial relationships, that advisers require special training during the entire time of their service as advisers, and that the program and the advisers require continual monitoring so that deficient performance and changing needs can be promptly identified.

Decision rules for hypertension screening: application in a poor community with endemic hypertension.

Data from a hypertension screening project involving 4,272 black residents of a rural southern community were analyzed to determine the effects of a set of admission-decision rules on the case load of a proposed hypertension clinic. Four decision rules were investigated: conjunctive (diastolic high or systolic high); disjunctive (diastolic and/or systolic high); additive (sum of diastolic and systolic high); and systolic only. Most information relevant to admission to treatment came from knowledge of systolic blood pressures, even though knowledge of the diastolic pressure is essential in individual diagnosis. Incremental increases in the minimum blood pressure necessary for admission to treatment from 140/90 mm Hg to 160/95 mm Hg resulted in a one-third reduction in the number of patients treated, a 24% reduction in personnel utilization per patient, and a 34% reduction in drug costs; but in an estimated 14% increase in the attack rate for morbid events in men.