Perceived effectiveness of counselling patients about smoking among medical students in Amman, Jordan.

We identified the prevalence of smoking and perceived effectiveness of physicians counselling patients about smoking among 340 1st and 4th year medical students in Amman, Jordan. Smoking prevalence was 26% for males and 7% for females, similar to that of their peers in the general population. Smokers and male students were less likely to believe it is wrong for physicians to smoke in front of patients or that smoking policy or physician interaction with patients can influence smoking practices. Students believed that physicians can more effectively prevent smoking than influence patients to stop smoking. Student training on how to effectively counsel patients about smoking prevention and cessation is warranted.

Perceived effectiveness of counselling patients about smoking among medical students in Amman, Jordan

We identified the prevalence of smoking and perceived effectiveness of physicians counselling patients about smoking among 340 1st and 4th year medical students in Amman, Jordan. Smoking prevalence was 26% for males and 7% for females, similar to that of their peers in the general population. Smokers and male students were less likely to believe it is wrong for physicians to smoke in front of patients or that smoking policy or physician interaction with patients can influence smoking practices. Students believed that physicians can more effectively prevent smoking than influence patients to stop smoking. Student training on how to effectively counsel patients about smoking prevention and cessation is warranted

Thanatophobia and opiophobia of hospice nurses compared with that of other caregivers.

In meeting national needs for our terminally ill, health care educators need to become more aware of their students' aptitudes for hospice work. For these reasons we measured hospice nurses' attitudes toward caring for the terminally ill and their views on using opioids, and compared them to those of other health care personnel and their students. Thirty-eight hospice nurses, 64 other nurses, 93 physicians, and 676 senior medical students participated in this study. Our primary measures were scales assessing thanatophobia and opiophobia and a battery of personal and professional role trait measures. Our results indicated that in providing end-of-life care, hospice nurses expressed less discomfort, helplessness, and frustration, and indicated less reluctance to use opioids than did any of the other groups surveyed. Overall, these hospice nurses had 35 percent lower opiophobia and 55 percent lower thanatophobia scores than the other health care professionals. Despite dealing with issues of death and dying on a daily basis, hospice nurses also scored lower on depressed mood. In caring for the terminally ill, hospice nurses' other personal traits were also less maladaptive than those of the other health professionals. Psychiatrists exhibited the most opiophobia, not only scoring higher than physicians practicing oncology, but also higher than senior medical students. To assure cancer patients that they can expect to live their lives free of pain, medical educators can use these thanatophobia and opiophobia scales to develop better teaching, counseling, and monitoring strategies.

Medical students' attitudes toward pain and the use of opioid analgesics: implications for changing medical school curriculum.

BACKGROUND: Barriers to pain management include physicians' lack of knowledge and attitudes. Our aim was to investigate future physicians' knowledge and attitudes toward pain and the use of opioid analgesics. METHODS: We tested a medical school class during their freshman and senior years. Stepwise regression analysis was used to identify the personal traits that predicted opiophobia. RESULTS: The professionalization process of medical training may reinforce negative attitudes. Psychologic characteristics were associated with reluctance to prescribe opioids, and fears of patient addiction and drug regulatory agency sanctions. CONCLUSIONS: Consistent attitudes were found in senior medical students with preferences for certain specialty areas and the practitioners of their future specialties, suggesting a "preselection" effect. Higher scores on reliance on high technology, external locus of control, and intolerance of clinical uncertainty were associated with higher scores on one or more of the three dimensions of opiophobia. Implications for medical education are discussed.

Physicians' attitudes toward pain and the use of opioid analgesics: results of a survey from the Texas Cancer Pain Initiative.

BACKGROUND: Despite extensive progress in the scientific understanding of pain in humans, serious mismanagement and undermedication in treating acute and chronic pain is a continuing problem. This study was designed to examine the barriers to adequate pain management, especially as they might be associated with community size and medical discipline. METHODS: A 59-item survey was used to measure physicians' attitudes, knowledge, and psychologic factors that contribute to pain management practices. RESULTS: Overall, a significant number of physicians in this survey revealed opiophobia (prejudice against the use of opioid analgesics), displayed lack of knowledge about pain and its treatment, and had negative views about patients with chronic pain. There were significant differences among groups of physicians based on size of geographic practice area and medical discipline. CONCLUSIONS: New educational strategies are needed to overcome these barriers and to improve pain treatment in routine medical practice. The effect of practice milieu must be taken into consideration.

Substance abusers: role of personal and professional role traits in caregivers' causal attributions.

Substance abuse continues to be a major health problem compounded by caregivers' negative attitudes toward these patients. We investigated attributions 55 primary care physicians and 315 senior medical students make toward substance abusers. Half of both groups expressed negative causal attributions, with women slightly less negative than men. Mental models based on LISREL regression coefficients showed that higher negative attributions by both physicians and students were related to their increased authoritarianism and depressed mood. Medical students choosing careers in primary care specialties, including psychiatry, expressed a less negative attributional style toward substance abusers than those students entering nonprimary careers. Health professional educators may find that using attribution theory to redefine successful outcomes in management of substance abuse can result in better attitudes for caregivers.

Measuring medical students' reluctance to prescribe opioids for cancer pain.

Among 644 senior medical students a 14-item scale which was internally consistent indicated no change over the 6 years of testing in intent to reserve opioids for terminally ill.

Medical manners: medical students' perceptions of their own.

BACKGROUND: Because good interpersonal skills are essential for successful careers in primary care, we investigated senior medical students' (SMS) perceptions of the impression they leave with patients. METHODS: To assess the key elements that define the impression we make on others, we developed measures for self monitoring/social desirability, sensitivity, and Machiavellianism. These scales were used to predict SMS' attitudes toward various patient problems and their residency choices. RESULTS: Lower sensitivity scores and higher Machiavellianism scores predicted negative attitudes toward patients with psychologic problems. Positive attitudes toward elderly patients were predicted by higher self-monitoring/social desirability scores and lower Machiavellianism scores. Overall, women scored higher than men on self-monitoring/social desirability and sensitivity and lower on Machiavellianism. CONCLUSIONS: Among SMS, impression management's dimensions are readily measured and the students with the best scores tend to choose primary care careers.

Reliance on high technology among senior medical students.

To gain a better understanding of senior medical students who perceive high-technology medicine as the desirable form of medical practice, we developed and evaluated a structural equation model. Intolerance to clinical uncertainty, Machiavellianism, and authoritarianism characterized students who scored higher on reliance on high-technology medicine. High scorers also tended to have a negative orientation toward patients' psychological problems and were unlikely to choose careers in primary care medicine. Students who perceive high technology as a panacea in clinical medicine share personal traits and attitudes toward patients that are not conducive to achieving the national goal of a 50:50 ratio between primary and non-primary care physicians.

Self-esteem and caregivers' attitudes toward elderly persons.

A scale identifying 141 medical students who responded positively to geriatric patients was based on Rosenberg's Self-esteem Scale modified by adding a phrase about geriatric care. Personal and professional role traits that predicted a positive therapeutic attitude were high scores on social desirability or self-monitoring and low scores on thanatophobia and depression. Senior medical students who expressed the highest self-esteem toward caring for elderly people indicated family medicine as their first choice of residency.

Management of early-stage Hodgkin's lymphoma. The radiation oncology experience at Northwestern University/Northwestern Memorial Hospital.

Early-stage Hodgkin's lymphoma patients treated with radiotherapy alone or combined modality therapy were retrospectively analyzed for survival, patterns of failure, salvage, and toxicity. Of 75 evaluable patients, 47 were given radiotherapy alone and 28 were given combination radiotherapy and chemotherapy. Of the patients studied, 26 were clinical stage I and 49 were clinical stage II, with nine patients upstaged at laparotomy. Minimum follow-up was 2 years, with a median of 81 months. Complete response rate was 95%. Relapse-free survival and overall survival were 89% and 96%, respectively, at 2 years; 78% and 86% at 5 years; and 76% and 82% at 10 years. Of 16 patients who relapsed (21%), 13/47 patients were treated with radiotherapy and 3/28 were treated with combined modality therapy. Salvage rates were higher in those treated with radiotherapy alone. There were 13 deaths: six from disease, two from treatment-related complications, and five from second primary malignancies. There was a higher incidence of second malignancies and deaths due to complication in patients treated with combined modality therapy. Radiotherapy alone or with chemotherapy is an effective modality in the treatment of Hodgkin's lymphoma. Treatment should be selected properly to optimize results and decrease complications.

Measuring social desirability among senior medical students.

The purpose of the study was to assess the role of medical students' social desirability scores on influencing their attitudes toward either a geriatric or hypochondriac patient. To carry out this investigation, we developed a social desirability scale that was domain-specific for medicine. Students' medical social desirability scores predicted negative attitudes and beliefs toward the geriatric but not the hypochondriac patient. This difference suggests that medical students find it acceptable to dislike the hypochondriac as a patient but not the elderly person. Social desirability scores were inversely related to Machiavellan scores, suggesting that medical students with a Machivellian response pattern tended to view their role as a physician in a less idealized way. Students who scored highest on social desirability tended to choose obstetrics-gynecology for their future career and those with the lowest scores either pathology or surgical subspecialties. Research with this scale should help access social desirability's role in medical students' in managing the impression they leave with patients.

Is obstetrics-gynecology a primary care specialty?

Suddenly everyone wants more primary care physicians. For several years, we collected data from senior medical students to relate their attitudes and beliefs about several clinical problems common to primary care to their choices of residencies. Because the Texas Medical Association's Special Committee on Primary Care included obstetrics-gynecology as a primary care specialty, we reviewed our data to see if the personal traits and professional role characteristics of seniors choosing obstetrics-gynecology differed materially from those of seniors choosing family medicine, internal medicine, or pediatrics. Results of this analysis put obstetrics-gynecology about as firmly in the primary care group as if the experimental design had planned it that way.

Uncertainties and ambiguities: measuring how medical students cope.

To develop psychometric measures specific to the ambiguities encountered in medicine and determine their value in predicting medical students' attitudes towards patients and their choice of residency, we administered to senior and first-year medical students a 25-item Likert-type questionnaire to assess their intolerance of ambiguity (ITA). Factor analysis yielded two dimensions that were converted to scales: 'Aversion to uncertainties in clinical medicine' (ITA1) and 'Preference for highly structured training environs' (ITA2). First-year students scored higher on ITA1 and lower on ITA2 than seniors. An excessive reliance on high-technology medicine, a negative orientation toward psychological problems, and Machiavellianism predicted ITA1. ITA1 was the best predictor of senior medical students' negative attributional style toward hypochondriac, geriatric and chronic pain patients. The following rank order of seniors' career choice was predicted by ITA1 scores: internal medicine, psychiatry and family medicine (lowest); radiology, surgery and anaesthesiology (highest). And by ITA2 scores: surgery, obstetrics and gynaecology, and surgical subspecialties (lowest); radiology, psychiatry and anaesthesiology (highest). We concluded that personality traits and role characteristics which predict 'Aversion to uncertainties in clinical medicine' are maladaptive to managing many primary care patients, and this mismatch is reflected in seniors' residency choice.