Changes in medical students' exposure to and attitudes about drug company interactions from 2003 to 2012: a multi-institutional follow-up survey.

PURPOSE: To ascertain whether changes occurred in medical student exposure to and attitudes about drug company interactions from 2003-2012, which factors influence exposure and attitudes, and whether exposure and attitudes influence future plans to interact with drug companies. METHOD: In 2012, the authors surveyed 1,269 third-year students at eight U.S. medical schools. Items explored student exposure to, attitudes toward, and future plans regarding drug company interactions. The authors compared 2012 survey data with their 2003 survey data from third-year students at the same schools. RESULTS: The 2012 response rate was 68.2% (866/1,269). Compared with 2003, in 2012, students were significantly less frequently exposed to interactions (1.6/month versus 4.1/month, P < .001), less likely to feel entitled to gifts (41.8% versus 80.3%, P < .001), and more apt to feel gifts could influence them (44.3% versus 31.2%, P < .001). In 2012, 545/839 students (65.0%) reported private outpatient offices were the main location of exposure to pharmaceutical representatives, despite spending only 18.4% of their clerkship-rotation time there. In 2012, 310/703 students (44.1%) were unaware their schools had rules restricting interactions, and 467/837 (55.8%) planned to interact with pharmaceutical representatives during residency. CONCLUSIONS: Students in 2012 had less exposure to drug company interactions and were more likely to have skeptical attitudes than students in 2003. These changes are consistent with national organizations' recommendations to limit and teach about these interactions. Continued efforts to study and influence students' and physician role models' exposures to and attitudes about drug companies are warranted.

Cognitive enhancement drug use among future physicians: findings from a multi-institutional census of medical students.

BACKGROUND: Nonmedical use of prescription psychostimulants such as methylphenidate and amphetamine salts for the purpose of cognitive enhancement is a growing trend, particularly in educational environments. To our knowledge, no recent studies have evaluated the use of these psychostimulants in a medical academic setting. OBJECTIVE: To conduct an online census of psychostimulant use among medical students. DESIGN: In 2011, we conducted a multi-institutional census using a 31-48 item online survey regarding use of prescription psychostimulants. PARTICIPANTS: 2,732 actively enrolled medical students at four private and public medical schools in the greater Chicago area. MAIN MEASURES: Prevalence and correlates of psychostimulant use KEY RESULTS: 1,115 (41 %) of students responded to the web-based questionnaire (range 26-47 % among schools). On average, students were 25.1 years of age (SD = 2.7, range 20-49), and single (70 %). Overall, 18 % (198/1,115) of this medical student sample had used prescription psychostimulants at least once in their lifetime, with first use most often in college. Of these, 11 % (117/1,115) of students reported use during medical school (range 7-16 % among schools). Psychostimulant use was significantly correlated with use of barbiturates, ecstasy, and tranquilizers (Pearson's correlation r > 0.5, Student's t-test p < 0.01); male gender (21 % male versus 15 % female, Chi squared p = 0.007); and training at a medical school which by student self-report determined class rank (68 % versus 51 %, Chi-squared p = 0.018). Non-users were more likely to be first year students (Chi-squared p = 0.048) or to have grown up outside of the United States (Chi-squared p = 0.013). CONCLUSIONS: Use of psychostimulants, including use without a prescription, is common among medical students. Further study of the side effects, medical implications, and use during post-graduate medical training and medical practice is needed to inform evidence-based policy.

Perspective: the revolution is upon us.

Profound socioeconomic pressures on medical student education have been catalogued extensively. These pressures include teaching patient shortages, teacher shortages, conflicting systems, and financial problems. Many of these problems have been caused by an unregulated free market affecting medicine overall, with market values sometimes overshadowing the academic values of education, research, and patient care. This has caused profound changes in the conduct of medical student education. Particularly important has been a reduction in the "gold standard" of teaching: direct student-teacher and supervised student-patient interaction, replaced by a potpourri of online and simulated modules. The aggregate of these changes constitutes a revolution that challenges whether medical schools, school buildings, classes, and dedicated faculty are even necessary. The author posits several recommendations in response to this revolution: (1) recognize the revolution as such, and carefully guide or abort it, lest its outcome be inadequate, inauthentic, or corrupt, (2) prioritize academic rather than business values, (3) ensure that funds allotted for education are used for education, (4) insist that medical schools, not industry, teach students, (5) value authentic education more than simulation, (6) adopt learner-centered teaching without misusing it, (7) maintain acceptable class attendance without requiring it, (8) provide, from the first school day, authentic, patient-centered medical education characterized by vertical integration, humanism, early patient exposure, biopsychosocial orientation, and physician role modeling, (9) ensure that third- and fourth-year students have rich patient-care responsibility, and 10) keep tenure. These actions would permit the preservation of an educational gold standard that justifies medical education's cost.

Use of clerkship learning objectives by members of the Association of Directors of Medical Student Education in Psychiatry.

OBJECTIVE: The authors aimed to determine the extent and use of the 1995 psychiatry clerkship goals and objectives published by the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) and to obtain members' guidance regarding their proposed revision. METHODS: ADMSEP members were surveyed regarding their awareness and current use of the objectives, their advantages and disadvantages, and suggestions for revision. RESULTS: Fifty-four of approximately 130 members returned surveys, including 60% of members who identified as clerkship directors. Ninety percent of respondents were aware of the objectives and 48% used them. Use was significantly related to years of ADMSEP membership. Those who used the objectives did so moderately or extensively, and 84% found them moderately to very useful. Reasons for nonuse were the employment of other objectives, unawareness of them, too lengthy/not user-friendly, and lack of resources to implement them. Comprehensiveness and specificity were cited as both their most useful aspects and their least useful aspects. The most frequently suggested revisions included prioritization, adding more clinical competencies, decreasing the total number, and developing supporting documents such as clinical cases, references, sample examinations, and a resource manual. Respondents held strongly favorable attitudes regarding the utility of learning objectives. CONCLUSION: The ADMSEP psychiatry clerkship learning objectives were widely but not uniformly used among members surveyed, and use is significantly related to years of membership. Respondents strongly favor using learning objectives and desire that a new iteration of the document be more user-friendly, oriented to competencies, and supported by resource materials.

Do the personalities of international and U.S. medical graduates in psychiatry differ? A preliminary study.

OBJECTIVE: To compare personality traits of psychiatry residents with various characteristics. METHOD: The authors administered Cloninger's personality inventory to residents at two schools. RESULTS: There were no trait differences between international medical graduates (IMGs) and U.S. medical graduates (USMGs) or those for whom psychiatry was a first or second choice. CONCLUSION: Perceived differences between IMG and USMG psychiatry residents appear unrelated to personality.

Medical students' exposure to and attitudes about drug company interactions: a national survey.

CONTEXT: While exposure to and attitudes about drug company interactions among residents have been studied extensively, relatively little is known about relationships between drug companies and medical students. OBJECTIVE: To measure third-year medical students' exposure to and attitudes about drug company interactions. DESIGN, SETTING, AND PARTICIPANTS: In 2003, we distributed a 64-item anonymous survey to 1143 third-year students at 8 US medical schools, exploring their exposure and response to drug company interactions. The schools' characteristics included a wide spectrum of ownership types, National Institutes of Health funding, and geographic locations. In 2005, we conducted a national survey of student affairs deans to measure the prevalence of school-wide policies on drug company-medical student interactions. MAIN OUTCOME MEASURES: Monthly frequency of students' exposure to various activities and gifts during clerkships, and attitudes about receiving gifts. RESULTS: Overall response rate was 826/1143 (72.3%), with range among schools of 30.9%-90.7%. Mean exposure for each student was 1 gift or sponsored activity per week. Of respondents, 762/818 (93.2%) were asked or required by a physician to attend at least 1 sponsored lunch. Regarding attitudes, 556/808 (68.8%) believed gifts would not influence their practices and 464/804 (57.7%) believed gifts would not affect colleagues' practices. Of the students, 553/604 (80.3%) believed that they were entitled to gifts. Of 183 students who thought a gift valued at less than $50 was inappropriate, 158 (86.3%) had accepted one. The number of students who simultaneously believed that sponsored grand rounds are educationally helpful and are likely to be biased was 452/758 (59.6%). Students at 1 school who had attended a seminar about drug company-physician relationships were no more likely than the nonattending classmates to show skepticism. Of the respondents, 704/822 (85.6%) did not know if their school had a policy on these relationships. In a national survey of student affairs deans, among the 99 who knew their policy status, only 10 (10.1%) reported having school-wide policies about these interactions. CONCLUSIONS: Student experiences and attitudes suggest that as a group they are at risk for unrecognized influence by marketing efforts. Research should focus on evaluating methods to limit these experiences and affect the development of students' attitudes to ensure that physicians' decisions are based solely on helping each patient achieve the greatest possible benefit.

Using film as the basis of an american culture course for first-year psychiatry residents.

OBJECTIVE: There is a developing literature on the use of movies for educating psychiatric residents. This may be the first report of the use of film as the basis of a psychiatric resident acculturation course. METHOD: The author describes an American culture course for PGY-1 psychiatric residents and presents satisfaction and construct validity data. RESULTS: Resident satisfaction was high. Three staff members scored higher than international medical graduates (IMG) residents on a precourse exam. CONCLUSION: Feature films can be used as the basis for an enjoyable acculturation course.

Relationship between specialty choice and medical student temperament and character assessed with Cloninger Inventory.

BACKGROUND: Multiple variables affect medical specialty choice, including temperament, sociodemographic factors, and personal experiences. Many studies address specific variables for specific specialties, but few assess the relative impact of each factor. PURPOSE: To identify the relative influence of temperament in choosing a specialty. METHODS: A sociodemographic and personal experiences questionnaire and a 240-question temperament and character inventory was distributed to 682 medical students. Their scores for 6 medical specialties were examined using analyses of variance, multivariate analyses of variance, and discriminant analysis. RESULTS: Students choosing surgery, emergency medicine, and obstetrics and gynecology were higher on novelty seeking than other students. Future surgeons were lower in harm avoidance and reward dependence (RD) than the others. Students choosing primary care specialties, emergency medicine, and obstetrics and gynecology were all high on RD; with pediatrics being highest. Students differed from college students, the women differed from the men, and the Asian Americans differed from the other groups. CONCLUSION: The implications of these findings are discussed for career counseling and future research.

Academic performance of psychiatrists compared to other specialists before, during, and after medical school.

OBJECTIVE: This study was designed to compare psychiatrists with other physicians on measures of academic performance before, during, and after medical school. METHOD: More than three decades of data for graduates of Jefferson Medical College (N=5,701) were analyzed. Those who pursued psychiatry were compared to physicians in seven other specialties on 18 performance measures. Analysis of covariance was used to control for gender effect. RESULTS: Compared to other physicians, psychiatrists scored higher on measures of verbal ability and general information before medical school and on evaluations of knowledge and skills in behavioral sciences during medical school, but they scored lower on United States Medical Licensing Examinations step 3. CONCLUSIONS: The results generally confirmed the authors' expectations about psychiatrists' academic performance. More attention should be paid to the general medical education of psychiatrists.

How to do research with self-administered surveys.

Given the absence of brief "how to do it" articles on self-administered survey research, the author presents suggestions for conducting and publishing questionnaire research successfully. The article covers choosing a topic, framing a core research question that can be tested scientifically with survey data, respecting the study subjects' time and pride, keeping the survey materials succinct, being persistent, and guaranteeing study subjects' anonymity or confidentiality.

Complications associated with surveying medical student depression: the importance of anonymity.

OBJECTIVE: To evaluate students' attitudes and concerns regarding potential repercussions of completing the Beck Depression Inventory (BDI). METHODS: A survey based on focus group data was developed and distributed. RESULTS: One hundred and ninety-one of 400 surveys (48%) were returned. Of 160 students who remembered completing the BDI, 31 (19%) admitted to concerns about the research, and nearly 10% admitted to recording dishonest answers. CONCLUSIONS: These findings emphasize the importance of conducting anonymous assessments of medical students, particularly when assessing sensitive psychological states.

Recruitment of U.S. medical graduates into psychiatry: reasons for optimism, sources of concern.

The authors explain the importance of recruiting U.S. medical graduates into psychiatry, give reasons for optimism about future recruitment, express concerns about problems that could hinder it, and recommend ways to address these concerns. Reasons for optimism include: features of the specialty, such as its focus on the doctor/patient relationship; its increasing job availability and incomes; its scientific achievements; the peaking and possible fading of the National Generalist Initiative; and a 5-year upward recruitment trend. Concerns are: low "overt" interest in psychiatry among entering medical students; clerkship directors' perceptions of a negative educational impact of managed care; graduating seniors' suboptimal satisfaction with their psychiatry clerkships; and what is likely to be a small impact of New Mexico legislation on prescribing privileges for psychologists. The authors make recommendations for addressing these concerns.

Factors affecting medical student career choice of psychiatry from 1999 to 2001.

OBJECTIVE: The proportion of students matching into psychiatry (PMP) at each medical school results from a complex interplay between extrinsic (e.g., national trends, geographic region) and intrinsic factors (e.g., the quality of psychiatric education). The goal of the study was to learn the extent to which regional and local extrinsic factors (and one intrinsic factor) influenced PMP at medical schools in the U.S. from 1999 to 2001. METHODS: The authors obtained data about these factors from deans of student affairs, the National Resident Matching Program (NRMP), American Medical Association (AMA), Association of American Medical Colleges (AAMC), American Psychiatric Association (APA), and Harvard University's HealthSystem Consortium. RESULTS: The best predictor of a school's PMP is the PMP of the prior year for that particular school. Local and regional extrinsic factors were not significantly associated with PMP. There was a modest inverse correlation between PMP and the proportion of international medical graduates (IMGs) in psychiatry residency. CONCLUSIONS: The authors infer that intrinsic factors are most important for recruitment, and they make recommendations for addressing these factors.

Clerkship directors' perceptions of the effects of managed care on medical students' education.

PURPOSE: Little is known about the effect of managed care on medical students' education. Because clerkship directors (CDs) are especially well positioned to observe any changes, this study surveyed CDs from six medical specialties about their perceptions of the effects of managed care on medical students' education. METHOD: Anonymous questionnaires were mailed to 808 CDs from departments of six medical specialties at 125 U.S. allopathic medical schools between October 1997 and March 1998. Among other questions, respondents were asked whether they had observed changes in 19 different aspects of medical students' education, whether these changes were beneficial or detrimental, and whether they believed the changes were due to managed care and/or to other factors. Results were analyzed to determine perceptions of the overall magnitude and source(s) of changes, the perceived positive versus negative effect of managed care, and whether these outcomes were statistically associated with the perceived degree of managed care's market penetration. RESULTS: Five hundred questionnaires (61.9%) were returned. For full-time and voluntary faculty teaching, faculty availability for educational administration, directors' clinical responsibilities, and quality of professional life, the most common response was that managed care had an adverse effect. For faculty's enthusiasm for teaching, directors' administrative and educational duties, and clerkship training sites, the second most common response after "not changed" was that managed care had a negative effect. The majority of respondents held negative opinions of managed care and thought that medical students did not understand it. CONCLUSIONS: CDs in six medical specialties perceived that managed care has negatively affected medical students' education. These perceptions may influence medical students' education. Measures must be taken to ensure excellent education through adequate resources and training in the context of high-quality medical care.

Psychometric Properties of ABPN-Style Oral Examinations Administered Jointly by Two Psychiatry Residency Programs.

The authors examined the reliability and validity of American Board of Psychiatry and Neurology-style oral exams (ASOs) given jointly by two schools. ASOs were given to 80 psychiatry residents from all four postgraduate years during the study period. Interrater reliability was near perfect for two years at one university, but it was much weaker at the second site. Test-retest reliability could not be demonstrated at either institution. Concurrent validity was demonstrated one year but was inconsistently demonstrated the second year. Likewise, predictive and construct validity were variable. International medical graduates were more apt to fail than American medical graduates. Although resident and faculty satisfaction with the examination was high, site-to-site variability in reliability and validity indicates the need to improve this ASO before using it for high-stakes evaluations.