The effects of communication skills training on pediatricians' and parents' communication during "sick child" visits.

This article reports the development and evaluation of a physician-parent communication skills training program designed to improve communication regarding antibiotic prescribing for children. Four pediatricians and 81 parents participated in the study, which involved audiotaping "sick child" office visits and then coding transcripts for evidence of program influence on information seeking, giving, and verifying, as well as relational communication. Parents who received training were more likely to verify information, t(79) = 1.82, p = .04, and more likely to express concerns, t(79) = 1.79, p = .04, than were parents who did not receive training; there was a nonsignificant trend for trained parents to be more likely to give information, t(79) = 1.7, p = .051. In terms of physician behavior, there were nonsignificant trends for physicians to spend more time creating a partnership with parents after training than before training, t(3) = 2.29, p = .053, and to encourage more questions from parents after training than before, t(3) = 2.15, p = .06. In addition, once one outlier parent in the control condition was removed from the analysis, the results showed that physicians spent more time addressing treatment options after training than before, t(3) = 2.9, p = .03. The results of this study are considered promising, with effects shown for various important elements of physician-parent communication. Implications of results and directions for future research are discussed.

Stories from the field: students' descriptions of gender discrimination and sexual harassment during medical school.

PURPOSE: Previous studies have documented the prevalence of gender discrimination and sexual harassment during medical training, but very few have examined the behaviors that students perceive as discriminatory or harassing. The authors addressed this lack of information by examining graduating medical students' written descriptions of personal experiences with such behaviors during medical school. METHOD: The authors reviewed the responses of graduating seniors at 12 U.S. medical schools to a questionnaire, administered in 2001-02, that asked them to provide written descriptions of their personal experiences with gender discrimination and sexual harassment. Seven response categories were created on the basis of recurring themes: educational inequalities; stereotypical comments; sexual overtures; offensive, embarrassing, or sexually explicit comments; inappropriate touching; sexist remarks; and not classifiable. The three authors examined the students' written accounts and placed each into one or more of the categories. RESULTS: Of the students' responses, 290 (36.6%) contained 313 written descriptions of personal experiences that the students perceived as either discriminatory or harassing. The most frequently reported experiences involved educational inequalities; experiences in this category were reported more frequently by men than by women. All other categories of experiences were reported more frequently by women. CONCLUSIONS: The results support earlier findings of the prevalence of gender discrimination and sexual harassment during undergraduate medical education. Perhaps formal antiharassment policies should provide examples of unacceptable behavior that are based on categories such as those revealed by this analysis. Perhaps, too, medical students' comments could be used to develop educational interventions for physicians in supervisory positions.

Does students' exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection?

PURPOSE: To examine the role of gender discrimination and sexual harassment in medical students' choice of specialty and residency program. METHOD: Anonymous, self-administered questionnaires were distributed in 1997 to fourth-year students enrolled in 14 public and private U.S. medical schools. In addition to reporting the frequency of gender discrimination and sexual harassment encountered during preclinical coursework, core clerkships, elective clerkships, and residency selection, students assessed the impact of these exposures (none, a little, some, quite a bit, the deciding factor) on their specialty choices and rankings of residency programs. RESULTS: A total of 1,314 (69%) useable questionnaires were returned. Large percentages of men (83.2%) and women (92.8%) experienced, observed, or heard about at least one incident of gender discrimination and sexual harassment during medical school, although more women reported such behavior across all training contexts. Compared with men, significantly (p