Is the quality of surgical residency applicants deteriorating?

BACKGROUND: Among directors of general surgery residencies, there is a concern that the quality of medical students applying to surgical residencies is declining. METHODS: Quality of surgical applicants was assessed by several methods including subjective opinions determined by survey and by objective data including student United States Medical Licensing Examination (USMLE) scores of matched candidates. The number of applicants interviewed, total interviews granted, proportion of Alpha Omega Alpha (AOA) students, and the rank order of the candidates matched was obtained by survey. The survey included data on postgraduate year 1 (PGY-1) residents from July 1996 to July 1999. Three mailings were made to 226 US surgical residency programs. RESULTS: Data were obtained from 90 programs. Surgery program directors disagreed with a survey statement that overall quality of applicants had declined (P <0.01), but agreed with a statement that activities of medical schools to enroll graduating students into primary care had hurt recruitment (P <0.001). Objective data revealed no change in mean USMLE part I scores of PGY-1 residents over the 4 years (P = 0.265, power = 0.81). There was no change in proportion of matched residents who were AOA over time. The mean score of all new PGY-1 residents, the rank of the first matched resident, the rank of the last ranked resident, and proportion of AOA students was higher in programs with five or more categorical spots when compared with programs of at most four (P <0.001). Across all programs, there was a trend to go lower on the rank list to fill categorical positions over time (P <0.001). CONCLUSIONS: There is a perception that medical school policies act to discourage recruitment of quality medical students into general surgery programs, and surgery programs are going deeper into their rank lists to fill categorical positions. However, the average USMLE part I score of applicants to surgical residencies and proportion of AOA applicants has not decreased.

Self-reported narcissism and perceived parental permissiveness and authoritarianism.

The hypothesis that inadequate parenting promotes the development of pathological narcissism was tested in a sample of 370 undergraduate students. They responded to the O'Brien (1987) Multiphasic Narcissism Inventory (OMNI) and to measures of parental permissiveness, authoritarianism, and authoritativeness. Perceived parental permissiveness and authoritarianism served as independent predictors of greater narcissistic tendencies. The students who scored high on the OMNI were also less likely to evaluate both of their parents as having been especially strong in their use of the adjustment-promoting authoritative style. Theoretical efforts to link narcissism with inadequate parenting therefore may have merit and may deserve additional research attention.

Narcissistic Personality Inventory factors, splitting, and self-consciousness.

Narcissistic Personality Inventory (NPI; Emmons, 1984) factors were correlated with Splitting, Self-Consciousness, Depression, Anxiety, and Self-Esteem. Exploitativeness/Entitlement was largely maladaptive, whereas Leadership/Authority, Superiority/Arrogance, and Self-Absorption/Self-Admiration yielded ambiguous outcomes. Partialing out Exploitativeness/Entitlement uncovered stronger ties of the other factors with adjustment, and controlling for the other three dimensions caused Exploitativeness/Entitlement to appear more pathological. Raskin and Terry (1988) NPI factors and a narcissistic Superiority Scale were similarly affected by partialing, appearing healthier when controlling for "maladaptive" narcissism and more unhealthy when removing the more "adaptive" variance. These data suggest that complex entanglements between adaptive and maladaptive forms of self-love may make it difficult to understand and assess pathological narcissism.

Narcissism and object relations.

Questionnaire measures of the narcissistic personality disorder can predict healthy and unhealthy self-functioning. That this outcome might support Heinz Kohut's psychoanalytic psychology of the self was tested in a sample of 354 undergraduates. In canonical correlations, factors from the Narcissistic Personality Inventory were associated more strongly with grandiose than with idealizing immaturities in Kohut's bipolar self, while difficulties in interpersonal relationships (i.e., poor object relations) were associated more strongly with idealizing deficits. Zero-order and partial correlational data were congruent with Kohut's hypothesis that self-grandiosity can include elements of both "pathology" and relative mental health, but canonical correlations did not support Kohut's claim that narcissism can be described in a bidimensional self-structure.

Variables related to body-weight status of mentally retarded adults.

Mentally retarded male and female adult subjects displayed mean body weights in excess of their ideal weights; excessive body weight of females was also apparent in comparison to normative data for the United States. Maintenance of appropriate weight appeared to be more likely in a controlled residential setting than in the natural home environment. These sex and environmental relationships could not be explained by medication and dietary programming differences, and age, race, and level of retardation were unrelated to body weight.

Narcissism and empathy: validity evidence for the Narcissistic Personality Inventory.

Three empathy questionnaires were correlated with scores on the Narcissistic Personality Inventory (NPI), and the predicted negative relationship was observed in two of the three cases. In addition, the Exploitiveness/Entitlement (E/E) subscale of the NPI was inversely related to all three empathy scales and directly related to another hypothesized measure of narcissism. Unexpected negative correlations between the E/E subscale and social desirability scales were interpreted as evidence of E/E subscale sensitivity to the manipulative dimension of narcissistic relationship styles. These data further support the construct validity of the NPI in general and of the Exploitiveness/Entitlement subscale in particular.

Glucoprivic responsivity after insulin in hypodipsic and in water deficit rats.

Long Evans rats were made acutely hypodipsic through quinine adulteration of their water supply, and they ate normally in response to 2, 4, and 6 unit insulin injections. Other subjects were made chronically hypodipsic through adulteration; and while their glucoprivic feeding was lowered absolutely, it remained relatively elevated over their control session intake. These data indicate that subjects with reduced drinking abilities can respond to the insulin-induced glucoprivic challenge and that hydrational factors apparently do not serve as critical confounds in brain lesion investigations into the glucoprivic feeding response.

Failure of rats deprived of water to increase food intake during glucoprivation induced by 2-deoxy-D-glucose.

Thirsty rats denied access to water did not significantly increase their food intake following the glucoprivic stimulus provided by 750 mg/kg 2-deoxy-D-glucose (2-DG). In a second study, subjects were made hypodipsic through adulteration of their water supply with 0.2% w/v quinine hydrochloride; and they too displayed glucoprivic feeding deficits at 250 mg/kg, 500 mg/kg, and 750 mg/kg dosages. A reduced ability to ingest fluids therefore can inhibit 2-DG-induced eating when rats are examined after experience with water restriction schedules. These data consequently suggest that caution may be necessary in interpreting post-lesion disruptions of 2-DG glucoprivic feeding when severe water intake deficits are also observed.

Eating induced by injections of 2-deoxy-D-glucose in neurologically intact hypodipsic rats.

Neurologically intact rats were presented with a 0.2% (w/v) quinine adulterated water supply, and they failed to meter fluid consumption homeostatically in accordance with the elevated food intake that followed glucoprivation induced by 250, 500, and 750 mg/kg injections of 2-deoxy-D-glucose (2DG). These animals, nevertheless, were statistically indistinguishable from controls in the amount of food eaten following the 2DG treatments. These data suggest that the hypodipsia produced by some brain lesions is not a sufficient stimulus to produce the deficient glucoprivic feeding that accompanies such lesions; therefore, future lesion investigations that simultaneously yield hypodipsia and reduced eating in response to 2DG need not employ hypodipsic neurologically intact controls.

Emergence of deprivation-induced drinking: implications for hypothalamically elicited behavior.

The possibility that 23-hr water deprived rats must learn to drink in response to thirst states was examined in subjects presented with consecutive days (CD), alternate days (AD), or no days (ND) of deprivation experience CD animals displayed a gradual rise in water intake; however, motivational factors seemed critical in producing this effect because CD rats drank more and weighed less than the AD animals. In addition, AD subjects always drank more than ND animals; thus, the gradual rise in drinking could not be attributed to an ad lib body water surplus that prevented subjects from being thirsty during the initial drinking session. All subjects were allowed to recover from the first phase of deprivation, and then each group was presented with the consecutive-day deprivation procedure. In this second phase, the groups did not differ in the amount of water drunk; so, learning factors once again were contraindicated because more "practiced" subjects did not ingest more. Habituation processes also were implicated in the gradual increase in drinking. These data contrast with those indicating that rats must "learn" to display consummatory responding during electrical stimulation of the lateral hypothalamus, and they strongly support the possibility that learning-like effects during water deprivation reflect the operation of motivational processes.

Nystagmus and ocular fixation difficulties in learning-disabled children.

The visual fixation ability of learning-disabled children was evaluated after sensory integrative therapy had been administered for short or long periods of time. Children with hyporesponsive postrotary nystagmus displayed reduced oculomotor control skills, but the deficit was apparent only in those who had been in therapy for a shorter interval. These results present further support for the hypothesis that the learning disabled can be differentiated according to their nystagmus characteristics. In addition, very tentative evidence suggested that sensory integrative therapy may have been successful in ameliorating the fixation deficiency; however, further research into this possibility is needed. The data also indicate that oculomotor control dysfunction may be a mediating mechanism for at least part of the learning disabilities experienced by some learning-disabled children.

Effects of social influence in a recognition task of auditory intensity: a temporary shift in criterion.

The effects of responses of another person or a computer occurring prior to the subjects' responses in tasks to recognition model which assumed that subjects shifted their decision criteria temporarily on each trial. A parameter representing the amount of criterion shift reliably estimated sensitivity to social influence. When the social sensitivity parameter was estimated from the data, discriminative ability, defined as d', was unaffected by the presence of social influence. Principal components analyses suggested that social sensitivity and discriminative ability represented essentially orthogonal components of subjects' decision behavior.