Handedness and sex differences in intelligence: evidence from the medical college admission test.

Our analysis of Medical College Admission Test subtest scores by writing hand preference and sex suggests that (a) right hemispheric dominance is associated with intellectual giftedness in verbal reasoning (left-handers obtained higher scores on the verbal reasoning test and were overrepresented in the upper tail of the distribution), (b) different patterns of brain lateralization are associated with different subcomponents of cognition (right-handers scored higher, on average, on the writing test and were overrepresented in the upper tail of the distribution), and (c) men generally score higher than women on tests of scientific knowledge (the most striking differences between men and women were on the biological and physical science tests).

Characteristics of medical students by level of interest in family practice.

BACKGROUND AND OBJECTIVES: This study provides information on student factors associated with a career choice in family practice. METHODS: Information was used from multiple surveys completed by medical students, including the Premedical Questionnaire, the Matriculating Student Questionnaire, and the Graduation Questionnaire, as well as information from residency directors about residents in the Graduate Medical Education Tracking Census. These questionnaires are all a part of the Student and Applicant Information Management System of the Association of American Medical Colleges. Participants were 30,789 students graduating from US medical schools in 1991 and 1992. Comparisons were made between longitudinal student responses on the surveys to four types of outcomes. RESULTS: A total of 1,029 (3.3%) students were in the "Maintained" group (students who originally planned to enter family practice and were in a family practice residency at postgraduate year 1; 1,958 (6.4%) were "Gained" (originally chose a specialty other than family practice but entered a family practice residency); 1,950 (6.3%) were "Lost Interest" (originally identified family practice but entered another residency-two thirds of whom selected non-primary care specialties); 21,573 (70.1%) were "Never Interested" (did not express an early interest nor select a family practice residency); and the remainder (13.9%) had incomplete specialty data. Of those originally interested in family practice, 34.5% entered family practice residencies. Only 8.3% of those not originally interested entered family practice residencies. The four groups of students differed on many demographic, attitudinal, and experiential characteristics. Prestige, income, opportunities for research, and faculty status were more important to future specialists, while emphasis on primary care and prevention and practice in smaller communities were more important to the future family physicians. CONCLUSIONS: Medical schools could potentially increase the number of students selecting family practice residencies through both admissions policies and medical school experiences. These data provide some specifics on how to recruit students and prevent loss of those originally interested in family practice.

The MD-PhD researcher: what species of investigator?

Though MD-PhD programs have grown rapidly since their introduction in the mid-1960s, and are widely regarded as fostering excellent young investigators and future leaders in research and academic medicine, the types of research careers their graduates can be expected to pursue have been a point of some confusion. Some regard MD-PhD programs as a flexible approach to scientific training, producing both basic scientists and clinical investigators, while others tend to view these programs as generating either one type of researcher or the other. This range of expectations associated with dual-degree programs and their graduates has perplexed observers over the years and complicated the efforts of planners and policymakers in projecting workforce needs and generating recommendations for research training. To learn more about the research careers of MD-PhDs and how these investigators fit into the larger biomedical research workforce, the authors undertook a review of the types of research proposed by dual-degree and other investigators in 12,116 applications to the National Institutes of Health in 1993 and 1994. In comparing the types of research projects proposed by investigators of various degree types (MDs, MD-PhDs, and PhDs) the authors found that the research interests of the MD-PhDs studied were more closely aligned with the laboratory pursuits of most of their PhD counterparts than with the more clinically-oriented endeavors of those with the MD degree alone. During a time when there are persistent concerns about a shortage of investigators to conduct clinical research and growing fears that America's universities may be producing more PhDs than can be meaningfully employed in the scientific enterprise, the authors' finding indicates a need for future workforce planning to better reflect the respective roles played by MDs, MD-PhDs, and PhDs in biomedical and behavioral research.

Effect of debt on U.S. medical school graduates' preferences for family medicine, general internal medicine, and general pediatrics.

The authors assess the importance of educational debt in graduates' primary care specialty choices, and the variety of mechanisms through which debt may influence career decisions. Logistic regression models were used to identify significant predictors of the primary care specialty choices made by the 1991 and 1992 graduates of U.S. medical schools. These predictors were debt itself; other financial indicators; certain medical school characteristics; certain practice location plans; certain demographic factors; aspects of academic performance; and students' predisposition to a primary care specialty. Data for this study were gathered from a variety of sources at the Association of American Medical Colleges and from the Health Education Assistance Loans program. Both direct and indirect effects of debt were identified under specific conditions. The study revealed complex relationships between debt and the other predictors identified. For example, debt operated in relation to the levels of the graduates' expected incomes; debt from subsidized loan sources was significant for women who chose general internal medicine; debt was important in choices of family practice; and debt by itself was significant for those planning to practice in the West and who chose general internal medicine. Also, seemingly opposing effects of debt occurred. For example, in the family practice model used in this study, the threshold effect of debt was positive, while the linear effect of debt above the threshold was negative. Such vriations help explain the conflicting findings of some past research. These and other findings prompt the authors to state that when investigating the effects of debt, it is not fruitful to ask what the effect of the debt is on all three primary care fields as a group. It is more appropriate to ask several questions, such as: under what conditions does debt influence specialty plans? Among which groups of students does debt have an impact on specialty plans? Are all of the primary care specialties similarly affected by the issues surrounding debt? Does the effect of debt change over time? The authors conclude by indicating possible policy implications of their findings.

Preparing for health care reform and an LCME site visit: addressing the generalist-non-generalist imbalance.

PURPOSE: The purpose of the present study was to evaluate primary care outcomes for the Loma Linda University School of Medicine (LLUSM), using Association of American Medical Colleges (AAMC) data files. The two principal objectives were to estimate the percentages of LLUSM graduates who are practicing or will practice primary care medicine and to determine what information available on application to LLUSM is useful in predicting graduates' specialty choices (i.e., primary versus non-primary care). METHOD: In 1993-94 data were taken from several AAMC data files (available to all medical schools), including the Graduate Medical Education (GME) Tracking Census and the American Medical College Application Service (AMCAS) Applicant Master File. The second and fourth years after graduation were used as points of evaluation. Primary care (generalist) was defined as taking or having completed a residency in family practice, internal medicine, or pediatrics, and not having taken any fellowship training. RESULTS: Fourth year after graduation: 42.4% of the 1,064 LLUSM graduates (1983 to 1990) were training in or had completed residencies in family practice (19.8%), internal medicine (16.2%), or pediatrics (6.4%). Second year of GME: of the 1,365 LLUSM graduates (1983 to 1992), 49.3% were in the primary care pipeline (19.8% in family practice, 21.9% in internal medicine, and 7.6% in pediatrics). Two variables available on admission to medical school were associated with being in the primary care pipeline (second-year GME generalist): being a woman and being a member of a non-underrepresented minority. One variable was associated with being in the non-primary care pipeline: having a rural county code. Undergraduate grades and Medical College Admission Test scores were not good predictors. CONCLUSION: The AAMC data files, available to all medical schools, are useful for estimating and evaluating primary care outcomes.

A model to determine the influence of medical school on students' career choices: psychiatry, a case study.

BACKGROUND: A major concern of medical educators is to understand better how the experience of medical school influences students' career choices. This concern is of particular relevance for specialties experiencing or anticipating serious shortages (e.g., psychiatry, generalist specialties, general surgery). METHOD: To construct a case study of a model to determine the influence of medical school on students' selections of specialty, Association of American Medical Colleges (AAMC) databases were used to examine students' interests in one specialty (psychiatry) at two time periods: (1) at or before matriculation and (2) in the first year of residency. Data were examined for all graduates of all U.S. medical schools from 1991 and 1992. In addition to examining data for each school individually, comparisons were made of schools by region and by institutional control (public or private). RESULTS: Increased interest in psychiatry was found in seven of eight regions across the country. The greatest increases were found among graduates of public and private medical schools in the southeast: both types of schools increased the interest in psychiatry among their graduates by 250%, compared with the national average of 170%. A decrease in interest in careers in psychiatry was found among graduates of private medical schools in the northeast. CONCLUSION: The findings point to one way of understanding better the influence of a medical school on its students' career choices. By using this model, each specialty may be able to develop studies to examine the complex interactions between students and specific medical schools.

Specialty selection and success in obtaining choice of residency training among 1987 U.S. medical graduates by race-ethnicity and gender.

The authors developed baseline data on specialty selection and success in obtaining residency positions for the medical school graduates of 1987 who participated in the National Resident Matching Program (NRMP), compared by gender and race-ethnicity. They focused on primary care specialties and obstetrics-gynecology versus all other specialties, and sought to identify group differences in (1) patterns of specialty preference, (2) evolution of specialty choice from before to after medical school, (3) success in attaining the first choice of specialty through the NRMP, and (4) patterns in switching from an alternate specialty (ranked second or lower) to the first-choice specialty between the first and second years of residency training. The results showed substantial intergroup and intragroup variations, both before and after medical school, for family practice, internal medicine, and obstetrics-gynecology. Examination of NRMP outcomes revealed that the underrepresented-minority (URM) graduates, particularly men, were less successful both in achieving any match and in matching to their first-choice specialties. Analyses of patterns in switching specialties revealed several important facts about those who were matched to alternate specialties: (1) over half entered their first-choice specialties in the second year; (2) women had more success in switching to their first-choice specialties than did men, particularly among the URMs; (3) among those who received alternate specialties, the URM women were more likely than the URM men to leave graduate medical education by the second year (reversing the trend for the other groups); and (4) individuals whose alternate specialties were in primary care were much less likely to switch to their first-choice specialties.

House staff recruitment to municipal and voluntary New York City residency programs during the AIDS epidemic.

OBJECTIVE: To determine the impact on house staff recruitment of large numbers of patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Trends in yearly survey data from the National Resident Matching Program from 1983 to 1990 were examined for residency programs in New York City, NY, where AIDS is epidemic, in the four largest US cities with the fewest AIDS cases, and nationally. Within New York City, trends were compared for residency programs serving large numbers of AIDS patients (high AIDS) and for other programs (low AIDS). MAIN OUTCOME MEASURES: Number of matches in each study year as compared with the baseline year of 1983 and the yearly percentage of positions offered that were filled by matches. RESULTS: During the study period, New York City experienced a greater decline in US graduate matches than did the four low-AIDS cities or the nation. Within New York City, recruitment to municipal programs, all with large AIDS patient populations, dropped from 241 to 173 matches (28.2%) despite a 3.6% increase in positions. However, recruitment to both high-AIDS and low-AIDS voluntary programs improved in all years except 1990. After controlling for numbers of offered positions, high-AIDS and low-AIDS voluntary programs again showed similar trends until 1990. CONCLUSIONS: These observations cannot be attributed to AIDS alone. Multiple economic and social factors, including AIDS, may have contributed.

Students who consider medicine but decide against it.

Changes in the medical student applicant pool during the 1980s prompted educators and researchers to question why students' interest in medicine may have shifted. The research presented here addresses the issue of why students may decide against careers in medicine. The authors report historical data from 1983 through 1988 on the number of individuals who expressed an interest in medicine when they took the Medical College Admission Test but failed to apply to medical school, and the results of two surveys sent to such individuals in 1986 and 1988 by the Association of American Medical Colleges. The findings indicate that the non-applicants are a stable and fairly large group (approximately 2,000 each year) and that they decide against medical careers because of financial concerns, discouragement from practicing physicians, and the ability of another field to satisfy their interest in science. These kinds of concerns, as well as some of the other reasons provided by non-applicants, can be changed and so have implications for admission and recruitment programs.

Medical student attitudes about internal medicine: a study of U.S. medical school seniors in 1988.

OBJECTIVE: To determine the attitudes of medical students toward careers in internal medicine. DESIGN: Cross-sectional national survey of U.S. medical school seniors. PARTICIPANTS: The 10,379 respondents to the 1988 Medical Student Graduation Questionnaire from the Association of American Medical Colleges. MEASUREMENTS AND MAIN RESULTS: Most men and women selecting internal medicine (n = 1931) as well as those switching from earlier preferences for internal medicine (n = 1606) made their final decisions about specialty during the third and fourth years of medical school. Almost 50% of students planning to be internists cited "intellectual content" as the most important factor in their choice of specialty. "Diagnostic challenge" was next most frequently cited. "Type of patient seen" and "role models" were more frequently cited as the most important factors in specialty choice for all other specialties than for internal medicine. Students who switched away from earlier preferences for general internal medicine cited the following most important factors in descending order of frequency: "too demanding of time and effort," "inconsistent with personality," "negative clerkship experiences," "don't like the type of patient," and "specialty chosen more fulfilling." The same five factors, in a different order of frequency, were given for switching from the subspecialties of internal medicine. CONCLUSIONS: Most medical students make their final choices about specialty during or after their clerkship year. Knowledge of these students' attitudes toward internal medicine could form the basis for the development of strategies to enhance the attractiveness of internal medicine among these students while they are making their final decisions about specialty.

Likelihood of contact with AIDS patients as a factor in medical students' residency selections.

Results from the National Resident Matching Program for the years 1980, 1983, and 1987 were used to examine changes over time in the matches of U.S. medical students to residencies in cities with high concentrations of patients with acquired immunodeficiency syndrome (AIDS) and to specialties in which the care of AIDS patients was most concentrated. Medical students seeking postgraduate training in categorical surgery residency programs were less likely to be matched with programs located in areas where the numbers of reported AIDS cases were high in 1987 as compared with the "pre-AIDS" years of 1980 or 1983. This trend was more pronounced for students from medical schools located in cities with high numbers of AIDS cases. There was a decline in matches to residencies in categorical internal medicine nationally, regardless of location; this decline was also greater among the students coming from medical schools in cities with high numbers of AIDS cases. The authors discuss the implications for medical educators of declines in matches to specialties in which the care of AIDS patients is most concentrated. The imperfect nature of available measures of students' exposure to AIDS patients makes the data of this study preliminary, and further studies are being undertaken. However, the finding of significant effects in spite of the imprecision of some measures suggests that future work will confirm the results of this study.

Racial-ethnic background and specialty choice: a study of U.S. medical school graduates in 1987.

This study used two Association of American Medical Colleges' questionnaires to determine whether there was a relationship between the racial-ethnic backgrounds and the specialty choices of a 1987 cohort of 11,136 U.S. medical school seniors, both prior to entering medical school and as they prepared for residency training. Their specialty preferences as premedical students were shown by their responses to the Premedical Student Questionnaire, administered when they registered for the Medical College Admission Test; their specialty choices at the end of their medical school training were shown by their responses to the Medical Student Graduation Questionnaire, which they completed shortly before graduation. Racial-ethnic backgrounds, self-recorded, were classified into black, other underrepresented minorities, Asian, other non-underrepresented minorities, and white. Specialties were clustered into primary care, medical specialties, surgical specialties, and supporting services. Before entering medical school, the students had similar specialty preferences regardless of background. As seniors in medical school, there was even greater convergence of specialty choices among the students of all backgrounds. Racial-ethnic background in itself appears not to have been a major factor influencing the senior medical students' specialty choices.

Trends in evolution of specialty choice. Comparison of US medical school graduates in 1983 and 1987.

This study describes the evolution of specialty choices among US medical school seniors in 1983 and 1987. Its purposes were to determine the specialty interests of the 1987 cohort as these 11,264 students proceeded through medical school and to compare their evolving specialty plans with those of the 10,321 US medical school seniors in 1983. As the 1987 cohort advanced through medical school, they became increasingly interested in general and subspecialty internal medicine, psychiatry, obstetrics and gynecology, anesthesia, radiology and rehabilitation medicine and less interested in family practice, general surgery, pathology, and public health. Compared with the 1983 cohort, 1987 seniors were significantly less likely to choose general internal medicine and more likely to choose internal medicine and pediatric subspecialties. Similar proportions of each cohort of seniors chose family practice. Between 1983 and 1987, men's interest in pediatrics, general surgery, and obstetrics and gynecology declined, while their interest in the surgical subspecialties, anesthesia, and rehabilitation medicine increased.

Changes in housing in Guatemala following the 1976 earthquake: With special reference to earthen structures and how they are perceived by disaster victims*.

This paper reports on what has happened to earthen structures in 26 Guatemalan communities studied over a 4-year period since the 1976 earthquake. The data were obtained from three waves of personal interviews with 1472 randomly sampled household heads. The results show that adobe, which was the primary housing material before the earthquake was heavily damaged in that event. As a consequence the number of adobe structures and of other earthen structures has been drastically reduced. The people of Guatemala individually and because of agency housing programs have abandoned adobe as a building material and turned to concrete block and wood. Surviving earthen structures have not been improved substantially and remain with largely the same structural features as before the earthquake. The greatest improvement is in the use of comer posts or columns in the walls but most of these are made of untreated crude logs or lumber, subject to rot and termite damage. Little information on aseismic housing seems to have spread either within the earthquake area or in the unaffected areas surrounding it. A program to spread information on how to use adobe in aseismic designs needs to be conducted along with one to assist citizens to aquire the resources necessary to improve the earthquake vulnerability of houses.