Medical students' motivation for internal medicine.

OBJECTIVE: To verify that motivational concepts tested in other educational settings are relevant to understanding medical students' choice of a career in internal medicine. More specifically, to compare the effects of "facilitating students' interest" versus "controlling students' learning" as educational models during the internal medicine clerkship. DESIGN: An observational retrospective study of 89 fourth-year medical students. Structural equation modeling compared the two models statistically. MAIN OUTCOME MEASURE: Student choice of internal medicine residency. RESULTS: Instructors who supported students' autonomy engendered in students greater feelings of competence and interest in internal medicine than did controlling instructors. Perceived competence further enhanced students' interest in internal medicine. In turn, interest predicted students' choosing an internal medicine residency. Overall, the facilitating students' interest model better explained students' choice of internal medicine than did the controlling students' learning model. CONCLUSIONS: The results verify that the nature of the learning climate during the internal medicine clerkship is an important predictor of students' subsequent pursuit of internal medicine training. Instructors who teach in an autonomy-supportive manner enhance students' perceived competence and interest in internal medicine, which increases the likelihood they will select an internal medicine residency.

Aortic regurgitation first appearing 12 years after successful septal myectomy for hypertrophic obstructive cardiomyopathy.

Substantial aortic regurgitation developed in a patient with hypertrophic (obstructive) cardiomyopathy (HCM) who underwent septal myectomy. It was first noted 12 years after surgery. There was no evidence for surgical damage to the valve, subacute bacterial endocarditis, coexisting discrete subaortic stenosis or any other known etiology of aortic incompetence. This experience suggests that aortic regurgitation occasionally may be a late mode of deterioration in surgically treated patients with hypertrophic cardiomyopathy. Possible mechanisms for the development of aortic incompetence in such patients are discussed.