American Medical Students Research Articles

Diseño y validación de una escala para medir la percepción sobre el trabajo en el primer nivel de atención en estudiantes de medicina de Latinoamérica

Objectives. To design and validate a scale to assess Latin American medical students’ perception on first level of health care (FLHC). Materials and methods. An observational, analytic and multicentre study was carried out in two phases: i) A self-administered questionnaire regarding perceptions on FLHClabor was designed. ii) This questionnaire was applied to to medical students from 18 universities of eight Spanish-speaking Latin American countries. An exploratory factor analysis (EFA) was performed through a principal components analysis with orthogonal varimax rotation. Sample adequacy was evaluated. Factor extraction was based on Kaiser’s criteria, Cattell’s Scree test and the explained variance (>5%). Internal consistency was measured with Cronbach’s alpha. Results. 423 students were included in the analysis; 53.4% were from Peruvian universities. After the EFA, the questionnaire conserved 11 items, which were distributed in three domains, that explaining together 55.47% of the total variance: i) Perceptions concerning the FLHC physician; ii) Perceptions concerning the FiLC labor and iii) Perceptions about the economic consequences of working in FLHC. Conclusion. The scale is composed by three domains and can be used to assess the perceptions of the medical work on first level of health care of Spanish-speaking Latin American medical students.

Prevalence and Predictors of High Sexual Prejudice Among Medical Students From Two Colombian Cities

Around the world, sexual prejudice is still a concerning attitude present in health care providers and institutions. Identification of sexual prejudice during medical training could be an initial strategy to improve health care assistance to this particular population. Despite significant knowledge in the area, almost all previous studies were based on samples from developed countries, and there are no studies evaluating sexual prejudice and its conditionings among Latin American medical students. Objectives of the study were to estimate prevalence and predictors of sexual prejudice among medical students from two large cities in Colombia. This research found that 22.9% of medical students had a high sexual prejudice. Males and individuals with high religiosity were associated with a higher sexual prejudice and may require more sensitization and education in the area. Medical training represents a very good opportunity to approach the problem and decrease sexual prejudice in future physicians.

The Contagious City: The Politics of Public Health in Early Philadelphia

Simon Finger's The Contagious City: The Politics of Public Health in Early Philadelphia traces the connections between politics and public health in Philadelphia from the seventeenth to the nineteenth centuries. The author does a fine job showing how political ideology corresponded with health and medical reform. Finger writes, “I … show how political efforts to promote health on a collective basis … shaped the political culture of that city and of the province and the nation around it” (5). He continues, “Ideas about people, politics, and space influenced the way colonists, rebels, and republicans conceived their polity” (6). As Philadelphia underwent colonial development, experienced revolutionary transformation, and exerted national influence, political leaders, medical professionals, city planners, and public health reformers did their best to positively influence the health of the city's residents as well as the urban body politic.Finger begins his study in the colonial period. He describes how William Penn promoted the physical transformation of the Pennsylvania landscape and fashioned Philadelphia's layout. He hoped these measures might convince additional settlers to make the journey to his fledgling colony. He connected colonial power with demographic growth. As a result, he marketed his colony not only to residents of the British Isles, but also to Protestants in Europe. The decision to reach out to continental Protestants, specifically Germans, as potential settlers affected public health in several ways. Foreign migration, which was often accompanied by disease due to the tragic circumstances aboard ship, soon was seen as contagion. The association of the stranger with sickness brought about discrimination. Colonists wondered whether foreign bodies could be incorporated into the British body politic. Public health measures, including quarantine and the establishment of medical institutions, developed to help the ailing.Philadelphia's contributions to the Enlightenment also highlight the connections between politics and public health. Benjamin Franklin embodied the era's devotion to association and improvement. He championed the Pennsylvania Hospital as a means of improving the well-being of the city and its ailing people. Philadelphians and other Pennsylvanians also participated in the Enlightenment exchange of knowledge. American colonists sent samples of all sorts to England and Europe for analysis and took advantage of the opportunity to study in cities, like Edinburgh, that led in medical education. Yet, as the political atmosphere in the colonies became inflamed by the revolutionary crises of the 1760s and 1770s, American medical students abroad united in the face of British condescension and heavy-handedness.Finger also studies Philadelphia's role in the Revolution and the early national period. He proves how “the war played a crucial part in transforming Philadelphia's medical community” (86). Medical practitioners gained experience and prestige, associated with military and political leaders, and came to understand the significance of public health programs. Medical veterans of the Revolution continued to lead the city after the war. They founded the College of Physicians of Philadelphia, advocated for health reform, and contributed to city institutions like the dispensary. The yellow fever epidemics of the 1790s tested the power of these medical leaders and their political colleagues. Fear of the disease divided health professionals and even separated the new United States, as neighboring states feared the introduction of disease via trade.The author completed an impressive amount of primary source research. He coupled archival manuscripts with published material and consulted documents from the seventeenth through the nineteenth centuries. Finger includes examples of visual primary sources, such as maps, a frontispiece, and a sketch, in his narrative so that the reader can see the connections between public health and politics.Overall, the book works well. One weakness that detracts from Finger's otherwise fine work is the author's tendency to move quickly from one topic to another without adequate analysis. For example, after analyzing the incorporation of Germans into the Pennsylvania body politic, Finger abruptly discusses the forced resettlement of Acadians in Pennsylvania. His investigation of the Acadian experience lasts for only three pages.Despite this weakness, Finger's book succeeds. Historians of medicine will appreciate the author's study of politics and medicine. Students of Philadelphia and Pennsylvania history will find a story of how the city and the state debated and dealt with issues related to public health.

A Medical Student Elective Promoting Humanism, Communication Skills, Complementary and Alternative Medicine and Physician Self-Care: An Evaluation of the HEART Program

In 2002 the American Medical Student Association (AMSA) created a fourth-year medical student elective known as the Humanistic Elective in alternative medicine, Activism, and Reflective Transformation (HEART) that provided the opportunity for students to explore humanism in medicine, self-care, complementary and alternative medicine modalities, communication, activism, and community building in a four-week immersion experience. The educational effects of this elective, and whether it has met its stated goals, are unknown. The authors conducted a web-based, cross-sectional survey of the first eight cohorts of HEART graduates in 2010. Survey questions assessed respondents' demographics and perspectives on the educational impact of the elective. Descriptive statistics were used to characterize the sample and qualitative analyses were guided by grounded theory. Of 168 eligible alumni, 122 (73%) completed the survey. The majority were female (70%), age ≤35 (77%) years, and trained in primary care specialties (66%). Half were attendings in practice. The majority of respondents felt the elective taught professionalism (89%) and communication skills (92%) well or very well. The majority highly agreed that the elective helped them better cope with stress during residency training (80%), taught them self-care skills (75%), and improved their ability to empathize and connect with patients (71%). Qualitative analysis of the personal and professional impact of the elective identified twelve common themes with self-discovery, self-care, and collegial development/community most frequently cited. The majority of HEART graduates endorse learning important skills and benefiting from the experience both personally and professionally. Aspects of the HEART curriculum may help training programs teach professionalism and improve trainee well-being.

Educational Programs at the UCLA Center for East West Medicine: Undergraduate, Graduate, and Beyond

In 2002 the American Medical Student Association (AMSA) created a fourth-year medical student elective known as the Humanistic Elective in alternative medicine, Activism, and Reflective Transformation (HEART) that provided the opportunity for students to explore humanism in medicine, self-care, complementary and alternative medicine modalities, communication, activism, and community building in a four-week immersion experience. The educational effects of this elective, and whether it has met its stated goals, are unknown.The authors conducted a web-based, cross-sectional survey of the first eight cohorts of HEART graduates in 2010. Survey questions assessed respondents’ demographics and perspectives on the educational impact of the elective. Descriptive statistics were used to characterize the sample and qualitative analyses were guided by grounded theory.Of 168 eligible alumni, 122 (73%) completed the survey. The majority were female (70%), age ≤35 (77%) years, and trained in primary care specialties (66%). Half were attendings in practice. The majority of respondents felt the elective taught professionalism (89%) and communication skills (92%) well or very well. The majority highly agreed that the elective helped them better cope with stress during residency training (80%), taught them self-care skills (75%), and improved their ability to empathize and connect with patients (71%). Qualitative analysis of the personal and professional impact of the elective identified twelve common themes with self-discovery, self-care, and collegial development/community most frequently cited.The majority of HEART graduates endorse learning important skills and benefiting from the experience both personally and professionally. Aspects of the HEART curriculum may help training programs teach professionalism and improve trainee well-being.

Gun Deaths, The Invisible Epidemic, by the Numbers

In 2002 the American Medical Student Association (AMSA) created a fourth-year medical student elective known as the Humanistic Elective in alternative medicine, Activism, and Reflective Transformation (HEART) that provided the opportunity for students to explore humanism in medicine, self-care, complementary and alternative medicine modalities, communication, activism, and community building in a four-week immersion experience. The educational effects of this elective, and whether it has met its stated goals, are unknown.The authors conducted a web-based, cross-sectional survey of the first eight cohorts of HEART graduates in 2010. Survey questions assessed respondents’ demographics and perspectives on the educational impact of the elective. Descriptive statistics were used to characterize the sample and qualitative analyses were guided by grounded theory.Of 168 eligible alumni, 122 (73%) completed the survey. The majority were female (70%), age ≤35 (77%) years, and trained in primary care specialties (66%). Half were attendings in practice. The majority of respondents felt the elective taught professionalism (89%) and communication skills (92%) well or very well. The majority highly agreed that the elective helped them better cope with stress during residency training (80%), taught them self-care skills (75%), and improved their ability to empathize and connect with patients (71%). Qualitative analysis of the personal and professional impact of the elective identified twelve common themes with self-discovery, self-care, and collegial development/community most frequently cited.The majority of HEART graduates endorse learning important skills and benefiting from the experience both personally and professionally. Aspects of the HEART curriculum may help training programs teach professionalism and improve trainee well-being.

A Compelling Practice: Empowering Future Leaders in the Medical Humanities

Medical students and faculty explore the medical humanities for diverse reasons: as a medium for self-reflection, a means to cultivate professionalism and humanism, and a way to gain an appreciation for the broader contexts in which illness and health occur. One important area for development is increasing the exposure of learners and clinicians of various levels of training to the medical humanities and to role models in the field. Student-led programs in the medical humanities at the American Medical Student Association (AMSA) address these needs by offering unique opportunities for learning and sharing experiences. AMSA programs connect physicians-in-training using technology to create virtual communication and learning opportunities. These include monthly book discussion webinars, the Writers' Institute and the Medical Humanities Scholars Program (MHSP).

Physician Trainees’ Interactions with the Pharmaceutical Industry

To the Editors—It is striking that Austad et al1 found no association between an institution’s grade on the American Medical Student Association (AMSA) conflict-of-interest (COI) policy scorecard and its trainees’ behavior and attitudes toward industry—findings which contradict those of contemporaneous studies. For example, King et al found that graduates of medical schools that banned industry gifts were less likely to prescribe newly marketed “me-too” psychotropic drugs than were graduates of programs without such policies.2 And Epstein et al found that “rates of prescribing heavily promoted, brand reformulated, and brand antidepressants in 2009 were lower among post-COI graduates than pre-COI graduates at all levels of COI restrictiveness.3 Of note, Austad et al did show that a majority of medical trainees are critical of the pharmaceutical industry’s marketing strategies, up from 2005, when Sierles et al found that fewer than a quarter of third-year medical students supported separation between the pharmaceutical industry and trainees.4 To make progress in enhancing objectivity and integrity in medical education, we must take a multifaceted approach, including both adoption and meaningful enforcement of strong conflict-of-interest policies, along with improved education of trainees and faculty on the clinical consequences of industry influence.

Profiles in Science for Science Librarians: Anthony S. Fauci, M.D.

Tony Fauci is arguably America's best known clinical investigator and federal medical research administrator. He has authored a torrent of papers in research and professional journals (1,368 as of May 15, 2013) and has appeared well over 100 times on TV news shows explaining aspects of America's fight against autoimmune and infectious diseases, particularly AIDS. The vast majority of today's American medical students and their librarians will also recognize him as editor in chief of the best-selling textbook Harrison's Principles of Internal Medicine. He has been awarded honorary degrees by thirty-eight universities, including Harvard, Yale, Princeton, Penn, and Georgetown. His productivity and visibility have spanned three generations of Americans, and yet his work has probably had an even greater impact far beyond our borders. An analysis of the evolving assortment of journals in which he has been published over the course of his career discloses three major patterns: a progressively higher proportion of more prestigious titles as he tackled bigger and bigger scientific and clinical challenges; an extraordinary output of “big picture” papers (generally one in every twenty of his papers were invited review articles); as well as great willingness to publish in brand-new journals (twenty-six), most of which would go on to be highly successful.

Physician Trainees’ Interactions with the Pharmaceutical Industry

The Authors’ Reply—The differences Ramachandran et al. note between our results1 and two other recent publications2,3 may be explained by both the analytic approaches used in our different studies and the outcomes we examined. In their important papers, both King et al. and Epstein et al. analyzed prescribing patterns for psychoactive drugs, using difference-in-differences models that dichotomized medical schools or residency training programs based on their conflict of interest policies alone, and found that those policies were important predictors of subsequent actual drug prescribing decisions. By contrast, we examined the relationship between students’ self-reported receipt of gifts and two characteristics of their medical schools—conflict of interest policies represented by the American Medical Student Association (AMSA) PharmFree Scorecard score and National Institutes of Health (NIH) funding. We found that students’ receipt of gifts correlates strongly with lower levels of NIH funding at their schools, but less so with the schools’ AMSA score after controlling for NIH funding level, suggesting that a higher AMSA score is closely correlated with a school’s receiving above-average NIH funding. As a result, the score may add little further power to account for this behavior beyond the research intensity of the institution. Our findings should not be interpreted to reduce the importance of institutional policies to control conflict of interest issues for trainees. This is still a young area of investigation, and more studies such as these are needed to clarify the best way to implement conflict of interest policies, and the effect of doing so on improving clinical decision-making. These policies emerged in the King et al. and Epstein et al. studies as valid predictors of subsequent rational prescribing behavior on the part of trainees. Despite these salutary downstream effects, our findings also suggest that the reported policies may not completely reflect the day-to-day reality of the medical learning environment that shape trainees. We agree with Ramachandran et al. that meaningful enforcement of conflict of interest policies is essential. Further research can identify better ways to measure implementation of these policies to ensure that resources are optimally directed to interventions that will change trainees’ attitudes and behaviors to benefit patients. Finally, we would like to direct readers’ attention to the revised Figure 1 in an accompanying Erratum. The original Figure contained clerical errors in the regression models.

Apreciación de estudiantes de Medicina latinoamericanos sobre la capacitación universitaria en investigación científica

Learning research skills should be a goal during undergraduate training of physicians.To identify Latin American medical students' appraisal on research skills university training.A self-administered survey about experience in research, self-assessment of research skills, quality of training in the area received at the university and that importance of publishing as undergraduate students, was answered by 208 medical students aged 23 ± 3 years (54% male), attending a medical students congress.Seventy percent of respondents pertained to medical students' scientific societies and 34% had published in a scientific journal. Fifty two percent considered as good or very good the training level received at their universities on information retrieval and 45% considered good the training in research methodology. Thirty two percent considered as poor or none the training received in scientific writing and 37% in the publishing process. Eighty nine percent considered student publishing as important and 61% perceived limitations in this matter.The university training level received by Latin American medical students on research and publication process was evaluated as deficient by these students.

Do you D.A.RE. take the USMLEs?: The stages an IMG (International Medical Graduate) goes through while taking the “Steps”: My experience

When we graduate from our medical school we only have one dream, to be able one day to change a patient’s life for the better. And in order to do so, we hope to get research opportunities and advance our knowledge and skills in up-to-date medical institutions. We dream to become practicing physicians in the USA, where most of the innovations in the medical field take place. The first step towards that goal is to have our medical school credentials from our home country verified by the ECFMG (Educational Committee for Foreign Medical Graduates) and pass a series of exams called USMLEs (United States Medical Licensing Examinations), exams that American medical students take as well. Only after passing these exams we become eligible to apply for our residency. Preparing for the ‘‘Steps’’ of the USMLE is a unique experience. It can get frustrating, exhausting, anxiety-provoking but the end (the successful end that is) is so satisfying. It is a magical journey in the way that gets us back through all the phases we went through during medical school. And even though we would never admit it, those years will always have a special place in our hearts.

Design and validation of a scale to assess Latin American medical students' perception on the labour of the first level of health care

To design and validate a scale to assess Latin American medical students' perception on first level of health care (FLHC). An observational, analytic and multicentre study was carried out in two phases: i) A self-administered questionnaire regarding perceptions on FLHClabor was designed. ii) This questionnaire was applied to to medical students from 18 universities of eight Spanish-speaking Latin American countries. An exploratory factor analysis (EFA) was performed through a principal components analysis with orthogonal varimax rotation. Sample adequacy was evaluated. Factor extraction was based on Kaiser's criteria, Cattell's Scree test and the explained variance (>5%). Internal consistency was measured with Cronbach's alpha. 423 students were included in the analysis; 53.4% were from Peruvian universities. After the EFA, the questionnaire conserved 11 items, which were distributed in three domains, that explaining together 55.47% of the total variance: i) Perceptions concerning the FLHC physician; ii) Perceptions concerning the FiLC labor and iii) Perceptions about the economic consequences of working in FLHC. The scale is composed by three domains and can be used to assess the perceptions of the medical work on first level of health care of Spanish-speaking Latin American medical students.

Exposure to, Understanding of, and Interest in Interventional Radiology in American Medical Students

The purposes of this study were to determine the degree to which medical students are exposed to interventional radiology (IR) in medical school, to assess their knowledge of the field, and to gauge their interest in IR as a career choice. An institutional review board-approved survey was generated using the website www.surveymonkey.com. Medical student participation nationwide was elicited by sending e-mails to administrators of medical schools and radiology residency program directors and asking them to distribute the survey link to their students. Seven hundred twenty-nine medical students from 21 states responded to the survey. Although 58% of students said they were interested in a hands-on career, only 5.5% of students said they had participated in an IR rotation and only 12.7% were interested in IR. Less than half of the IR domain-related questions used to assess understanding of IR were answered correctly, with greater understanding found among the students who had participated in an IR rotation. Exposure to IR in accredited US medical education programs is inconsistent, although interest in the field is moderate among medical students compared with interest in other hands-on specialties. Understanding of IR is limited among the study population. Improved understanding of the field and recruitment could result from greater exposure.

Changing Interactions Between Physician Trainees and the Pharmaceutical Industry: A National Survey

Increasingly, medical school policies limit pharmaceutical representatives' access to students and gifts from drugmakers, but little is known about how these policies affect student attitudes toward industry. To assess interactions between trainees and the pharmaceutical industry, and to determine whether learning environment characteristics influence students' practices and attitudes. We conducted a cross-sectional survey with a nationally-representative sample of first- and fourth-year medical students and third-year residents, stratified by medical school, including ≥ 14 randomly selected trainees at each level per school. We measured frequency of industry interactions and attitudes regarding how such interactions affect medical training and the profession. Chi-squared tests assessed bivariate linear trend, and hierarchical logistic regression models were fitted to assess associations between trainees' attitudes and their schools' National Institutes of Health (NIH) funding levels and American Medical Student Association (AMSA) PharmFree Scorecard grades reflecting industry-related conflict of interest policies. Among 1,610 student (49.3 % response rate) and 739 resident (43.1 %) respondents, industry-sponsored gifts were common, rising from 33.0 % (first-year students) to 56.8 % (fourth-year students) and 54 % (residents) (p < 0.001). These gifts included meals outside the hospital (reported by 5 % first-year students, 13.4 % fourth-year students, 27.5 % residents (p < 0.001)) and free drug samples (reported by 7.4 % first-year students, 14.1 % fourth-year students, 14.3 % residents (p < 0.001)). The perception that industry interactions lead to bias was prevalent, but the belief that physicians receive valuable education through these interactions increased (64.1 % to 67.5 % to 79.8 %, p < 0.001). Students in schools receiving more NIH funding reported industry gifts less often (OR = 0.51, 95 % CI: 0.38-0.68, p < 0.001), but the strength of institutional conflict of interest policies was not associated with this variable. Despite recent policy changes, a substantial number of trainees continue to receive gifts from pharmaceutical representatives. We found no relation between these outcomes and a school's policies concerning interactions with industry.

Perspective

Ours is an age of unprecedented levels of environmental alteration and biodiversity loss. Beyond the exposure to environmental hazards, conditions such as environmental degradation, biotic impoverishment, climate change, and the loss of ecosystem services create important health threats by changing the ecology of many pathogens and increasing the incidence and/or severity of certain noncommunicable conditions. They also threaten health in the future by weakening the Earth's life support systems.Although physicians remain one of the most often accessed and most trusted sources of information about the environment, there is currently little emphasis on educating medical professionals about these environmental issues. This lack of training reduces the ability of most physicians to be efficient science-public interfaces and makes them ineffective at contributing to address the fundamental causes of environmental problems or participate in substantive environmental policy discussions. This is an important challenge facing medical education today.To turn medical students into effective physician-citizens, an already-overwhelmed medical school curriculum must make way for a thoughtful exploration of environmental stressors and their impacts on human health. The overarching question before medical educators is how to develop the competencies, standards, and curricula for this educational endeavor. To this end, the authors highlight some of the critical linkages between health and the environment and suggest a subset of key practical issues that need to be addressed in order to create environmental education standards for the physician of the future.

CME Information:Sexuality Education in North American Medical Schools: Current Status and Future Directions (CME)

Both the general public and individual patients expect healthcare providers to be knowledgeable and approachable regarding sexual health. Despite this expectation there are no universal standards or expectations regarding the sexuality education of medical students. To review the current state of the art in sexuality education for North American medical students and to articulate future directions for improvement. Evaluation of: (i) peer-reviewed literature on sexuality education (focusing on undergraduate medical students); and (ii) recommendations for sexuality education from national and international public health organizations. Current status and future innovations for sexual health education in North American medical schools. Although the importance of sexuality to patients is recognized, there is wide variation in both the quantity and quality of education on this topic in North American medical schools. Many sexual health education programs in medical schools are focused on prevention of unwanted pregnancy and sexually transmitted infection. Educational material on sexual function and dysfunction, female sexuality, abortion, and sexual minority groups is generally scant or absent. A number of novel interventions, many student initiated, have been implemented at various medical schools to improve the student's training in sexual health matters. There is a tremendous opportunity to mold the next generation of healthcare providers to view healthy sexuality as a relevant patient concern. A comprehensive and uniform curriculum on human sexuality at the medical school level may substantially enhance the capacity of tomorrow's physicians to provide optimal care for their patients irrespective of gender, sexual orientation, and individual sexual mores/beliefs.

How and why social science theory can contribute to medical education research

How and why social science theory can contribute to medical education research

Preparing Students to Be Academicians

Medical schools have the responsibility of producing future leaders in academic medicine, yet few students choose academic medicine as a career. In 2009, the American Medical Student Association (AMSA) and the George Washington University School of Medicine and Health Sciences joined forces to provide students with a comprehensive introduction to careers in academic medicine through the redesign of an existing annual summer program for medical students. Since 2004, AMSA had hosted the Medical Education Leadership Institute, a weeklong program that attracted medical students from across the country who were interested in gaining teaching skills. In the redesigned sixth annual program, the authors expanded the curriculum to include principles of leadership, of medical education scholarship (or project development), and of academic medicine career-building. The purpose of this article is to describe the features of this comprehensive program and to share the lessons learned from its development and implementation. The authors also describe the multifaceted approach they used to evaluate the program, which featured a rubric they derived from social cognitive career theory.

The Impact of Participation in Undergraduate Extracurricular Activities on the Transformation of Habitus among American Medical Students

Building on the work of Pierre Bourdieu, we look at the question of whether extracurricular activities at the undergraduate level have an impact on American medical students' habitus, which we operationalize as a sense of inclusion, belonging. Using a national sample of 375 medical students and controlling for relevant variables, we find that for students from high-prestige backgrounds, being white is the major influence on sense of belonging. For students from low-prestige backgrounds, being white, multiple school acceptances, and participation in cultural activities as undergraduates are directly related to sense of belonging. The effect of participation in undergraduate cultural activities on sense of belonging illustrates the hysteresis effect. We discuss the consequences of cultural omnivorousness with its implications for a broad symbolic touch including the ability to decode a wide range of cultural texts in physician–patient communication in the context of a diverse population.