Medical School Entry Research Articles

Relationship between decile score of secondary school, the size of town of origin and career intentions of New Zealand medical students

New Zealand is facing a general practice workforce crisis, especially in rural communities. Medical school entrants from low decile schools or rural locations may be more likely to choose rural general practice as their career path. To determine whether a relationship exists between secondary school decile rating, the size of the town of origin of medical students and their subsequent medical career intentions. University of Auckland medical students from 2006 to 2008 completed an entry questionnaire on a range of variables thought important in workforce determination. Analyses were performed on data from the 346 students who had attended a high school in New Zealand. There was a close relationship between size of town of origin and decile of secondary school. Most students expressed interests in a wide range of careers, with students from outside major cities making slightly fewer choices on average. There is no strong signal from these data that career specialty choices will be determined by decile of secondary school or size of town of origin. An increase in the proportion of rural students in medical programmes may increase the number of students from lower decile schools, without adding another affirmative action pathway.

Predicting medical students’ intentions to take up rural practice after graduation

Using a novel longitudinal tracking project, this study develops and evaluates the performance of a predictive model and index of rural medical practice intention based on the characteristics of incoming medical students. Medical school entry survey data were obtained from the Medical Schools Outcome Database (MSOD) project implemented in all Australian and New Zealand medical schools and coordinated through Medical Deans Australia and New Zealand, the representative body for the Deans of 18 Australian and two New Zealand medical schools and faculties. The medical school commencement survey collects data on students' education and family background, including rural upbringing, personal circumstances and scholarships, and on their practice intentions in terms of location and specialty. The MSOD will also allow tracking of medical graduates after graduation. Logistic regression modelling was used to develop a predictive model of rural practice intention. Split-sample validation was used to gain some insight into the stability of performance of the model. Response rates to the MSOD survey exceeded 90% on average. The model findings confirm and extend previous research examining the association of medical student characteristics with intention to take up rural medical practice. The statistically significant independent factors in the model included students' rural backgrounds, financial arrangements and intentions regarding specialist versus generalist practice upon graduation. Model performance was good, with an area under the receiver-operator characteristics curve of 0.86, and reproducible, with an area in a validation sample of 0.83. The model and related index provide important insights into individual factors associated with rural practice intention among students commencing medical studies. The model can also provide a means for optimising the use of scarce medical programme resources, thereby helping to improve the supply of rural medical practitioners. This study illustrates the power and potential of a robust, consistent, systematic longitudinal tracking project.

Whether or wither some specialties: a survey of Canadian medical student career interest

BackgroundGiven the looming shortage of physicians in Canada, we wished to determine how closely the career preference of students entering Canadian medical schools was aligned with the current physician mix in Canada.MethodsCareer choice information was collected from a survey of 2,896 Canadian medical students upon their entry to medical school. The distribution of career choices of survey respondents was compared to the current physician speciality mix in Canada.ResultsWe show that there is a clear mismatch between student career choice at medical school entry and the current specialty mix of physicians in Canada. This mismatch is greatest in Urban Family Medicine with far fewer students interested in this career at medical school entry compared to the current proportion of practicing physicians. There are also fewer students interested in Psychiatry than the current proportion of practicing physicians.ConclusionThis mismatch between the student interest and the current proportion of practicing physicians in the various specialities in Canada is particularly disturbing in the face of the current sub-optimal distribution of physicians. If nothing is done to correct this mismatch of student interest in certain specialities, shortages and misdistributions of physicians will be further amplified. Studies such as this can give a window into the future health human resources challenges for a nation.

Choosing a Career in Psychiatry: Factors Associated with a Career Interest in Psychiatry among Canadian Students on Entry to Medical School

To report the proportion of Canadian medical students interested in a career in psychiatry at medical school entry and to describe the unique demographics and career influences associated with this early interest. From 2001 to 2004, during the first 2 weeks of medical school, a 41-item survey of career choice, demographics, and attitudes toward various aspects of medical practice was distributed to all students in 18 classes at 8 Canadian medical schools. Associations between early career interest, demographics, and career influences were explored. Of the 2096 completed surveys, 3.2% of students named psychiatry as their first career choice. While 34% of students considered psychiatry a possible career option, 54.9% stated that they had not considered this option. Students interested in psychiatry were more likely than other students to have an undergraduate education in the arts, to have close family or friends practicing medicine, and to have worked voluntarily with people with mental illness. Students interested in psychiatry had a lesser social orientation than students interested in family medicine but had a greater social orientation and lesser hospital orientation than students interested in other specialties. Enhanced psychiatric care may be aided by the selective recruitment into medical school of students with a demonstrated empathy toward people with mental illness, an educational background in the arts, and a strong social orientation. As career influences change throughout medical school, participants in this study will be re-surveyed at graduation to better understand the evolution of career choice decision-making throughout medical school.

Emergency medicine as a career choice: a descriptive study of Canadian medical students

Studies indicate that a student's career interest at medical school entry is related to his or her ultimate career. We sought to determine the level of interest in emergency medicine among students at the time of medical school entry, and to describe characteristics associated with students primarily interested in emergency medicine. We surveyed students in 18 medical school classes from 8 Canadian universities between 2001 and 2004 at the commencement of their studies. Participants listed their top career choice and the degree to which a series of variables influenced their choices. We also collected demographic data. Of 2420 surveys distributed, 2168 (89.6%) were completed. A total of 6.1% (95% confidence interval 5.1%-7.1%) of respondents cited emergency medicine as their first career choice. When compared with students primarily interested in family medicine, those primarily interested in emergency medicine reported a greater influence of hospital orientation and a lesser influence of social orientation on their career choice. When compared with students primarily interested in the surgical specialties, those primarily interested in emergency medicine were more likely to report medical lifestyle and varied scope of practice as important influences. When compared with students primarily interested in the medical specialties, those who reported interest in emergency medicine were more likely to report that a hospital orientation and varied scope of practice were important influences, and less likely to report that social orientation was important. Students primarily interested in emergency medicine at medical school entry have attributes that differentiate them from students primarily interested in family medicine, the surgical specialties or the medical specialties. These findings may help guide future initiatives regarding emergency medicine education.

The educational background and qualifications of UK medical students from ethnic minorities

BackgroundUK medical students and doctors from ethnic minorities underperform in undergraduate and postgraduate examinations. Although it is assumed that white (W) and non-white (NW) students enter medical school with similar qualifications, neither the qualifications of NW students, nor their educational background have been looked at in detail. This study uses two large-scale databases to examine the educational attainment of W and NW students.MethodsAttainment at GCSE and A level, and selection for medical school in relation to ethnicity, were analysed in two separate databases. The 10th cohort of the Youth Cohort Study provided data on 13,698 students taking GCSEs in 1999 in England and Wales, and their subsequent progression to A level. UCAS provided data for 1,484,650 applicants applying for admission to UK universities and colleges in 2003, 2004 and 2005, of whom 52,557 applied to medical school, and 23,443 were accepted.ResultsNW students achieve lower grades at GCSE overall, although achievement at the highest grades was similar to that of W students. NW students have higher educational aspirations, being more likely to go on to take A levels, especially in science and particularly chemistry, despite relatively lower achievement at GCSE. As a result, NW students perform less well at A level than W students, and hence NW students applying to university also have lower A-level grades than W students, both generally, and for medical school applicants. NW medical school entrants have lower A level grades than W entrants, with an effect size of about -0.10.ConclusionThe effect size for the difference between white and non-white medical school entrants is about B0.10, which would mean that for a typical medical school examination there might be about 5 NW failures for each 4 W failures. However, this effect can only explain a portion of the overall effect size found in undergraduate and postgraduate examinations of about -0.32.

Even one star at A level could be "too little, too late" for medical student selection

BackgroundMore and more medical school applicants in England and Wales are gaining the maximum grade at A level of AAA, and the UK Government has now agreed to pilot the introduction of a new A* grade. This study assessed the likely utility of additional grades of A* or of A**.MethodsStatistical analysis of university selection data collected by the Universities and Colleges Admissions Service (UCAS), consisting of data from 1,484,650 applicants to UCAS for the years 2003, 2004 and 2005, of whom 23,628 were medical school applicants, and of these 14,510 were medical school entrants from the UK, aged under 21, and with three or four A level results. The main outcome measure was the number of points scored by applicants in their best three A level subjects.ResultsCensored normal distributions showed a good fit to the data using maximum likelihood modelling. If it were the case that A* grades had already been introduced, then at present about 11% of medical school applicants and 18% of entrants would achieve the maximum score of 3 A*s. Projections for the years 2010, 2015 and 2020 suggest that about 26%, 35% and 46% of medical school entrants would have 3 A* grades.ConclusionAlthough A* grades at A level will help in medical student selection, within a decade, a third of medical students will gain maximum grades. While revising the A level system there is a strong argument, as proposed in the Tomlinson Report, for introducing an A** grade.

Is the grass greener? A survey of female pediatric surgeons in the United Kingdom

Background/Purpose Since 1990, at least 50% of UK medical school entrants have been females, although women comprise only 2% of surgical consultants. If women continue to reject surgical careers, recruitment will be limited to a decreasing pool of male applicants. A recent North American study suggested lack of mentorship and role models may be contributory factors. We undertook a survey of UK female pediatric surgeons to ascertain career satisfaction and professional development. Methods UK female pediatric surgeons were identified from the British Association of Pediatric Surgeons members' handbook 2004 and via personal communication. Postal or e-mail questionnaires were sent and anonymized responses were analyzed. Results Thirty-three questionnaires were distributed to all 16 female consultants (13% of BAPS consultant workforce) and 17 trainees (SpRs [specialist registrars/higher surgical trainees]). Twenty-seven (82%) replies were received. Of 27 (85%) respondents, 23 worked full time; “on-call” commitments range from 1 in 2 (2 consultants) to 1 in 8, with several trainees working shifts. Eighteen (67%) respondents had taken a career break—11 for maternity leave. Twelve (44%) are planning further “time-out,” of whom 10 are SpRs. Ninety-three percent are contented with their career and would choose pediatric surgery again. However, 19 (70%) reported factors that had hindered their development, 13 (68%) included insufficient research time, whereas only 3 cited a lack of mentorship. Conclusions Female representation in medicine is increasing. In contrast to North American experience, very few UK female pediatric surgeons felt hampered by lack of mentorship or role models. Education and training committees need to work proactively to ensure training programs achieve clinical excellence to continue to attract women into pediatric surgery. For women in the United Kingdom, pediatric surgery challenges will also be met by ensuring healthy “work-life balance,” along with flexibility in training and established consultant practice.

A future career in general practice? A longitudinal study of medical students and pre-registration house officers

Objective: To monitor the future career preferences of medical students throughout their undergraduate years and into their postgraduate career, and to evaluate which factors may influence career choice intentions, and when this happens, over time. Design: Longitudinal study. Methods: Questionnaire to all Aberdeen, United Kingdom, Medical School entrants in 1996, and five annual follow-ups (four undergraduate, one postgraduate). Results: Response rates: year 1, 100%; year 2, 78%; year 3, 70%; year 4, 64%; year 5, 65%; pre-registration house officer (PRHO), 60%. Throughout the study, females were more positive about a career in general practice. General practice was the first choice for 13% of students in year 1; year 2, 9%; year 3, 22%; year 4, 24%; year 5, 27%; PRHO, 29%. Those choosing general practice were more likely than those choosing other specialties to be female, have their family home in Scotland, rate their academic abilities lower and their non-academic abilities as average, and have decided on their future career earlier. Reasons for general practice included: working in and being part of a community; continuity of patient contact; variety of illnesses and people encountered; undergraduate teaching experiences; dislike of or disillusionment with hospital medicine; and an increasing awareness of part-time opportunities.Conclusion: As medical undergraduates progressed through the curriculum and became PRHOs, general practice became more popular as a career choice, particularly with females. This may be partly explained by the increased exposure to general practitioners and patients in the new community-based teaching programme and the increasing awareness of lifestyle advantages with the particular benefits of more regular hours and working part time.

Symposium for Medical School Entrance Examinations

Symposium for Medical School Entrance Examinations

Internal medicine residency training in Turkey

Medical school entrance depends on passing a central examination that is given annually by the National Selection and Placement Center. Undergraduate medical education takes 6 years. About 5000 students graduate from medical faculties annually. The central exam necessary for residency training is given by the National Selection and Placement Center. A Specialist Training Regulation regulates residency training. Internal medicine residency training takes 4 years and includes inpatient and outpatient care in wards and rotations. Residents prepare a dissertation that is used in the evaluation of residency competency. At the end of the residency period, residents who have been successful in previous evaluations take an oral exam followed by a written exam, which lead to their certification in internal medicine. Residents' scientific knowledge and skills are assessed by a jury consisting of five people, four from the same department and one from the equivalent department in another training institution. The title of specialist is granted after a certification exam given by training institutions and approved by the Ministry of Health. Internists are mainly employed in state hospitals, which are under the Ministry of Health. Subspecialty areas in internal medicine include gastroenterology, geriatrics, endocrinology, nephrology, hematology, rheumatology, immunology, allergology, and oncology. The training period for a subspecialty is 2 years. A substantial effort is being made all over the country to improve regulations and health care service delivery. These changes will also affect the residency training and manpower planning and employment of internists.

Impact of social factors on health status and help seeking behavior among migrants and Germans

Several studies show significant differences between Germans and migrants in health status, help-seeking behavior and utilization of health care facilities. Social factors are potential determinants partially explaining these differences. The main objective of the present cross-sectional study is to study the impact of social factors on health status and health care utilization including preventive services among Germans and migrants in the German health care system. A survey was conducted among 565 adults (mostly parents; 49% migrants, 51% Germans) accompanying their children at the compulsory medical school entry examination. The survey aimed at the self-reported health status of the adults, the help-seeking behavior, social and demographic variables as well as factors describing the ethnic background and the process of migration. As a result we found a statistically significant lower level of health care utilization for migrants compared to Germans whereas the self-reported health status was similar between Germans and migrants and not dependant on social factors. Social factors accounted for differences in health care utilization including the use of preventive services among both groups (Germans and migrants). Despite the ethnic background, a low social class was significantly associated with a decreased use of health care facilities among Germans and migrants compared to adults from a high social class. Further studies are needed to identify certain obstacles to utilizing the German health care system by adults from a low social class. Public health interventions could be suitable for addressing these difficulties.

Graduate entry to medical school? Testing some assumptions.

Debate abounds regarding the most appropriate candidates to admit to medical school. This paper examines whether there is any advantage to admitting 'graduate' entrants over secondary school leavers on selected medical school and practice outcomes. To compare the medical school experiences, research and academic achievements and practice outcomes of graduates who entered 1 medical school in Australia directly from high school (secondary school entry) to those of graduates who entered with tertiary level education (tertiary entry). Cross-sectional study using a mail-out survey to graduates from the first 16 graduating years (1983-98 inclusive) of the University of Newcastle Medical School. Secondary school entrants were, on average, 8 years younger than tertiary entrants and were less likely to have received rural-based schooling. However, there were no differences with respect to gender or type of secondary school attended (public or private). Motivations for studying medicine did not generally differ according to entry type, except that more secondary students were motivated by parental expectations and more tertiary entrants were motivated by the need for professional independence and the desire to prevent disease. A greater proportion of tertiary entrants experienced stress at medical school. However, secondary students experienced more stress due to doubts about being a doctor, while tertiary entrants experienced more stress due to lack of leisure time, finances and balancing commitments. There were no significant differences between the groups in terms of academic performance (as measured by the award of medical school honours) or research outcomes (as measured by completion of a research degree during or after medical school training, publication of scientific papers or holding career posts in the research sciences). There were no differences in career positions held by clinicians, choice of general practice or another specialty as a career, practice location (rural or urban) or employment sector (public or private). There is no clear advantage, at least on the outcomes measured in this study, to limiting medical school entry to either those candidates from secondary school or those with tertiary backgrounds. Medical schools could reasonably broaden their selection criteria to include more graduate entry candidates in addition to secondary school leavers without compromising medical school and practice outcomes.

Impact of undergraduate and postgraduate rural training, and medical school entry criteria on rural practice among Australian general practitioners: national study of 2414 doctors.

To determine the association between rural undergraduate training, rural postgraduate training and medical school entry criteria favouring rural students, on likelihood of working in rural Australian general practice. National case-control study of 2414 rural and urban general practitioners (GPs) sampled from the Health Insurance Commission database. Participants completed a questionnaire providing information on demographics, current practice location and rural undergraduate and postgraduate experience. Rural GPs were more likely to report having had any rural undergraduate training [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.32-1.95] than were urban GPs. Rural GPs were much more likely to report having had rural postgraduate training (OR 3.14, 95% CI 2.57-3.83). As the duration of rural postgraduate training increased so did the likelihood of working as a rural GP: those reporting that more than half their postgraduate training was rural were most likely to be rural GPs (OR 10.52, 95% CI 5.39-20.51). South Australians whose final high school year was rural were more likely to be rural GPs (OR 3.18, 95% CI 0.99-10.22). Undergraduate rural training, postgraduate training and medical school entry criteria favouring rural students, all are associated with an increased likelihood of being a rural GP. Longer rural postgraduate training is more strongly associated with rural practice. These findings argue for continuation of rural undergraduate training opportunities and rural entry schemes, and an expansion in postgraduate training opportunities for GPs.

What is a good tutorial from the student's point of view? Evaluation of tutorials in a newly established PBL block course "Basics of Drug Therapy".

Problem-based learning (PBL) within a tutorial is the core element in a 6-week block course "Basics in Drug Therapy" recently introduced into the medical curriculum of an eastern German university. Under the supervision of one tutor a group of 6-9 students solved a total of six clinical cases related to drugs used in general anaesthetics; to analgetic/antiphlogistic, antihypertensive, cardiovascular and lipid-lowering drugs; to drugs acting on the central nervous system; and to intoxicating agents. By answering questionnaires students and tutors extensively evaluated each individual case as well as the whole block course. Factors evaluated also included students' and tutors' behaviour during sessions. The purpose of the analysis was to identify factors associated with the students' perception of tutorials with the aim of improving future courses. The ratings which tutorials, cases and tutor performance received by the students differed significantly between 14 groups that could be analysed. A ranking order of groups was established according to the scores they gave for the cases and the three groups with top ratings were further compared with the three groups with lowest ratings. We found significant differences between the two groups in their assessment of tutor performance and perception of team-work during tutorials. The tutors of the groups giving top ratings were considered to have more effectively supported the students' work during tutorials. Furthermore, self-assessment of the tutors judging their own ability to facilitate PBL correlated with their familiarity with case content. The marks achieved in the first national exam (i.e. "Physikum", equivalent to medical school entrance exams), performance in triple jump examination and multiple choice test at the end of the course, or marks obtained in the first state board exam after the course, did not differ between the two groups. From students' point of view, the main characteristics for a good tutorial as far as tutors are concerned consist of allowing enough time for discussion, accepting students as partners, refraining from interference and having expertise. As a consequence we will increase our efforts to optimise case quality as well as support and training of tutors in order to improve our new PBL course.

University Pre-medical Academic Performance as a Predictor of performance in the Medical School: A Case Study at the College of Medicine of the University of Lagos

The present study was carried out to evaluate student achievement in medical school professional examinations in the light of previous pre-medical school academic performance. This was done as part of the process of evaluating factors which might contribute to academic success and high quality of medical education. Medical and Dental students of the University of Lagos Medical School were studied over a five-year performance period. They were divided into high, medium and low-performance groups based on their performance in the pre-medical school examination. The high performance group were students who scored above 59%, medium performance — those who scored between 53% and 58%, while the low-performance group were those who scored below 51%. The mean achievements of the three groups in medical school examinations were studied and compared. It was observed that pre-medical school high-performers continued to perform better than the medium-performers, scoring an average of 60% in all the exams. The medium performers were also found to perform better than the low-performance group, scoring an average of 55% in their exams while the low performers scored an average of 50%. Results of the study imply that performance in the medical school entrance examinations is a good index of student performance and achievement in the medical school and is therefore predictive of future clinical performance. Low performance in pre-medical school exams generally leads to poor performance in the medical school. These results will be relevant when there is need to modify academic and admission policies in the Medical School. Key words: Pre-medical school performance, medical school achievement. [Nig. Jnl Health & Biomedical Sciences Vol.1(1) 2002: 49-53]

Spontaneous concept maps aiding the understanding of scientific concepts

This study evaluated concept maps spontaneously constructed by applicants (N = 502) in a medical school entrance examination. In all, 36 maps were produced. Concept maps were evaluated for content of relevant terms and for the number of interrelationships indicated. The aim was to determine whether including relevant ideas on a concept map is related to the learning of those ideas. Because concept maps are effective tools for making the structure of knowledge explicit, it was hypothesized that the quality and content of spontaneously made maps would be related to improvement in the comprehension of text material. Understanding was assessed in terms of success in essay-type tasks designed to measure the ability to define, explain, and apply statistical knowledge. The results indicated that merely including the relevant concepts in a map has little effect on the comprehension of those concepts, whereas the extent and complexity of concept maps plays a powerful role in the understanding of scientific texts.

Critical thinking: change during medical school and relationship to performance in clinical clerkships.

The development of critical thinking, the ability to solve problems by assessing evidence using valid inferences, abstractions, and generalizations, is one of the global goals advocated by most medical schools. This study determined changes in critical thinking skills between entry and near the end of the third year of medical school, assessed the predictive ability of a test of critical thinking skills, and assessed the concurrent validity of clerkship components and final grade. The Watson-Glaser Critical Thinking Assessment (WGCTA) was administered to one class of students at entry to medical school and near the end of year 3. Performance data for those students who completed their clinical clerkships on schedule were also recorded. Critical thinking improved modestly but significantly from entry to medical school to near the end of year 3. The ability of a critical thinking test to predict clerkship performance was limited; the correlation between WGCTA total score at entry and the components and final grade of five major clerkships ranged from near 0 to 0.34. The concurrent validity of clerkship components and final grade was also limited; correlations with WGCTA total score near the end of year 3 ranged between 0.08 and 0.49. The correlation between WGCTA total score and United States Medical Licensing Examination Step 2 was higher at year 3 than at medical school entry. Critical thinking skills improve moderately during medical school. Used alone, tests of critical thinking may be of limited value in predicting which students will be successful in clinical clerkships. Clerkship evaluation components and final grade have limited concurrent validity when a test of critical thinking is the criterion.

Workplace harassment and the self-medication of distress: a conceptual model and case illustrations

Research addressing the social causation of alcohol abuse has alluded to the tension-management or self-medication function of alcohol consumption. The use of alcohol (as well as other substances) can constitute a means to escape from, avoid, or otherwise regulate unpleasant emotions derived from undesirable social experiences (Cooper, Frone, Russell, Mudar,1995; Cooper, Russell, and George, 1988; Pohorecky, 1991; Wilsnack, 1992). This paper addresses the self-medication of distress engendered by relatively understudied forms of chronic stressors; negative interpersonal experiences in the that potentially may be defined as workplace harassment. We first present a critical review of the literature on contributors to the use of alcohol and drugs, arguing that future research should focus greater attention on interpersonal rather than task-related psychosocial stressors. We then present a conceptual framework for initiating this type of research. This framework focuses on the role of societal social constructions, interpersonal support resources, and attributional processes, which are hypothesized to function as mediators between harassment experiences and the use of substances to self-medicate distress. Last, we present case studies illustrating this model and depict an ongoing study designed to test the proposed model empirically. Workplace stressors as etiologic determinants of drinking behaviors Studies embodying the stress and alienation perspectives on alcohol consumption have examined particular attributes of work that may influence drinking for stress-reduction purposes (Fennell, Rodin and Kantor, 1981; Mandell, Eaton, Anthony and Garrison, 1992; Sonnenstuhl and Trice, 1991). Occupational conditions encompassing heavy work demands but limited control over work (Karasek, Baber, Marxer, Ahlbom and Theorell, 1981; Karasek and Theorell, 1990); Crum, Muntaner, Eaton and Anthony, 1995) or job content that is repetitive and monotonous in nature (Parker and Farmer, 1988, 1990) have received major attention. However, many studies have found limited empirical evidence for a link between stressful work conditions and drinking outcomes (Cooper, Russell and George, 1988; Mensch and Kandel, 1988; Seeman, Seeman and Budros, 1988). Other studies have found that heavy work demands coupled with little control over work (Crum, Muntaner, Eaton and Anthony, 1995) or unchallenging work (Lennon, 1987) are predictive of alcohol outcomes in males but not in females. Some researchers have therefore concluded that personality characteristics brought into work environments or problematic social experiences occurring outside of the play more salient roles in the psychosocial etiology of alcohol abuse than do stressful work conditions (Seeman, Seeman and Budros, 1988). Other researchers have suggested that occupational stress constructs have failed to tap all of the salient domains of stressors that affect female as well as male workers (Richman, Flaherty and Rospenda, 1996). Harassment as an additional domain of stress Variability in the extent to which lack of control over work is experienced as stressful may depend on the source and perceived meaning of the lack of control. Some task requirements, such as the pressure of meeting deadlines, may be viewed as inherent to the nature of given occupations. By contrast, lack of control over work linked to harassing or abusive interpersonal interactions rather than to task-related demands may have very different meanings and implications for perceived stress and the self-medication of related distress by workers in a variety of occupational statuses (Richman, Flaherty and Rospenda, 1996). In particular, abusive treatment by an employee's supervisor (or someone else who can affect an employee's job) might have greater deleterious consequences by virtue of engendering particular negative emotional reactions. Research conducted within one occupation (physicians surveyed from medical school entrance through the internship year of training) demonstrated significant links between negative interpersonal aspects of work and deleterious alcohol outcomes (Richman, Flaherty, Rospenda and Christensen, 1992; Richman, Flaherty and Rospenda, 1996). …

Medical school entrance and career plans of Malaysian medical students.

This study investigates the reasons for entry to medicine and the career perspectives of phase III medical students of the Universiti Sains Malaysia (USM). The majority of the students were Malays from low socio-economic backgrounds who entered medical school after completing a 2-year matriculation course. An interest in medicine and helping people were the two main stated reasons for entry to medical school. A group of students wishing to work in private practice was identified. In comparison to the rest of the study body, students in the group were: not well prepared to enter medical school; dissatisfied with the course; and subject to family influences. A desire for monetary gain motivated their choice of medicine as a career. Overall, 13% of the students wished to change career because they were dissatisfied with their experience of medicine as undergraduates. The study did not find a significant difference in career intentions between female and male medical students. However, women were less likely to seek entrance into private practice or pursue formal postgraduate education. The choice of surgery as a career was confined to men. About 90% of the students had already decided on their future specialty. Four well-established specialties were their most popular choices. The gender of the students had no significant influences of the decision to continue into postgraduate education. The proportion of female students who wished to marry doctors was significantly higher than for male students.