Swedish Medical Students Research Articles

Swedish in Name Only: The International Education of Nineteenth—Century Swedish Medical Students and Practitioners

Travelling abroad to learn about the latest innovations has long history but the importance and mechanisms of these cultural and professional interactions has recently become of growing interest among historians of medicine. Scandinavia is often perceived as being largely peripheral to the events and ideas found on the continent or in Britain and this paper is an attempt to illuminate the degree to which Swedish physicians were part of the medical world of the nineteenth century. Their numerous applications to travel and the published accounts of their adventures certainly throw into question the notion that particular national forms of medical practice and specific innovations waited patiently for permission to cross national borders. Instead, medical students and physicians were actively engaged in the 'Europeanization' of medicine built upon multiple personal and professional connections throughout the continent. In 2005, Ute Frevert defined Europeanness as a web of communication and interaction ... [that] displays different degrees and patterns of involvement, shifting centers and margins, uneven and asymmetric relations, and competitive, often violent encounters, and proposed that various professional networks contributed to the dissemination of knowledge.1By arguing that centres and margins are not fixed in time and space, Frevert's definition also addresses one of the major short-comings with core-periphery models that envision single, hegemonic and largely permanent core and similarly fixed but much weaker periphery. The alleged subservience of the latter on the former is often attributed to the temporal lag between the discovery of innovations and their wider reception and adoption which in turn is dictated by how easily information is able to move between these areas. Timo Myllyntaus suggests six 'channels' by which technology flows from industrial cores to more peripheral areas.2 During the nineteenth century at least three of these same 'channels' existed for the transmission of medical innovations from the continent to Sweden. First, the Swedish government had long history of financing educational trips abroad for its physicians and students so that they could study at foreign universities, visit medical institutions, or attend international conferences. Second, the teaching of medicine within Sweden improved and attracted more and more students at the same time that professional organisations arose with their own journals to foster the exchange of ideas. Third, and perhaps most important was the willingness to accept and import medical knowledge from various European locations regardless of their level of international acclaim. The combination of these forces plus improvements in transportation that enabled individuals to flit from place to place much more easily than in the past, minimised the temporal lag between discovery and implementation. At the same time, the mixing of students and physicians from numerous countries significantly reduced the cultural distance between them. The shrinking of physical and cultural distances, process that quickened during the course of the nineteenth century, makes the utility of thinking in terms and cores increasingly suspect. A clear example of how far supposedly peripheral Sweden had come by the mid-1870s can be seen in the international acclaim Uppsala University received when it celebrated its quatercentenary in 1877. Representatives from thirteen different countries and forty-eight different universities, academies and societies arrived to participate in the festivities and were uniformly impressed with what they saw.3There has been long tradition in Sweden and the rest of Scandinavia of borrowing ideas and technology from abroad so it should not be surprising that medical innovations would similarly find their way into the Swedish cities and countryside.4 Some historians have pointed to Sweden's high literacy rate and the importance the population placed on education, the country's 'human capital', as key reasons for its rapid industrialisation during the late nineteenth century that enabled it to compete with the economic powerhouses of Britain and Germany. …

Measuring strategies for learning regulation in medical education: Scale reliability and dimensionality in a Swedish sample

BackgroundThe degree of learners’ self-regulated learning and dependence on external regulation influence learning processes in higher education. These regulation strategies are commonly measured by questionnaires developed in other settings than in which they are being used, thereby requiring renewed validation. The aim of this study was to psychometrically evaluate the learning regulation strategy scales from the Inventory of Learning Styles with Swedish medical students (N = 206).MethodsThe regulation scales were evaluated regarding their reliability, scale dimensionality and interrelations. The primary evaluation focused on dimensionality and was performed with Mokken scale analysis. To assist future scale refinement, additional item analysis, such as item-to-scale correlations, was performed.ResultsScale scores in the Swedish sample displayed good reliability in relation to published results: Cronbach’s alpha: 0.82, 0.72, and 0.65 for self-regulation, external regulation and lack of regulation scales respectively. The dimensionalities in scales were adequate for self-regulation and its subscales, whereas external regulation and lack of regulation displayed less unidimensionality. The established theoretical scales were largely replicated in the exploratory analysis. The item analysis identified two items that contributed little to their respective scales.DiscussionThe results indicate that these scales have an adequate capacity for detecting the three theoretically proposed learning regulation strategies in the medical education sample. Further construct validity should be sought by interpreting scale scores in relation to specific learning activities. Using established scales for measuring students’ regulation strategies enables a broad empirical base for increasing knowledge on regulation strategies in relation to different disciplinary settings and contributes to theoretical development.

Swedish medical students' expectations of their future life

Objectives: To investigate future life expectations among male and female medical students in their first and final year.MethodsThe study was cross-sectional and conducted at a Swedish medical school. Out of 600 invited students, 507 (85%) answered an open-ended question about their future life, 298 (59%) first-year students and 209 (41%) last-year students. Women constituted 60% of the respondents. A mixed model design was applied; qualitative content analysis was utilized to create statistically comparable themes and categories.ResultsStudents’ written answers were coded, categorized and clustered into four themes: “Work”, “Family”, “Leisure” and “Quality of personal life”. Almost all students included aspects of work in their answers. Female students were more detailed than male ones in their family concerns. Almost a third of all students reflected on a future work-life balance, but considerations regarding quality of personal life and leisure were more common among last-year students.ConclusionsToday’s medical students expect more of life than work, especially those standing on the doorstep of working life. They intend to balance work not only with a family but also with leisure activities. Our results reflect work attitudes that challenge the health care system for more adaptive working conditions. We suggest that discussions about work-life balance should be included in medical curricula.

Swedish nursing and medical students’ high vaccination adherence during the influenza A (H1N1) pandemic 2009: Insights for pandemic preparedness

The aim of this study was to analyze Swedish health science student decision-making regarding vaccination against pandemic influenza during a national mass vaccination campaign. A questionnaire was distributed to 430 students during the influenza A (H1N1) pandemic in 2009. The data from medical and nursing students were compared and a multiple logistic regression model was applied to identify items independently associated with the decision to be vaccinated. The overall survey response rate was 90%. More medical (93.2%) than nursing students (84.8%) reported that they had received the vaccine (p < 0.01). Only the perception that benefits can outweigh possible side effects was significantly (p < 0.001) associated with the decision to get vaccinated. We recommend that, during pandemics, health science universities focus vaccination information for students on objective risk communication. It should be taken into account that the pandemic information provided by authorities to the general public also affects health care students.

Drama as a pedagogical tool for practicing death notification-experiences from Swedish medical students

BackgroundOne of the toughest tasks in any profession is the deliverance of death notification. Marathon Death is an exercise conducted during the fourth year of medical school in northern Sweden to prepare students for this responsibility. The exercise is designed to enable students to gain insight into the emotional and formal procedure of delivering death notifications. The exercise is inspired by Augusto Boal's work around Forum Theatre and is analyzed using video playback. The aim of the study was to explore reflections, attitudes and ideas toward training in delivering death notifications among medical students who participate in the Marathon Death exercise based on forum play.MethodsAfter participation in the Marathon Death exercise, students completed semi-structured interviews. The transcribed interviews were analyzed using the principles of qualitative content analysis including a deductive content analysis approach with a structured matrix based on Bloom's taxonomy domains.ResultsThe Marathon Death exercise was perceived as emotionally loaded, realistic and valuable for the future professional role as a physician. The deliverance of a death notification to the next of kin that a loved one has died was perceived as difficult. The exercise conjured emotions such as positive expectations and sheer anxiety. Students perceived participation in the exercise as an important learning experience, discovering that they had the capacity to manage such a difficult situation. The feedback from the video playback of the exercise and the feedback from fellow students and teachers enhanced the learning experience.ConclusionsThe exercise, Marathon Death, based on forum play with video playback is a useful pedagogical tool that enables students to practice delivering death notification. The ability to practice under realistic conditions contributes to reinforce students in preparation for their future professional role.

Erratum to: Dying with dignity according to Swedish medical students

Erratum to: Dying with dignity according to Swedish medical students

On being a pathologist—full circle

As is the case with so many things that have happened in my life, I did not intend to be a pathologist. Having realized at a fairly young age that I could not sing I gave up an early desire to be an opera singer and decided, before I entered college, to go to medical school. This was at a time when medicine was not a career embraced by young women and my uncle, a neurosurgeon, felt that it would be much more appropriate for me to become a nurse. During my years at Radcliffe College, he tried to persuade me that nursing was the career I should follow. While still in high school I worked as a candy striper at the Carney Hospital in Dorchester, MA, taking a bus and train to Boston from my home town of Swampscott, MA, and then the subway to Dorchester. Being involved in a hospital, even as a volunteer, reinforced my desire for a career in medicine and I was determined to be a pediatrician when I entered Tufts Medical School in the fall of 1960. In the summer of 1961, I married my first husband, David Carpenter, then a student at Harvard Medical School, and the 2 of us left for Goteborg, Sweden, for David's research year in neurophysiology. I took pharmacology with the Swedish medical students (although not for credit) and studied neurophysiology and the year was an exciting time away from school. During my second year at Tufts, we were asked to examine our feet to make scrapings of potential athlete's foot to look at in laboratory sessions. I discovered a small pigmented lesion on my left fifth toe, which led to my first real contact with diagnostic surgical pathology. The lesion was excised and beautifully skin grafted at the New England Medical Center and the original diagnosis was a junctional nevus. However, my pathology teachers were concerned

A comparative study of stress and mental health among Argentinean and Swedish medical students

Background: Studies on medical students’ mental health rarely consider whether generalisability between nationalities is feasible, due to lack of comparative studies between different nationalities. This study aims to shed light on the question by comparing stress and mental health among medical students from Sweden and Argentina.Methods: This is a cross-sectional study. Argentinean (N=397) and Swedish medical students (N=342) received questionnaires on demographic data, alcohol, tobacco and drug use, study stress and depressive symptoms. Parts of the Swedish data were included in a previous study. Measures used were AUDIT-C, HESI (Higher Education Stress Inventory), MDI (Major Depression Inventory) and Meehan’s suicidal history items. Linear regressions were performed to assess associations between Depression scores and individual lifestyle, demographic and study stress variables, controlling for nationality in a second step.Results: Response rates were 77.1% (n=306) among Argentinean students and 90.4% (n=309) among Swedish students. The two populations differed with regard to demographical and lifestyle variables. Argentinean students had higher depression scores, rated peer support as lower and were more worried about the future than Swedish medical students. Associations between depression and study stress differed between the two nationalities. Conclusions: Generalisations from findings in different medical student populations should be made with caution. Studies from a broader selection of nationalities and large-scale comparative studies are called for to identify commonalities and differences within an international population of medical students and professionals

Transplant tourism and compensated kidney donation: A survey of opinions amongst Swedish medical students

Objective: Transplant tourism and proposals for regulated compensated donation are reactions to the global scarcity in kidneys. These areas raise unique ethical challenges in medical education and clinical practice. We aimed to elucidate the opinions of soon-to-be physicians on transplant tourism, and compensated donation. We investigated how these opinions are formed, if they are interrelated, and their impact on encounters with patients. Design and Methods: a 14 item survey was developed using cognitive interviewing techniques, and distributed to the graduating class at Linköping Medical University. Spearman's correlation coefficient and Pearson's chi-square test were employed to investigate significant associations. Results: The response rate was 43/47 (92%). The majority were strongly (64%), or somewhat (29%) against transplant tourism. Those with strong negative positions on transplant tourism were significantly (p<0.05) more likely to dissuade patients from pursuing it. More students expressed support for regulated compensation from a clinical perspective (34%) as compared with support from an ethical perspective (15%). Conclusions: The opinions of young physicians on transplant tourism are a significant indicator for their clinical approach. Young physicians balance competing ethical responsibilities such as respect for autonomy against concerns for kidney vendors in the developing world. Clinical and policy scenarios, similar to those used in this survey are useful tools for students to explore challenging ethical issues within their medical education, to provide appropriate guidance for patients and empower them through health education.

Attitudes towards priority-setting and rationing in healthcare — an exploratory survey of Swedish medical students

Healthcare priority-setting is inextricably linked to the challenge of providing publicly funded healthcare within a limited budget, which may result in difficult and potentially controversial rationing decisions. Despite priority-setting's increasing prominence in policy and academic discussion, it is still unclear what the level of understanding and acceptance of priority-setting is at different levels of health care. The aim of this study is threefold. First we wish to explore the level of familiarity with different aspects of priority-setting among graduating medical students. Secondly, to gauge their acceptance of both established and proposed Swedish priority-setting principles. Finally to elucidate their attitudes towards healthcare rationing and the role of different actors in decision making, with a particular interest in comparing the attitudes of medical students with data from the literature examining the attitudes among primary care patients in Sweden. A cross-sectional survey containing 14 multiple choice items about priority-setting in healthcare was distributed to the graduating medical class at Linkoöping University. The response rate was 92% (43/47). Less than half of respondents have encountered the notion of open priority-setting, and the majority believed it to be somewhat or very unclear. There is a high degree of awareness and agreement with the established ethical principles for priority-setting in Swedish health care; however respondents are inconsistent in their application of the cost-effectiveness principle. A larger proportion of respondents were more favourable to physicians and other health personnel being responsible for rationing decisions as opposed to politicians. Future discussion about priority-setting in medical education should be contextualized within an explicit and open process. There is a need to adequately clarify the role of the cost-effectiveness principle in priority-setting. Medical students seem to acknowledge the need for rationing in healthcare to a greater extent when compared with previous results from Swedish primary care patients.

Attitudes toward euthanasia among Swedish medical students

Attitudes toward euthanasia differ between individuals and populations, and in many studies the medical profession is more reluctant than the general public. Our goal was to explore medical students' attitude toward euthanasia. A questionnaire containing open-ended questions was answered anonymously by 165 first- and fifth-year medical students. Data were analysed using qualitative content analysis with no predetermined categories. The students' arguments opposing euthanasia were based on opinions of 1. euthanasia being morally wrong, 2. fear of possible negative effects on society, 3. euthanasia causing strain on physicians and 4. doubts about the true meaning of requests of euthanasia from patients. Arguments supporting euthanasia were based on 1. patients' autonomy and 2. the relief of suffering, which could be caused by severe illnesses, reduced integrity, hopelessness, social factors and old age. There are several contradictions in the students' arguments and the results indicate a possible need for education focusing on the possibility of symptom control in palliative care and patients' perceived quality of life. Palliative Medicine 2007; 21 : 615—622

Proximity morality in medical school – medical students forming physician morality "on the job": Grounded theory analysis of a student survey

BackgroundThe value of ethics education have been questioned. Therefore we did a student survey on attitudes about the teaching of ethics in Swedish medical schools.MethodsQuestionnaire survey on attitudes to ethics education with 409 Swedish medical students participating. We analyzed > 8000 words of open-ended responses and multiple-choice questions using classic grounded theory procedures.ResultsIn this paper we suggest that medical students take a proximity morality stance towards their ethics education meaning that they want to form physician morality "on the job". This involves comprehensive ethics courses in which quality lectures provide "ethics grammar" and together with attitude exercises and vignette reflections nurture tutored group discussions. Goals of forming physician morality are to develop a professional identity, handling diversity of religious and existential worldviews, training students described as ethically naive, processing difficult clinical experiences, and desisting negative role modeling from physicians in clinical or teaching situations, some engaging in "ethics suppression" by controlling sensitive topic discussions and serving students politically correct attitudes.ConclusionWe found that medical students have a proximity morality attitude towards ethics education. Rather than being taught ethics they want to form their own physician morality through tutored group discussions in comprehensive ethics courses.

Dietary intake in Swedish medical students

Dietary intake in Swedish medical students

Dietary intake in Swedish medical students

BackgroundA 3 day food record is a part of the medical curriculum in Göteborg, and the dietary intake of medical students from 1987 to 1993 has been reported previously.ObjectiveTo study dietary intake in medical students, detect changes over time and qualitative differences between men and women, and compare with nutrition recommendations, intake in the Swedish population in general and in medical students in other countries.DesignA 3 day estimated food record of 1737 students during the years 1994–2006, performed at the medical school at Göteborg University.ResultsMean energy intake for men and women was 10.9 and 7.8 MJ, respectively, without significant differences between 1994 and 2006. Proportions of energy from fat, protein, carbohydrates and alcohol were 29/30, 16/16, 51/53 and 2/3E% in female/male students, respectively. The dietary intake of folate and dietary fibre was higher in 2006 than in 1994 in both genders, whereas the percentage of energy from saturated fat and dietary iron intake decreased over time.ConclusionsEnergy intake was stable during 1994–2006. Significant and mostly positive differences over time were observed. The dietary intake in medical students compared quite well with Nordic Nutrition Recommendations, and in some aspects was better than in the general population.

Visual working memory influences the performance in virtual image–guided surgical intervention

This study addresses for the first time the relationship between working memory and performance measures in image-guided instrument navigation with Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) and GI Mentor II (a simulator for gastroendoscopy). In light of recent research on simulator training, it is now prime time to ask why in a search for mechanisms rather than show repeatedly that conventional curriculum for simulation training has effect. The participants in this study were 28 Swedish medical students taking their course in basic surgery. Visual and verbal working memory span scores were assessed by a validated computer program (RoboMemo) and correlated with visual-spatial ability (MRT-A test), total flow experience (flow scale), mental strain (Borg scale), and performance scores in manipulation and diathermy (MD) using Procedicus MIST-VR and GI Mentor 11 (exercises 1 and 3). Significant Pearson's r correlations were obtained between visual working memory span scores for visual data link (a RoboMemo exercise) and movement economy (r = -0.417; p < 0.05), total time (r = -0.495; p < 0.01), and total score (r = -0.390; p < 0.05) using MIST-MD, as well as total time (r = -0.493; p < 0.05) and efficiency of screening (r = 0.469; p < 0.05) using GI Mentor 11 (exercise 1). Correlations also were found between visual working memory span scores in rotating data link (another RoboMemo exercise) and both total time (r = -0.467; p < 0.05) and efficiency of screening (r = -0.436; p < 0.05) using GI Mentor 11 (exercise 3). Significant Pearson's r correlations also were found between visual-spatial ability scores and several performance scores for the MIST and GI Mentor II exercises. Findings for the first time demonstrate that visual working memory for surgical novices may be important for performance in virtual simulator training with two well-known and validated simulators.

Child abuse study among Swedish physicians and medical students

The purpose of the present paper was to examine the attitudes and experiences of reporting child abuse and neglect among primary care and hospital-based physicians and to study the responses of physicians and medical students to case vignettes suggestive of possible physical abuse or neglect. Physicians at the child health centers in Göteborg primary care (n= 44) and the general pediatricians at the pediatric hospital (n= 21) in Göteborg answered a questionnaire regarding their attitude and experiences reporting child abuse and neglect. The physicians and medical students (n= 34) responded to three case vignettes in which child abuse and neglect could be suspected. A majority of the physicians had reported child abuse and neglect to the social services (80%). No differences were found between primary care and hospital-based physicians in terms of reporting or attitudes. Two-thirds of the physicians had suspected child abuse and neglect and decided not to report, and the major reason for not reporting was a lack of confidence in social services organization. Twenty-one percent had never reported a child for abuse or neglect during their working career. Medical students were more likely to report hypothetical cases than physicians. Many physicians have reported child abuse to social services but also have neglected to do so even when suspecting abuse. It is important that medical students' willingness to report is continued when starting to work clinically and that all physicians should be continuously educated.

Dying with dignity according to Swedish medical students

To die with dignity is an important but ambiguous concept, and it is used in contradictory contexts, both for the promotion of palliative care and as an argument for euthanasia. Our goal was to explore medical students' definition of a dignified death. A questionnaire containing open-ended questions was answered anonymously by 165 first- and fifth-year medical students. The data were analysed using qualitative content analysis with no predetermined categories. The students' descriptions of a dignified death resulted in five categories of death: (1) without suffering, (2) with limited medical interventions, (3) with a sense of security, which implied a safe environment nursed by professional staff, (4) with autonomy, respect for the individual and empowerment to the patient and (5) with acceptance. These findings show similarity to the established concepts of a good death, as well as the view of a dignified death by terminally ill patients. The data suggest that the students perceive that the medical system is over-treating patients and sometimes causing harm to dying patients. The results reveal a potential misunderstanding and contradiction relating to death without suffering and the use of necessary palliative interventions. These findings are important when planning education as regards palliative care and dignified death.

Swedish medical students' views of the changing professional role of medical doctors and the organisation of health care.

Medical students will influence future health care considerably. Their professional orientation while at medical school will be related to their future professional development. Therefore, it is important to study this group's view of the role of medical doctors, especially because Swedish health care is currently undergoing major changes and financial cut backs. Here, the theoretical framework was contemporary theories of competence development, which has shown that people's understanding of their work influences their actions. The aim of this study was to describe medical students' views of their future professional role in health care. In total, 57 fourth-year medical students at a Swedish university were asked to write a short essay about how they conceptualised their professional role in future health care. Fifty-three students (93%) replied. The essays were analysed qualitatively in three steps and four themes were subsequently identified: the professional role in change, organisation of health care, working conditions and the possibilities of having a balanced life. Some factors mentioned that would strongly influence the professional role were being team leader, increased specialisation, supporting the patient and computer science and technology. The students expressed ambiguous feelings about power and leadership. The results indicate that the students share a rather dark view of both the medical profession and health care, which seems to be related to stress and financial cut backs. Mentoring, time for reflection and changes in the curricula might be needed.

Attitude of Swedish veterinary and medical students to animal experimentation

Nearly all veterinary and medical students (94 per cent) found it morally acceptable to use animals in research and believed it to be a necessity in order to treat human...

Attitudes to Psychiatry among Swedish and Nicaraguan Medical Students: A Cross-Cultural Study

Attitudes to psychiatry were examined with the self-report questionnaire APT-30 among 60 Swedish and 130 Nicaraguan medical students who had entered the curriculum in psychiatry. There was a slight female dominance (54%). Nicaraguan students were from two different university sites. In general, the students from all sites had higher scores, indicating a more positive attitude, on the ATP-30 than has been reported from earlier studies in the 1980s. There were no cross-cultural differences between Swedish and Nicaraguan students with regard to overall attitude to psychiatry. Differences on subscales were in general small. Nicaraguan students expressed a significantly more positive attitude to psychiatric patients, but there were no cross-cultural differences on other subscales. Having a close relative with a mental disorder or being a religious person did not significantly influence attitudes in any university site. Gender was a clear discriminating factor. Female students had a significantly more positive ...