Trends in the number and administrative characteristics of medical school health promotion programmes.

Over the course of almost 10 years, 1988-97, there has been a significant decline in the number of United States and Canadian medical schools offering health promotion programmes for students. All efforts should be made to enhance the overall health and well-being of medical students and to increase the number of health promotion programmes for them.

Personality types in academic medicine.

Based on Swiss physician-scholar Carl G. Jung's theory of psychological types proposed in the 1920s, Kathleen Cook Briggs and her daughter Isabel Briggs Myers developed the Myers-Briggs Type Indicator (MBTI) three decades later. They applied Jung's dynamic theory to determine how persons take in information, make decisions, and communicate thoughts and feelings. Medical students were of special interest to their research and much has been written since then about the use of the MBTI in medicine. In this study, results of MBTIs administered to 1797 freshmen students at Louisiana State University School of Medicine--New Orleans from 1988 to 1998 are compared with those reported by the MBTI developers and others over the years and throughout the United States. Findings indicate some noteworthy shifts in the psychological profile of medical students over time and among schools that may be due to changes in the delivery of health care, the increase in technology in the practice of medicine, and the dramatic increase of women in medicine.

Personality type and medical specialty choice.

The July 1999 issue of the Journal of the Louisiana State Medical Society reported results of the Myers-Briggs Type Indicator administered to 1,797 students at Louisiana State University School of Medicine in New Orleans, Louisiana from 1988 through 1998. The current follow-up study has as its subjects 1,262 matriculants who entered the School from 1988 through 1995 and completed their medical undergraduate studies by May 1999. In addition to identification of the graduates' Myers-Briggs type, information on their residency choice was also available. In this study, the authors explore possible association between the graduates' personality type and their chosen career, along with possible type differences of those graduates selecting primary care and those choosing non-primary care specialties.

Gay and lesbian issues in child and adolescent psychiatry training as reported by training directors.

OBJECTIVE: Although increased evidence of disproportionate psychosocial risk and other health problems encountered by lesbian, gay male, and bisexual (LGB) youths has emerged, no study has described how the topic of homosexuality is addressed within child and adolescent residency psychiatry training. METHOD: Residency training directors in U.S. child and adolescent psychiatry programs were asked questions about instruction on the topic of homosexuality and the care of LGB patients, the department's view of whether homosexuality represents a pathological condition, the director's awareness of LGB colleagues and residents, and the director's opinion of LGB residents' disclosure of their homosexuality to their patients and patients' families. Asking similar questions facilitated a comparison of survey results with those of an earlier study of general psychiatry training directors. RESULTS: The reported departmental attitudes about whether homosexuality represents a pathological condition were essentially equivalent in general and child programs. Child and adolescent training directors were, however, less likely to have a favorable view of disclosure of sexual orientation to patients, less likely to know LGB residents or faculty, and less likely to report LGB residents an asset to their departments. CONCLUSIONS: The prediction that the majority of child and adolescent training programs would reflect a heightened awareness of the vulnerability of LGB youths was not confirmed.

Clinical regeneration with guided tissue barriers.

This review of the current periodontal literature evaluates clinical regeneration with guided tissue barriers in infrabony defects and furcations. A meta-analysis was conducted by calculating weighted means with confidence intervals for each treatment group. Clinical improvement in infrabony defects was best for polylactic acid/polyglactin (PLA/PGA) barriers, with a mean pocket reduction of 5.3 mm and a mean gain in clinical probing attachment level of 4.7 mm. For furcations, special attention was given to the frequency of either complete or partial (> or = 50%) furcation closure. Complete furcation closure was an infrequent result of guided tissue regeneration, occurring in only 7% to 19% of furcations treated with barriers. For the time period reported, the best clinical results in furcations and infrabony defects occurred with PLA/PGA-type barriers. However, there were no statistically significant differences among the various barriers in infrabony defects or furcations.

Follow-up survey of support services for lesbian, gay, and bisexual medical students.

PURPOSE: To replicate and extend a pilot study conducted in 1990 regarding support services for lesbian, gay, and bisexual (LGB) medical students. METHOD: In 1994 the authors surveyed all 320 members of Lesbian, Gay, and Bisexual People in Medicine, a standing committee of the American Medical Student Association. Chi-square analyses were used to compare responses by subgroups. RESULTS: Responses were received from 185 students (58%) at 92 medical schools. Students who had access to school or community support groups were significantly more likely to disclose their sexual orientation and to know faculty with whom to discuss LGB issues. Nonwhite students were significantly less likely to know faculty with whom to discuss gay-related concerns, to disclose their orientation, and to know of support services. No difference between the academic experiences of lesbians and gay men was reported. Additionally, 115 (62%) of the students reported exposure to anti-gay comments, and 28 (15%) indicated they would not choose to enter the medical field if they were in college today. CONCLUSION: Although the needs of LGB medical students appear to be receiving increased attention (albeit with great variability from school to school), the survey results suggest that more student-faculty liaisons and more support groups are needed, that LGB patient care should be taught more widely, and that all medical students have too little exposure to non-pejorative descriptions of LGB patients.

Frequency of furcation closure with regenerative periodontal therapy.

A review of the literature was performed related to the frequency of closure of Grade II furcations with various regenerative therapies such as bone replacement grafts (BRG), coronally positioned flaps (CPF), guided tissue regeneration barriers (GTR), or open flap debridement (OFD). Fifty papers involving 1,016 furcations were evaluated. Complete furcation closure was reported only 20% of the time. Clinical change from Grade II to Grade I (partial furcation fill) was found in an additional 33% of the cases. Therefore, general improvement in clinical furcation status has been reported only about 50% of the time. The most effective furcation regenerative therapy was the combination of GTR plus BRG (91% overall positive). Similar overall positive results (88%) were achieved with nondemineralized allogeneic freeze-dried bone plus tetracycline without a barrier. The least effective therapy for regeneration in furcations was OFD (2% complete furcation closures and 13% partial furcation closures). If complete furcation closure is a primary goal of regenerative therapy, that goal would not appear to be commonly met.

Influence of a freshman-year panel presentation on medical students' attitudes toward homosexuality.

PURPOSE: To explore medical students' changes in group attitude toward homosexuality following mid-year exposure as freshmen to a panel presentation on the topic and, later, following clinical experiences. METHOD: At the beginning, middle, and end of 1991-92 and during the psychiatry clerkship in 1993-94, all 186 students in the class of 1995 at the Louisiana State University School of Medicine in New Orleans were asked to complete anonymously the Index of Attitudes toward Homosexuals. The two subsequent entering classes were also surveyed, at the beginning and in the middle of their freshman year. RESULTS: Group attitudes among the three consecutive classes were remarkably consistent. The original cohort displayed a decrease in group homophobic attitude over time, with the reduced mean score at mid-year continuing its downward trend at year's end, though rebounding somewhat by the junior year. However, the group mean score remained in the low-grade homophobic category throughout the three-year study. CONCLUSION: That the mean scores of the three classes remained at the low-grade homophobic level suggests the desirability of establishing an ongoing forum to enable students to examine all deeply held beliefs that may affect patient care.

Gay and lesbian issues in u.s. Psychiatry training as reported by residency training directors.

This study reports the results of a survey of U.S. residency training directors that explored the training milieu of gay and lesbian psychiatric residents. Of the 198 training directors surveyed, 134 (67.7%) completed the questionnaire. All but four of the directors reported the inclusion of gay and lesbian issues in the curriculum, most frequently in PGY-3. Using a 5-point rating scale, 47.3% reported that homosexuality was regarded at their programs as "normal" or "somewhat normal," 51.2% as "neutral," and 1.5% as "somewhat pathological" or "pathological." In general, the directors' overall assessment of departmental attitudes about homosexuality paralleled the findings previously reported by lesbian and gay residents, with some discrepancy concerning the disclosure of sexual orientation to psychotherapy patients. In the earlier study, nearly one-third of gay and lesbian residents reported such disclosure; in the current study, only three training directors (2.5%) regarded this practice favorably. The results of the present study reflect the diversity of opinion found among residency training directors on the topic of gay and lesbian issues.

Gay and lesbian issues in residency training at u.s. Psychiatry programs.

The authors conducted a survey that explored the training milieu of gay and lesbian psychiatric residents at various sites throughout the United States. In some ways, the residents surveyed have greater institutional support than was found in an earlier study of homosexual medical students. But there are clear and disturbing differences among residents based on gender, with men more likely than women to consider their program supportive of their sexual orientation. In spite of this relative advantage, gay men and lesbians, medical students and residents alike, would prefer that their training institutions be more supportive of their sexuality and more adept at facilitating sensitive care of homosexual patients.

How the topic of homosexuality is taught at U.S. medical schools.

In 1991 the authors surveyed all U.S. medical schools to assess both the number of curriculum hours devoted to the topic of homosexuality and the instructional strategies employed in its academic treatment; responses were sought from faculty with responsibility for teaching the topic (mostly directors of medical student education in psychiatry). Of the 126 schools, 82 (65%) responded. The mean number of hours reported was 3 hours and 26 minutes, with significant differences based on geographic region. The most frequently cited strategy was lectures in human sexuality, followed distantly by panel presentations and meetings with gay men or lesbians (both health care providers and others). To enhance sensitivity and comfort with gay and lesbian issues and to counter stereotypic responses, the authors propose that the topic of homosexuality be wholly integrated throughout the curriculum.

Support services for homosexual students at U.S. medical schools.

This study reports the results of a national survey conducted to assess current programs directed toward gay and lesbian medical students and to identify their perceptions, needs, and wishes. Support services are limited and those that do exist vary on the basis of class size, institutional affiliation, and geographic region. The topic of homosexuality is taught in most medical schools in a circumscribed way. Implications of the findings concern the medical education of all students, irrespective of their sexual orientations.