Frequency and negative impact of medical student mistreatment based on specialty choice: a longitudinal study.

PURPOSE: According to responses to the Association of American Medical Colleges' Medical School Graduation Questionnaire, 17% to 20% of medical students report mistreatment. This study examined the longitudinal nature of medical student mistreatment based on specialty choice. METHOD: From 2003 to 2010, the authors surveyed all medical students at one institution at the end of their third year, assessing the frequency and impact of any mistreatment based on specialty choice. They analyzed quantitative data on the frequency, impact, sources, and trends over time and qualitative data from students' open-ended responses and compared data by specialty interest (primary care versus subspecialty). RESULTS: Of the 1,059 students sent the survey, 801 (76%) responded. Mistreatment based on specialty choice was common. The frequency and impact of such mistreatment were tightly correlated (Pearson r = 0.8, P < .001). The nature of mistreatment differed between students interested in primary care and those interested in a subspecialty, occurred more commonly on specific clerkships, and originated most often from resident physicians. Students perceived that teaching opportunities and evaluations were negatively affected by their specialty choice. An association was found between the theme of respect and students reconsidering their specialty choice. These patterns of mistreatment were stable over the study period, despite several professionalism initiatives. CONCLUSIONS: Mistreatment based on specialty choice is a distinct and common phenomenon perpetuated by faculty, residents, and peers. More research is needed to explore the potential hidden curriculum drivers of these findings and to develop interventions specifically targeting this type of mistreatment.

Tobacco world: evaluation of a tobacco cessation training program for third-year medical students.

BACKGROUND: Training in tobacco cessation counseling is deficient in medical schools. Tobacco World, a tobacco cessation training program, was implemented in a family medicine clerkship and subsequently evaluated. METHOD: In the pilot year, students were assigned to either standard clerkship training (comparison group) or a group that also received Tobacco World training (intervention group). All students received intervention training in the second year of the study. A 35-item questionnaire was administered before and after the four-week clerkship to assess knowledge, attitude, and confidence regarding tobacco cessation counseling. RESULTS: Intervention training was highly rated. Students in the intervention group from both years demonstrated significant improvements in some key measurements of knowledge, attitude, confidence, and increased frequency of tobacco cessation counseling. CONCLUSIONS: This smoking cessation training program addresses an underrepresented area of medical school education and has the potential to translate into improved smoking cessation counseling by future physicians.

Enhancing doctor-patient communication using email: a pilot study.

BACKGROUND: The doctor-patient relationship has been eroded by many factors. Would e-mail enhance communication and address some of the barriers inherent to our medical practices? METHODS: Of our study population, 4 physicians offered e-mail communication to participating patients and 4 did not. Both patients and physicians completed questionnaires regarding satisfaction, perceived quality, convenience, and promptness of the communication. RESULTS: Patient satisfaction significantly increased in the e-mail group compared with the control group in the areas of convenience (P < .0001) and the amount of time spent contacting their physician (P < .0001). Physician satisfaction in the e-mail group increased regarding convenience, amount of time spent on messages, and volume of messages. The response time was longer with e-mail. When asked if patients should be able to e-mail their physicians, most patients in the e-mail group and all but 2 of the physicians in the non-e-mail group responded "yes." CONCLUSION: E-mail communication was found to be a more convenient form of communication. Satisfaction by both patients and physicians improved in the e-mail group. The volume of messages and the time spent answering messages for the e-mail group physicians was not increased. E-mail has the potential to improve the doctor-patient relationship as a result of better communication.