Competing professionalism values among community-based family physicians.

BACKGROUND: Professionalism has received considerable attention in recent years, mostly within academic settings. Little attention has been given to the perspectives of practicing physicians on professionalism. This study was designed to determine whether prevailing definitions of and guidelines for professionalism accurately reflect the perspectives and experiences of practicing community-based family physicians. METHOD: Eighteen practicing family physicians in Seattle were recruited from nonacademic settings to participate in focus groups during 2003. Transcripts were analyzed for content themes related to professionalism. RESULTS: Analysis revealed several tensions among values that the physician participants described balancing in their practices. Balancing organizational expectations and individual physician or patient values was a major source of tension. CONCLUSIONS: Practicing family physicians describe various tensions as they attempt to balance their own values with competing values of their patients, the organizations for which many work, and stated values of their profession. Such tensions among values have seldom been described in past literature and should be considered in designing medical curricula at all levels.

Faculty and student participation in online discussions of palliative care scenarios.

BACKGROUND AND OBJECTIVES: The use of online discussion is increasing in medical education curricula. Few studies have explored factors that affect patterns of participation in such an online learning environment. In this study, we examined how medical students interacted with one another in online discussions of end-of-life care during family medicine clerkships. METHODS: Based on factors that affect the quality of online discussions as identified in the literature, we developed a coding scheme for comments that facilitated social interactions (social presence) and learning (cognitive presence). Our study was based on available transcripts from discussions including two faculty and 42 students. RESULTS: Participants created social interactions by greeting one another, referring to students' names, and connecting their postings to previous comments. While faculty prompted student discussions and posed questions, they rarely highlighted learning points, corrected student errors, or summarized discussions. Students offered multiple perspectives on end-of-life issues based on personal and clinical experiences. However, they tended to share existing online resources without much interpretation or explanation. CONCLUSIONS: Most comments by students lacked critical thinking skills in linking evidence from the literature with ongoing discussions. Students may need direct modeling by faculty to learn how to use existing resources to support statements, pose critical questions, and justify proposed solutions.

Influence of Third-Year Clerkships on Medical Student Specialty Preferences.

Purpose - The purpose of this study was to investigate influences on third-year medical students' specialty preferences.Method - A survey questionnaire was mailed to third-year medical students at two medical schools. The questionnaire asked students to rate the degree to which various aspects of the third-year curriculum and perceived specialty characteristics influenced their specialty preferences.Results - A total of 214 (70%) of eligible students responded, of whom 46% were female and 57% preferred primary care (PC) specialties. The most frequently cited influential clerkship was internal medicine. Most clerkships (72%) had a positive influence on students' preferences. PC clerkships had more positive influences than non-primary care (NPC) clerkships, especially among PC-oriented students. The most influential aspects of clerkships were faculty and residents, especially in PC clerkships. For both PC- and NPS-oriented students, the diagnostic and patient-related characteristics of their preferred specialties were highly influential. PC-oriented students were more likely to be attracted to prevention and biopsychosocial aspects of specialties, and NPC-oriented students to the opportunity to do procedures and intervene in illnesses. Student gender appeared to have little influence on response patterns, except as a proxy for specialty preference, which, for women, was more likely to be a primary care specialty.Conclusion - These findings suggest that the third-year clerkships, especially at non-university sites, play an important role in specialty choice, and that factors attracting students to PC differ significantly from those attracting students to NPC.

Gender-related factors in the recruitment of physicians to the rural Northwest.

BACKGROUND: This study examines differences in the factors female and male physicians considered influential in their rural practice location choice and describes the practice arrangements that successfully recruited female physicians to rural areas. METHODS: This cross-sectional study was based on a mailed survey of physicians successfully recruited between 1992 and 1999 to towns of 10,000 or less in six states in the Pacific Northwest. RESULTS: Responses from 77 men and 37 women (response rate 61%) indicated that women were more likely than men to have been influenced in making their practice choice by issues related to spouse or personal partner, flexible scheduling, family leave, availability of childcare, and the interpersonal aspects of recruitment. Commonly reported themes reflected the respondents' desire for flexibility regarding family issues and the value they placed on honesty during recruitment. CONCLUSIONS: It is very important in recruitment of both men and women to highlight the positive aspects of the community and to involve and assist the physician's spouse or partner. If they want to achieve a gender-balanced physician workforce, rural communities and practices recruiting physicians should place high priority on practice scheduling, spouse-partner, and interpersonal issues in the recruitment process.