Facing uncertainty as a medical student--a qualitative study of their reflective learning diaries and writings on specific themes during the first clinical year.

OBJECTIVE: Tolerance of uncertainty related to the complex work is a major dimension of general practitioner's (GP) profession. Strategies for managing uncertainty have been studied among GPs but less is known about how medical students develop tolerance of uncertainty during their studies. The aim of this study was to investigate how the medical students experience uncertainty during their first clinical years and how their feelings develop with time as they progress from the 3rd year to the 4th year. METHODS: The material consisted of 22 students' reflective learning diaries and writings on specific themes collected during the 3rd and 4th year of their medical studies. The analysis was performed using thematic content analysis. In this article we present the results related to the theme of uncertainty. RESULTS: Uncertainty is a major cause of mental strain for medical students, particularly fear of making mistakes. Main themes related to facing uncertainty and found in the diaries and writings were insecurity of professional skills, own credibility, facing with the inexactness of medicine, fear of making mistakes, coping with responsibility, and tolerating oneself as incomplete and accepting oneself as a good-enough doctor-to-be. Common steps of development towards tolerance of uncertainty were found in diaries over a one-year time period as the students progressed in their clinical studies. CONCLUSIONS: Reflective writing showed to be an effective means for the students of both expressing and dealing with uncertainty, both with the difficult and the pleasant feelings and the experiences the students had with their first patient contacts. It also gave some of them the means of self-reflection which they afterwards found worthwhile. PRACTICE IMPLICATIONS: Reflective writing is powerful tool which medical students could use to facilitate their maturation process what comes to uncertainty during their first clinical year.

Professional socialization revised: medical students' own conceptions related to adoption of the future physician's role--a qualitative study.

This qualitative study investigated medical students' experiences of and conceptions concerning their professional development during their first clinical year. Twenty-two medical students participated in a portfolio course. Their personal writings were analysed by qualitative content analysis. Self-image as a future doctor rapidly evolved during patient contacts in the first clinical year. At the beginning, students felt lacking in credibility in front of their patients but towards the end they enjoyed their role as student-physicians. The medical students felt intense stress but the majority of this may stem from strong emotional experiences rather than the medical knowledge to be absorbed. Students were afraid of being humiliated by hospital staff and they felt themselves to be outsiders. No cynicism or suppression of feelings was observed in writings. The first clinical year is a period of intense emotional experiences and rapid development. Portfolios as learning tools may help in recognizing key experiences and in supporting professional development.

Looking over the horizon: an Internet-based international course in healthcare management.

The International Course in Healthcare Management is predicated on the belief that comparative benefits can most effectively be 'taught' by enabling students to work directly with colleagues in other countries, sharing views, discussing differences, and checking understandings on how healthcare is structured and managed in different countries. The course focuses on four countries--Canada, Germany, Finland and Ireland--which offer an interesting range and mix of approaches to healthcare, and yet are sufficiently similar to ensure relative ease of understanding. The course, which is delivered and taught jointly by faculty from five participating institutions in the four countries using the Internet as the distance delivery medium, is an integral component of each institution's participating department's graduate program. The aims of the course are: to enable the participants to develop an in-depth understanding of the healthcare systems of each country; to foster a deeper understanding, through comparative analysis, of each participant's own healthcare system; and to facilitate the development of new insights into ways of addressing common concerns in healthcare management. The course is structured around a series of case studies organized under four main themes: financing and funding; delivery issues; impact of health service reforms; and evidence-based management.

Use of alternative drugs in Finland.

OBJECTIVES: The purpose of this study was to assess the use of alternative drugs among the adult population in Finland, especially to find out how the health status, health behaviour and use of licensed drugs and health care services are related to the use of alternative drugs. DESIGN: A telephone interview was conducted in March 1992 with a response rate of 85%. SUBJECTS: A random, representative sample of 2134 Finns aged between 15 and 74 years. RESULTS: A total of 39% of the respondents had used one or more types of alternative drugs during the last year. Most common was the use of health food products. Women used all types of alternative drugs more often than men. The use of alternative drugs was more common among educated and urban respondents. Perceived health or existence of a long-standing illness was not related to alternative drugs use whereas reporting of psychosomatic symptoms was. Non-smoking was positively related to the use of alternative drugs and also active exercise among men. The use of non-prescription drugs, official and unofficial health services were positively related to alternative drugs use. CONCLUSIONS: The use of alternative drugs is popular and it may increase in the future. The use of alternative drugs can be considered a form of medicalization. More information on products used and people using alternative drugs is needed.

Alternative drug use for the climacteric in Finland.

OBJECTIVES: To investigate the use of alternative drugs for the climacteric in Finland, which products are used, and who are the women using them. METHODS: The study was based on a population-based survey conducted in 1989 among 2000 Finnish women aged 45-64 (response rate 86%). RESULTS: 11% of the women reported the use of alternative drugs for the climacteric. Food supplements and bee products were the most common types of alternative drugs used. Some of them may have allergic or other side effects. Users differ little from other women judging by health habits and the utilization of health care services. The best predictors for alternative drug use were urban residence, more than 9 years of general education, and among 50 54-year olds, the use of prescription or OTC drugs for menopause. Over half of the users of alternative drugs had also used hormone therapy. CONCLUSIONS: Women using alternative drugs during and after the climacteric represent a large group. More information is needed about the clinical effects of alternative drugs, and the characteristics of alternative drug users.

Physicians' gender and clinical opinions of reproductive health matters.

The purpose of this study was to investigate the effect of physicians' gender when sex-specific conditions are being treated in a country where almost half of the physicians are women. Five Finnish surveys originally conducted for other purposes were reanalyzed. Two surveys examined physicians' and medical students' views about hormone therapy during and after menopause, one survey examined medical students' attitudes about medicines, one survey examined physicians' obstetric practices, and one examined contraceptive counselling. All the surveys showed more similarities than differences in the clinical decision-making of women and men physicians. In opinions about menopause the physician's medical specialty was more important than gender. Physicians' obstetrical practices were also similar in five cases out of six, but in one situation where medical factors were not a deciding issue, women physicians acted differently. These results suggest that socialization into the medical profession makes physicians' practices more alike and diminishes gender differences.

PIP: To determine the effect of gender on the type of reproductive health treatment offered to women in a setting where half of the physicians are female, this study reanalyzed data collected from five surveys in Finland. The surveys were originally conducted to investigate the views of physicians (74% of 500 responding) and medical students (74% of 125 responding) about menopausal hormone replacement therapy, the attitudes of medical students about prescribing hormones, obstetric practices (83% of 90 responding), and contraceptive counseling (74% of 480 responding). It was found that the number of menopausal patients was highest for female gynecologists, followed by male gynecologists, female physicians, and male physicians. Female and male gynecologists offered similar recommendations for hormone replacement therapy, but female physicians were more likely to prescribe hormones for prevention only. Results for medical students were not influenced by gender. The only significant difference in obstetric practice was that female obstetricians were three times more likely than males to induce labor for convenience. While equal numbers of female and male physicians prescribed oral contraceptives and IUDs, females were more likely to prescribe condoms, implants, and diaphragms. It is concluded that professional identification among these physicians was stronger than gender influences.

Careprovider and obstetrical interventions--a comparative study of four European countries.

The purpose of this study was to compare the treatment recommendations of obstetricians and midwives in four European countries: the Czech Republic, Finland, Hungary, and Slovenia. Intervention orientation was examined with six hypothetical patient cases. We wanted to learn whether midwives differ from obstetricians in their choices, and whether there is any variation among countries regarding the willingness of staff to intervene. In Finland the two professions were quite similar in their recommendations for interventions, but in Hungary and Slovenia, midwives and obstetricians differed from each other. There were also differences between the countries in the treatment recommendations, and there was disparity between opinions and actual obstetrical practices. Slovenian obstetrical staff were the most interventionistic in many cases, compared with others, although the actual frequency of interventions was no greater than in other countries. In Finland the staff were the most passive in their opinions, yet the actual proportion of interventions was greatest.

A survey on the use of alternative drugs during pregnancy.

OBJECTIVE: To describe the use of alternative drugs during pregnancy. DESIGN: A trial including 3 surveys on drug use during pregnancy in maternity centers in one area of Finland in 1985-86 (study 1), and a retrospective survey in 2 maternity hospitals in Finland in 1988 (study 2). PATIENTS AND METHODS: Study 1: 2912 pregnant women (about 94% of pregnant women in the area during the study period); 97-88% returned questionnaires. Study 2: 180 out of 181 consecutive women giving birth. In study 1, drug use (including drug-like products) in the last two weeks was asked by questionnaires around 12th, 28th, and 36th gestation weeks. In study 2, women were interviewed 2-3 days after birth asking about any drugs used during pregnancy. Due to the method of asking, our studies underestimate the level of using alternative drugs. RESULTS: In study 1, a total of 97 (3.6%) pregnant women reported use of alternative drugs. Most drugs were dietary supplements, and by current knowledge harmless. But a few women had used (potentially) dangerous drugs. The users were from the higher social class and they had also used pharmaceutical specialties more often than non-users. In study 2, 14% had used alternative drugs at some time during pregnancy. CONCLUSION: Because our surveys showed that alternative drugs are used, possibly with increasing frequency, during pregnancy, further studies on safety are needed.