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Bechara JP, Shah PP, Lindor K. The power of rotation schedules on the career selection decisions of medical students. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1509-1522. [PMID: 37131109 PMCID: PMC10153029 DOI: 10.1007/s10459-023-10227-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/26/2023] [Indexed: 05/04/2023]
Abstract
Choosing a career pathway in medicine is a high stakes decision for both medical students and the field of medicine as a whole. While past research has examined how characteristics of the medical student or specialties influence this decision, we introduce temporal elements as novel variables influencing career selection decisions in medicine. Specifically, we investigate how timing and duration of residency options, based on a rotation schedule that medical students have limited control over, influence their career selection decisions. An archival study investigating 5 years of medical student rotation schedules (N = 115) reveals that clinical rotation options appearing earlier and more often in the schedule were more likely to be selected. Moreover, timing and duration of exposure interacted such that residency options appearing later in the schedules were more likely to be selected if they also appeared more often. Conditional logistic regressions using student fixed-effects to control for idiosyncratic medical student differences (i.e., gender, & debt, etc.), and residency fixed-effects to control for idiosyncratic residency differences (income, and lifestyle, etc.), revealed the rotation schedule had a significant impact on residency selection decisions even when controlling for factors typically influencing this decision. Medical students' career decisions are influenced by when and how long different choice options appear in their rotation schedule, especially when they have limited influence over this schedule. The results have implications for healthcare policy by highlighting a tool for adjusting physician workforce composition by broadening exposure to a greater array of career options.
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Affiliation(s)
- John P Bechara
- Department of Organization Studies, Tilburg University, Simon Building, PO Box 90153, Tilburg, 5000 LE, The Netherlands.
| | - Priti Pradhan Shah
- Work and Organizations, Carlson School of Management, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - Keith Lindor
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
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2
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Balas M, Scheepers RM, Zador Z, Ibrahim GM, Premji L, Witiw CD. Profiling medical specialties and informing aspiring physicians: a data-driven approach. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023:10.1007/s10459-023-10283-2. [PMID: 37698730 DOI: 10.1007/s10459-023-10283-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/03/2023] [Indexed: 09/13/2023]
Abstract
A detailed, unbiased perspective of the inter-relations among medical fields could help students make informed decisions on their future career plans. Using a data-driven approach, the inter-relations among different medical fields were decomposed and clustered based on the similarity of their working environments.Publicly available, aggregate databases were merged into a single rich dataset containing demographic, working environment and remuneration information for physicians across Canada. These data were collected from the Canadian Institute for Health Information, the Canadian Medical Association, and the Institute for Clinical Evaluative Sciences, primarily from 2018 to 2019. The merged dataset includes 25 unique medical specialties, each with 36 indicator variables. Latent Profile Analysis (LPA) was used to group specialties into distinct clusters based on relatedness.The 25 medical specialties were decomposed into seven clusters (latent variables) that were chosen based on the Bayesian Information Criterion. The Kruskal-Wallis test identified eight indicator variables that significantly differed between the seven profiles. These variables included income, work settings and payment styles. Variables that did not significantly vary between profiles included demographics, professional satisfaction, and work-life balance satisfaction.The 25 analyzed medical specialties were grouped in an unsupervised manner into seven profiles via LPA. These profiles correspond to expected and meaningful groups of specialties that share a common theme and set of indicator variables (e.g. procedurally-focused, clinic-based practice). These profiles can help aspiring physicians narrow down and guide specialty choice.
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Affiliation(s)
- Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Zsolt Zador
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Laila Premji
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, University of Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada.
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada.
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3
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Khan S. The impact of gendered experiences on female medical students' specialty choice: A systematic review. Am J Surg 2023; 225:33-39. [PMID: 36435655 DOI: 10.1016/j.amjsurg.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Women make up 50% of American medical school graduates, yet are not equally represented in the vast spectrum of medical specialties. Many fields within medicine remain male dominated. This systematic review will explore social factors that affect female medical students' specialty choice. HYPOTHESIS Gendered experiences influence the specialty choice of female medical students, resulting in their concentration in a specific cohort of specialties. METHODS Studies were gathered by searching MEDLINE/Pubmed and EBSCOhost for sociological factors that impact female medical students' specialty choice. RESULTS 34 articles were selected for this systematic review. Factors that contribute to gender segregation within medical specialties include gender discrimination, socialization, lifestyle considerations, negative perceptions of male-dominated medical specialties and lack of female role models. CONCLUSION This systematic review supported the hypothesis that gendered experiences impact women's medical specialty choice, and thus result in their concentration in specialties such as family medicine, pediatrics and obstetrics and gynecology.
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Affiliation(s)
- Sana Khan
- Detroit Medical Center/Wayne State University School of Medicine, United States.
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4
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My Thoughts: Death of the "Virgin Abdomen". Am J Surg 2021; 223:1230-1231. [PMID: 34809909 DOI: 10.1016/j.amjsurg.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/22/2021] [Accepted: 11/07/2021] [Indexed: 11/21/2022]
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Sarikhani Y, Bastani P, Bayati M. A National Survey on the characteristics of Iranian General Practitioners and Their Preferred Specialty: A Need to Transition toward Preventive Medicine. Int J Prev Med 2021; 12:84. [PMID: 34584650 PMCID: PMC8428318 DOI: 10.4103/ijpvm.ijpvm_441_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/14/2020] [Indexed: 12/30/2022] Open
Abstract
Background: The shortage and unbalanced distribution of physicians has adverse effects on the provision of equitable services at all levels of health care and especially at the prevention and primary care levels. The choice of specialty can seriously change the structure and composition of the physician workforce. Therefore, this study aimed to investigate the relationship between background characteristics of Iranian general practitioners' (GPs) and their preferred specialty fields. Methods: In this mixed-method study, first, 12 medical doctors participated in a nominal group technique to determine the most important background characteristics that affect GPs' preferences for specialty selection. In the second phase, we conducted a survey among 680 GPs in six provinces from different geographic regions. We gathered data using a researcher-made checklist and analyzed them using an adjusted multivariate regression. Results: The adjusted analysis showed that being female, being married, being in an older age group, having children, graduation from universities located in the provincial centers, and decision for living and practicing in the less-populated areas were significantly associated with the Iranian GPs' preferences for non-surgical specialties. Conclusions: This study provided evidence that could inform national health workforce policy-makers to avoid unbalanced distribution of physicians and accordingly to ensure the provision of equitable services at all levels of healthcare and especially at the primary care level. Other effective factors on the selection of specialty should be evaluated at the national level using specific surveys and econometrics studies such as discrete selection experiment to move toward preventive medicine.
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Affiliation(s)
- Yaser Sarikhani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peivand Bastani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Bayati
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Reifen-Tagar M, Saguy T. Early Sociopolitical Development Matters for Inequality: SDO and the Gender Gap in Leadership. PSYCHOLOGICAL INQUIRY 2021. [DOI: 10.1080/1047840x.2021.1930798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Michal Reifen-Tagar
- Baruch Ivcher School of Psychology, The Interdisciplinary Center (IDC), Herzliya, Israel
| | - Tamar Saguy
- Baruch Ivcher School of Psychology, The Interdisciplinary Center (IDC), Herzliya, Israel
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Yin K, Yang L, Zhang R, Zheng D, Wilkes MS, Lai Y. Gender Differences and Influencing Factors in Specialty Choices: Findings From One Medical School in China. Front Public Health 2021; 9:648612. [PMID: 33842425 PMCID: PMC8027487 DOI: 10.3389/fpubh.2021.648612] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Gender plays a significant role in the selection of medical specialty. Few studies have been conducted to explore the impact of gender differences on specialty choosing among Chinese medical students. Methods: The specialty choices of 648 students from six consecutive classes in an 8-year MD program were collected and compared between male and female students. A total of 110 students from one graduating class were surveyed by a questionnaire covering 22 career influencing factors. Each factor has a scale of zero to three (zero = no influence, one = mild influence, two = moderate influence, and three = strong influence). Results: Statistically significant gender differences were observed in 10 out of 16 specialties. Most male students limited their specialty choices to surgery (64%), internal medicine (12%), and orthopedics (12%), compared with a relatively diversified pattern in female students. For male students, the top three influencing factors were personal interest, future job prospects for the chosen specialty, and job opportunity in academic medicine. The strongest influencing factors of females were personal interest, specialty-specific knowledge and skills, and the sense of achievement. The expected salary was ranked among the top 10 influencing factors in male but not in females, while the work-life balance was ranked among the top 10 factors in females but not in males. Conclusion: There is a significant gender difference regarding specialty choices among Chinese medical students. Career coaching is needed to help students in their specialty choosing process.
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Affiliation(s)
- Kanhua Yin
- Medical Education Office, Fudan University, Shanghai, China
| | - Liu Yang
- Medical Education Office, Fudan University, Shanghai, China
| | - Rui Zhang
- Medical Education Office, Fudan University, Shanghai, China
| | - Difan Zheng
- Medical Education Office, Fudan University, Shanghai, China
| | - Michael S Wilkes
- Office of Dean, University of California, Davis School of Medicine, Sacramento, CA, United States
| | - Yanni Lai
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
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Carroll AL, Chan A, Steinberg JR, Bryant TS, Marin-Nevarez P, Anderson TN, Bereknyei Merrell S, Lau JN. Medical Student Values Inform Career Plans in Service & Surgery-A Qualitative Focus Group Analysis. J Surg Res 2020; 256:636-644. [PMID: 32810664 DOI: 10.1016/j.jss.2020.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diversifying the surgical workforce is a critical component of improving care for underserved patients. To recruit surgeons from diverse backgrounds, we must understand how medical students choose their specialty. We investigate how preclinical students contemplate entering a surgical field. MATERIALS AND METHODS We conducted semistructured focus groups during two iterations of a seminar class called Service Through Surgery. Discussion goals included identifying student values and assessing how they inform early career decisions. We used a systematic, collaborative, and iterative process for transcript analysis, including developing a codebook, assessing inter-rater reliability, and analyzing themes. RESULTS Twenty-four preclinical medical students from diverse backgrounds participated in seven focus groups; most were women (16; 67%), in their first year of medical school (19; 79%), and interested in surgery (17; 71%). Participants ranked professional fulfillment, spending time with family, and serving their communities and/or underserved populations among their most important values and agreed that conducting groundbreaking research, working long hours, and finding time for leisure activities were the least important. We constructed a framework to describe student responses surrounding their diverse visions for service in future surgical careers through individual doctoring interactions, roles in academia, and broader public service. CONCLUSIONS Our framework provides a basis for greater understanding and study of the ways in which preclinical medical students think about their personal values and visions for service in potential future surgical careers. This research can guide early interventions in medical education to promote diversity and care for the underserved in surgery.
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Affiliation(s)
- Anna L Carroll
- Stanford University School of Medicine, Stanford, California.
| | - Antonia Chan
- Stanford University School of Medicine, Stanford, California
| | | | - Tyler S Bryant
- Stanford University School of Medicine, Stanford, California
| | | | - Tiffany N Anderson
- Department of Surgery, Stanford Surgery ACS Education Institute/Goodman Surgical Education Center, Stanford University, Stanford, California
| | - Sylvia Bereknyei Merrell
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University, Palo Alto, California
| | - James N Lau
- Stanford University School of Medicine, Stanford, California; Department of Surgery, Stanford Surgery ACS Education Institute/Goodman Surgical Education Center, Stanford University, Stanford, California
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Baugh RF. The Evolution of Social Beliefs 1960-2016 in the United States and Its Influence on Empathy and Prosocial Expression in Medicine. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:437-446. [PMID: 32636695 PMCID: PMC7334402 DOI: 10.2147/amep.s246658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
This perspective surveys healthcare's response to the increased prominence of racial, ethnic, religious and sexual minorities as well as females in American culture. It argues for understanding physicians both as products of the broader society and its changes. Starting in the 1960s, empiric evidence for the rise of reactionary viewpoints in response to major social movements is outlined. Structural reasons for the prevalence of such ideologies within medicine are highlighted. Its negative consequences for minority health are addressed. Finally, the author turns to compensatory strategies to improve the social environment within healthcare. Alternative selection strategies for medical school are proposed, with a stronger focus on empathetic candidates.
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Affiliation(s)
- Reginald F Baugh
- University of Toledo College of Medicine and Life Sciences, Toledo, OH43623, USA
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Nairn S, Dring E, Aubeeluck A, Quéré I, Moffatt C. LIMPRINT: A Sociological Perspective on "Chronic Edema". Lymphat Res Biol 2020; 17:168-172. [PMID: 30995186 PMCID: PMC6639108 DOI: 10.1089/lrb.2018.0082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Chronic edema is a condition that is biologically complex, distressing for patients and sociopolitically weak. Like many other complex and chronic conditions, it has a low status within health care. The result is that it has a low priority in health policy and consequently is undervalued and undertreated. While evidence-based practice promotes a hierarchy of evidence, it is also the case that clinical practice is influenced by a hierarchy of social status. These are as much political as they are scientific. Methods and Results: This article will provide an explanation for why chronic edema is a low priority. It will do this through a critical review of the literature. We examine this through the theoretical lens of Pierre Bourdieu. The sociology of Bourdieu frames an understanding of power relations through habitus, field, and capital. We will employ these theoretical tools to understand the way that chronic edema is situated within the policy arena. We identify a number of social mechanisms that affect the status of chronic edema, including diagnostic uncertainty, social capital, scientific capital, cultural capital and economic capital. Conclusion: We argue that a whole system approach to care, based on human need rather than unequal power relations, is a prerequisite for the delivery of good health care. The specialty of chronic edema is not a powerless group and we identify some of the ways that the social mechanism that acts as barriers to change, can also be employed to challenge them.
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Affiliation(s)
- Stuart Nairn
- School of Health Sciences, University of Nottingham, Royal Derby Hospital Center, Derby, United Kingdom
| | - Eleanor Dring
- Nottingham University Business School, University of Nottingham, Jubilee Campus Nottingham, United Kingdom
| | - Aimee Aubeeluck
- School of Health Sciences, University of Nottingham, Queens Medical Center, Nottingham, United Kingdom
| | - Isabelle Quéré
- Montpellier Medecine Vasculaire, EA2992, Universite Montpellier I, CHU Saint Eloi, Montpellier, France
| | - Christine Moffatt
- School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
- Address correspondence to: Christine Moffatt, CBE, Nottingham School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, United Kingdom
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Fischer JP, Clinite K, Sullivan E, Jenkins TM, Bourne CL, Chou C, Diemer G, Dunne D, Hartung PJ, Paauw D, Reddy S. Specialty and Lifestyle Preference Changes during Medical School. MEDICAL SCIENCE EDUCATOR 2019; 29:995-1001. [PMID: 34457576 PMCID: PMC8368833 DOI: 10.1007/s40670-019-00790-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
PURPOSE Medical student specialty choices have significant downstream effects on the availability of physicians and, ultimately, the effectiveness of health systems. This study investigated how medical student specialty preferences change over time in relation to their demographics and lifestyle preferences. METHOD Students from ten medical schools were surveyed at matriculation (2012) and graduation (2016). The two surveys included questions about specialty and lifestyle preferences, demographics, educational background, and indebtedness. Student data from 2012 to 2016 were paired together and grouped into those whose specialty preferences remained constant or switched. RESULTS Response rates in 2012 and 2016 were 65% (997/1530) and 50% (788/1575), respectively. Fourth-year students ranked "enjoying the type of work I am doing" as less important to a good physician lifestyle than did first-year students (from 59.6 to 39.7%). The lifestyle factors "having control of work schedule" and "having enough time off work" were ranked as more important to fourth-year students than first-year students (from 15.6 to 18.2% and 14.8 to 31.9%, respectively). The paired dataset included 19% of eligible students (237/1226). Demographic and lifestyle factors were not significantly associated with specialty preference switching. Additionally, no significant association existed between changing lifestyle preferences and switching specialty preference (p = 0.85). CONCLUSIONS During the course of medical school, lifestyle preferences became more focused on day-to-day factors and less on deeper motivational factors. Neither demographics nor lifestyle preferences appear to relate to a student's decision to switch specialty preference during medical school. These findings represent an important step in uncovering causes of specialty preference trends.
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Affiliation(s)
- Jonathan P. Fischer
- University of Chicago Pritzker School of Medicine, 924 E 57th St., Suite 104, Chicago, IL 60637 USA
| | - Kimberly Clinite
- Santa Rosa Family Medicine Residency, University of California, San Francisco, San Francisco, CA USA
| | - Eric Sullivan
- University of Chicago Pritzker School of Medicine, 924 E 57th St., Suite 104, Chicago, IL 60637 USA
| | - Tania M. Jenkins
- Department of Sociology, University of North Carolina- Chapel Hill, Chapel Hill, NC USA
| | - Christina L. Bourne
- Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC USA
| | - Calvin Chou
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA USA
| | - Gretchen Diemer
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA USA
| | - Dana Dunne
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT USA
| | - Paul J. Hartung
- Department of Family & Community Medicine, Northeast Ohio Medical University, Rootstown, OH USA
| | - Doug Paauw
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA USA
| | - Shalini Reddy
- Department of Medicine, Cook County Hospital and Health System, Chicago, IL USA
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Emmerton-Coughlin H. Functional linguistics: the lens and the looking glass. MEDICAL EDUCATION 2019; 53:1169-1170. [PMID: 31750570 DOI: 10.1111/medu.14009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Ratain MJ. Enhancing the Visibility and Prestige of Clinical Pharmacology as a Medical Subspecialty. Clin Pharmacol Ther 2019; 106:914-915. [DOI: 10.1002/cpt.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Mark J. Ratain
- Department of Medicine The University of Chicago Chicago Illinois USA
- Committee on Clinical Pharmacology and Pharmacogenomics The University of Chicago Chicago Illinois USA
- Comprehensive Cancer Center The University of Chicago Chicago Illinois USA
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Logan AC, Prescott SL, Katz DL. Golden Age of Medicine 2.0: Lifestyle Medicine and Planetary Health Prioritized. J Lifestyle Med 2019; 9:75-91. [PMID: 31828026 PMCID: PMC6894443 DOI: 10.15280/jlm.2019.9.2.75] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/22/2019] [Indexed: 12/16/2022] Open
Abstract
The 'golden age of medicine' - the first half of the 20th century, reaching its zenith with Jonas Salk's 1955 polio vaccine - was a time of profound advances in surgical techniques, immunization, drug discovery, and the control of infectious disease; however, when the burden of disease shifted to lifestyle-driven, chronic, non-communicable diseases, the golden era slipped away. Although modifiable lifestyle practices now account for some 80% of premature mortality, medicine remains loathe to embrace lifestyle interventions as medicine Here, we argue that a 21st century golden age of medicine can be realized; the path to this era requires a transformation of medical school recruitment and training in ways that prioritize a broad view of lifestyle medicine. Moving beyond the basic principles of modifiable lifestyle practices as therapeutic interventions, each person/community should be viewed as a biological manifestation of accumulated experiences (and choices) made within the dynamic social, political, economic and cultural ecosystems that comprise their total life history. This requires an understanding that powerful forces operate within these ecosystems; marketing and neoliberal forces push an exclusive 'personal responsibility' view of health - blaming the individual, and deflecting from the large-scale influences that maintain health inequalities and threaten planetary health. The latter term denotes the interconnections between the sustainable vitality of person and place at all scales. We emphasize that barriers to planetary health and the clinical application of lifestyle medicine - including authoritarianism and social dominance orientation - are maintaining an unhealthy status quo.
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Affiliation(s)
- Alan C Logan
- in-VIVO Planetary Health, West New York, NJ, USA
| | - Susan L Prescott
- in-VIVO Planetary Health, West New York, NJ, USA.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - David L Katz
- Yale University, Prevention Research Center, Griffin Hospital, Derby, CT, USA
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Gaiaschi C. Same job, different rewards: The gender pay gap among physicians in Italy. GENDER WORK AND ORGANIZATION 2019. [DOI: 10.1111/gwao.12351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kumwenda B, Cleland J, Prescott G, Walker K, Johnston P. Relationship between sociodemographic factors and specialty destination of UK trainee doctors: a national cohort study. BMJ Open 2019; 9:e026961. [PMID: 30918038 PMCID: PMC6475150 DOI: 10.1136/bmjopen-2018-026961] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Many countries are driving forward policies to widen the socioeconomic profile of medical students and to train more medical students for certain specialties. However, little is known about how socioeconomic origin relates to specialty choice. Nor is there a good understanding of the relationship between academic performance and specialty choice. To address these gaps, our aim was to identify the relationship between socioeconomic background, academic performance and accepted offers into specialty training. DESIGN Longitudinal, cohort study using data from the UK Medical Education Database (https://www.ukmed.ac.uk/). PARTICIPANTS 6065 (60% females) UK doctors who accepted offers to a specialty training (residency) post after completing the 2-year generic foundation programme (UK Foundation Programme) between 2012 and 2014. MAIN OUTCOME MEASURES Χ2 tests were used to examine the relationships between sociodemographic characteristics, academic ability and the dependent variable, specialty choice. Multiple data imputation was used to address the issue of missing data. Multinomial regression was employed to test the independent variables in predicting the likelihood of choosing a given specialty. RESULTS Participants pursuing careers in more competitive specialties had significantly higher academic scores than colleagues pursuing less competitive ones. After controlling for the presence of multiple factors, trainees who came from families where no parent was educated to a degree level had statistically significant lower odds of choosing careers in medical specialties relative to general practice (OR=0.78, 95% CI, 0.67 to 0.92). Students who entered medical school as school leavers, compared with mature students, had odds 1.2 times higher (95% CI, 1.04 to 1.56) of choosing surgical specialties than general practice. CONCLUSIONS The data indicate a direct association between trainees' sociodemographic characteristics, academic ability and career choices. The findings can be used by medical school, training boards and workforce planners to inform recruitment and retention strategies.
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Affiliation(s)
- Ben Kumwenda
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Gordon Prescott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UK
| | - Kim Walker
- Institute of Education for Medical and Dental Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, UK, Centre for Healthcare Education Research and Innovation (CHERI), Aberdeen, UK
| | - Peter Johnston
- NHS, NHS Grampian and The Scotland Deanery, Aberdeen, UK
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Prescott SL, Logan AC. Planetary Health: From the Wellspring of Holistic Medicine to Personal and Public Health Imperative. Explore (NY) 2019; 15:98-106. [DOI: 10.1016/j.explore.2018.09.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/29/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
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Prescott SL, Logan AC, Katz DL. Preventive Medicine for Person, Place, and Planet: Revisiting the Concept of High-Level Wellness in the Planetary Health Paradigm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020238. [PMID: 30654442 PMCID: PMC6352196 DOI: 10.3390/ijerph16020238] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/11/2019] [Accepted: 01/13/2019] [Indexed: 12/29/2022]
Abstract
Experts in preventive medicine and public health have long-since recognized that health is more than the absence of disease, and that each person in the ‘waiting room’ and beyond manifests the social/political/economic ecosystems that are part of their total lived experience. The term planetary health—denoting the interconnections between the health of person and place at all scales—emerged from the environmental and preventive health movements of the 1970–1980s. Roused by the 2015 Lancet Commission on Planetary Health report, the term has more recently penetrated mainstream academic and medical discourse. Here, we discuss the relevance of planetary health in the era of personalized medicine, gross environmental concerns, and a crisis of non-communicable diseases. We frame our discourse around high-level wellness—a concept of vitality defined by Halbert L. Dunn (1896–1975); high-level wellness was defined as an integrated method of functioning which is oriented toward maximizing the potential of individuals within the total lived environment. Dunn maintained that high-level wellness is also applicable to organizations, communities, nations, and humankind as a whole—stating further that global high-level wellness is a product of the vitality and sustainability of the Earth’s natural systems. He called for a universal philosophy of living. Researchers and healthcare providers who focus on lifestyle and environmental aspects of health—and understand barriers such as authoritarianism and social dominance orientation—are fundamental to maintaining trans-generational vitality at scales of person, place, and planet.
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Affiliation(s)
- Susan L Prescott
- Department of Paediatrics, School of Medicine, University of Western Australia, Perth, WA 6009, Australia.
- The ORIGINS Project, Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA 6009, Australia.
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network (WUN), West New York, NJ 10704, USA.
| | - Alan C Logan
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network (WUN), West New York, NJ 10704, USA.
| | - David L Katz
- Prevention Research Center, Yale University School of Public Health, Griffin Hospital, Derby, CT 06418, USA.
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Choi DY, Gutierrez AS, Kang JH, Park JY, Sung CS. Entrepreneurs as rulers? Insights from the relationship between social dominance orientation and entrepreneurial intention. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2018. [DOI: 10.1111/jasp.12559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- David Y. Choi
- College of Business Administration; Loyola Marymount University
| | | | - Jae Hyeung Kang
- Department of Management and Marketing, School of Business Administration; Oakland University
| | | | - Chang-Soo Sung
- Department of Technology Entrepreneurship; Dongguk University
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Kumwenda B, Cleland JA, Prescott GJ, Walker K, Johnston PW. Relationship between sociodemographic factors and selection into UK postgraduate medical training programmes: a national cohort study. BMJ Open 2018; 8:e021329. [PMID: 29961026 PMCID: PMC6042613 DOI: 10.1136/bmjopen-2017-021329] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Knowledge about allocation of doctors into postgraduate training programmes is essential in terms of workforce planning, transparency and equity issues. However, this is a rarely examined topic. To address this gap in the literature, the current study examines the relationships between applicants' sociodemographic characteristics and outcomes on the UK Foundation Training selection process. METHODS A longitudinal, cohort study of trainees who applied for the first stage of UK postgraduate medical training in 2013-2014. We used UK Medical Education Database (UKMED) to access linked data from different sources, including medical school admissions, assessments and postgraduate training. Multivariable ordinal regression analyses were used to predict the odds of applicants being allocated to their preferred foundation schools. RESULTS Applicants allocated to their first-choice foundation school scored on average a quarter of an SD above the average of all applicants in the sample. After adjusting for Foundation Training application score, no statistically significant effects were observed for gender, socioeconomic status (as determined by income support) or whether applicants entered medical school as graduates or not. Ethnicity and place of medical qualification were strong predictors of allocation to preferred foundation school. Applicants who graduated from medical schools in Wales, Scotland and Northern Ireland were 1.17 times, 3.33 times and 12.64 times (respectively), the odds of applicants who graduated from a medical school in England to be allocated to a foundation school of their choice. CONCLUSIONS The data provide supportive evidence for the fairness of the allocation process but highlight some interesting findings relating to 'push-pull' factors in medical careers decision-making. These findings should be considered when designing postgraduate training policy.
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Affiliation(s)
- Ben Kumwenda
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jennifer A Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Gordon J Prescott
- Medical Statistics Team, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kim Walker
- NHS Grampian, NHS Education for Scotland and UK Foundation Programme, Aberdeen, UK
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Redford L, Ratliff KA. Retribution as hierarchy regulation: Hierarchy preferences moderate the effect of offender socioeconomic status on support for retribution. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2017; 57:75-94. [PMID: 28921582 DOI: 10.1111/bjso.12219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 08/28/2017] [Indexed: 11/29/2022]
Abstract
People punish others for various reasons, including deterring future crime, incapacitating the offender, and retribution, or payback. The current research focuses on retribution, testing whether support for retribution is motivated by the desire to maintain social hierarchies. If so, then the retributive tendencies of hierarchy enhancers or hierarchy attenuators should depend on whether offenders are relatively lower or higher in status, respectively. Three studies showed that hierarchy attenuators were more retributive against high-status offenders than for low-status offenders, that hierarchy enhancers showed a stronger orientation towards retributive justice, and that relationship was stronger for low-status, rather than high-status, criminal offenders. These findings clarify the purpose and function of retributive punishment. They also reveal how hierarchy-regulating motives underlie retribution, motives which, if allowed to influence judgements, may contribute to biased or ineffective justice systems.
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Affiliation(s)
- Liz Redford
- University of Florida, Gainesville, Florida, USA
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