Medical student interest in internal medicine: initial report of the Society of General Internal Medicine Interest Group Survey on Factors Influencing Career Choice in Internal Medicine

Article Abstract:

A report is presented from a survey of 1,244 senior medical students at 16 US medical schools, the aims of which were to learn more about their attitudes toward and perceptions of the specialty of internal medicine. The survey, sponsored by the Society of General Internal Medicine, was prompted by a decline in the number of students who choose to specialize in internal medicine that has reached crisis proportions. The survey instrument was a 10-page questionnaire, organized into four sections: sociodemographic information; the specialty the respondent would like to enter; the respondent's perceptions of internal medicine and other specialties; and the importance the respondent attached to each of 43 characteristics of internal medicine. Twenty-four percent of the respondents (295 people) ultimately chose a career in internal medicine, of which 9 percent (of the total group) planned to pursue general internal medicine and 15 percent, internal medicine subspecialties. These young physicians were less likely to be married or to have children than those who chose other specialties (942; 7 did not choose a specialty). Most of the 608 respondents who had seriously considered internal medicine as a choice, but had switched to another preference, said they changed their minds during the clerkship year. They had been influenced away from internal medicine by the type of patient seen in the specialty (chronically ill, substance abusers) and the stress and workload they anticipated. The specialty was also perceived as providing less satisfaction and lower income possibilities than other specialties. Attractive aspects of internal medicine were intellectual stimulation, continuity of care, the chance to make a contribution, and related factors. A discussion is presented of the ways the medical clerkship could be changed to allow students to glimpse the more satisfying sides of the specialty. The results should be viewed as presenting a positive challenge to the specialty. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Medical student attitudes about internal medicine: a study of U.S. medical student seniors in 1988

Article Abstract:

Since reaching its highest level in 1985, the proportion of medical school graduates who choose residencies in internal medicine has fallen precipitously to the point where, in 1990, there had been a 21 percent reduction in interest in the specialty. Results from a 1988 study of 10,379 graduating senior medical students are presented, based on students' responses to the 1988 Medical Student Graduation Questionnaire. This instrument collects demographic data, information concerning medical school experiences, specialty preferences, and career plans. Results are presented here from the graduates who planned careers in internal medicine (1,931 physicians) and those who had considered becoming internists but had changed their minds (1,606). The most important aspect of internal medicine for those who chose it was its intellectual content; next were the diagnostic challenges offered by the specialty, followed by the type of patient seen and the role models offered by internal medicine physicians. Those who switched away from internal medicine to other specialties did so because of the time and effort demands, the sense that the specialty was inconsistent with their personalities, and negative experiences during the internal medicine clerkship. Many did not like the type of patient they were likely to encounter, and believed the specialty they chose instead would be more rewarding. Results are also presented for those who chose general internal medicine versus internal medicine subspecialties. Overall, the results suggest that medical students' desire to avoid internal medicine is a consequence of several factors, and show that many of the problems turning away young physicians are not within the control of medical schools. (Consumer Summary produced by Reliance Medical Information, Inc.)

Beliefs, opinions and attitudes

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Clinical significance of a dizziness history in medical patients with syncope

Article Abstract:

Dizziness and syncope (a transient loss of consciousness resulting from inadequate blood flow to the brain) are two related, fairly common, medical problems that often defy explanation. Up to 48 percent of syncope patients and 37 percent of patients suffering from dizziness are never conclusively diagnosed. This results partly from the limited accuracy and utility of available diagnostic tests. Despite the observation that dizziness and syncope often (but not invariably) occur in the same patient, no analysis has been made of the diagnostic implications of a finding of one of these conditions in a patient with the other symptom. Consequently, a study was carried out involving 121 consecutive patients referred for treatment of syncope; each subject was asked a series of standardized questions concerning dizziness. Dizziness was reported by 70 percent of the patients. Patients complaining of dizziness tended to be younger (47 versus 56 years), more often female (75 percent versus 42 percent), and more likely to be assigned a psychiatric diagnosis than those not reporting dizziness. Psychiatric diagnoses included panic disorders, major depression, and conversion disorders (altered physical function stemming from psychological causes). Multivariate statistical analysis revealed young age and vertigo (a form of dizziness in which the patient perceives that either he or she or the surroundings are revolving) were associated with a psychiatric diagnosis. Hence, a careful history of patient-reported dizziness may guide initial evaluation of syncope patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Physiological aspects, Fainting, Vertigo

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