Faculty Bibliography

A stress management program that used computerized, telephone-based technology was offered to the public via a free, '800' telephone number. The program was intended to reach a very large number of persons, while requiring a minimum of staff time. The program used an interactive telephone system, employing natural sounding, digitized voice, and touch tone recognition of callers' responses. The program was available 24 hours a day. It composed each message to suit the individual needs and expectations of each caller. A controlled evaluation of the program was conducted to determine how the messages could be worded and presented most effectively. The results suggest that subjects were most likely to find the messages in the program helpful, to carry out the stress management instructions, and to continue calling when the messages were personalized and contained homework assignments

OBJECTIVE:To determine the factors that attract students toward and push students away from a career in internal medicine. DESIGN/METHODS:National survey of senior U.S. medical students using a stratified random cluster sampling of medical schools. PARTICIPANTS/METHODS:The survey included 1650 U.S. senior students from 16 medical schools, of whom 1244 (76%) responded. MEASUREMENTS AND MAIN RESULTS/RESULTS:A survey instrument was developed and pilot tested at 17 medical schools. Twenty-four percent of the respondents to the final survey chose a career in general internal medicine (9%) or subspecialty internal medicine (15%). A career in internal medicine had been "seriously considered" by 608 respondents (50%) who finally chose a career other than internal medicine (the "switchers"). Compared with other specialties, internal medicine was perceived as being more stressful to residents, more demanding of time and workload as a career and a residency, and as an easier residency to enter. Internal medicine was also seen as providing less satisfaction for residents, having lower income potential, and allowing less leisure time. For the 608 switchers, the most important influences leading to their decision to switch were the type of patient seen in internal medicine (for example, chronically ill, alcohol and drug abusing patients) as well as dissatisfaction and stress among internal medicine residents. Factor analysis showed that three factors, "intellectual challenge of internal medicine," "primary care interests," and "the medicine clerkship" attracted students toward internal medicine, whereas three others, "taking care of chronically ill patients," "level of satisfaction among internists and medical residents," and "workload and stress" pushed students away from internal medicine. Factors pushing students away from internal medicine were significantly more negative with regard to a career in general as opposed to subspecialty internal medicine (P less than 0.001). CONCLUSION/CONCLUSIONS:Medical students have serious reservations about internal medicine as a career choice. Perceptions about the medical residency, the patients they expect to see, and the dissatisfaction among residents and internists are foremost in their thinking. Changes to improve the attractiveness of internal medicine should address these adverse perceptions while building on the positive influences identified by the respondents.