Faculty Bibliography

BACKGROUND: A physician's effectiveness depends on good communication, and cognitive and technical skills used with wisdom, compassion, and integrity. Attaining the last attributes requires growth in awareness and management of one's feelings, attitudes, beliefs, and life experiences. Yet, little empiric research has been done on physicians' personal growth. OBJECTIVE: To use qualitative methods to understand personal growth in a selected group of medical faculty. DESIGN: Case study, using open-ended survey methods to elicit written descriptions of respondents' personal growth experiences. SETTING: United States and Great Britain. PARTICIPANTS: Facilitators, facilitators-in-training, and members of a personal growth interest group of the American Academy on Physician and Patient, chosen because of their interest, knowledge, and experience in the topic area and their accessibility. MEASUREMENTS: Qualitative analysis of submitted stories included initially identifying and sorting themes, placing themes into categories, applying the categories to the database for verification, and verifying findings by independent reviewers. RESULTS: Of 64 subjects, 32 returned questionnaires containing 42 stories. Respondents and nonrespondents were not significantly different in age, sex, or specialty. The analysis revealed 3 major processes that promoted personal growth: powerful experiences, helping relationships, and introspection. Usually personal growth stories began with a powerful experience or a helping relationship (or both), proceeded to introspection, and ended in a personal growth outcome. Personal growth outcomes included changes in values, goals, or direction; healthier behaviors; improved connectedness with others; improved sense of self; and increased productivity, energy, or creativity. CONCLUSIONS: Powerful experiences, helping relationships, and introspection preceded important personal growth. These findings are consistent with theoretic and empiric adult learning literature and could have implications for medical education and practice. They need to be confirmed in other physician populations

A distinct branch of the Mycobacterium tuberculosis W phylogenetic lineage (W14 group) has been identified and characterized by various genotyping techniques. The W14 group comprises three strain variants: W14, W23, and W26, which accounted for 26 clinical isolates from the New York City metropolitan area. The W14 group shares a unique IS6110 hybridizing banding motif as well as distinct polymorphic GC-rich repetitive sequence and variable number tandem repeat patterns. All W14 group members have high levels of streptomycin resistance. When the streptomycin resistance rpsL target gene was sequenced, all members of this strain family had an identical mutation in codon 43. Patients infected with the W14 group were primarily of non- Hispanic black origin (77%); all were US-born. Including HIV positivity, 84% of the patients had at least one known risk factor for tuberculosis

The recent admission by prize-winning historian Joseph J. Ellis that he misled students at Mount Holyoke College, as well as reporters from the Boston Globe, when he claimed to have spent the 1960s as a combat veteran in Vietnam, a civil-rights worker in Mississippi and an anti-war protester at Yale has raised some obvious questions: why did he do it? What did he have to gain? And whom, exactly, did he hurt? Over time, it seems, this stigma has grown worse. In the recent U.S. presidential campaign, the media roasted George W. Bush for lacking passion and commitment during his college days in the 1960s. Unlike Al Gore, who supposedly wrestled with the issues of war and peace while at Harvard, George W. was portrayed as the polar opposite: a good-time preppie who snored his way through Yale as president of Delta Kappa Epsilon, described in the Washington Post as "the hardest-drinking jock house on campus." The implication was clear: anyone not sufficiently engaged in the moral turmoil of the 1960s was unfit to lead America today. Sometimes it's no fun to tell the truth. Like Ellis, I was a college student in the 1960s, I now teach American history at the college level and I speak personally and anecdotally about events of the not-too-distant past. My students already hold vaguely positive views of that storied decade. Movies and music have taught them to see the decade as the zenith of youthful idealism - a time of Freedom Rides, anti-war rallies, unbridled student power and, of course, free love. Naturally, they ask questions about the choices I made in this era, when I was close to their present age. Answering them honestly, I can see the disappointment in their faces

A second artificial heart implant seems weeks away because four surgical teams in other cities that expect to implant the device need time to gear up and meet federal requirements, the principal researchers and Abiomed, AbioCor's manufacturer, said in interviews. Dr. Laman A. Gray Jr., Dr. [Robert D. Dowling]'s partner, said he had treated patients as sick as the AbioCor recipient who still recovered with a ventricular assist device and subsequently a heart transplant. To boost the AbioCor recipient's morale a few days after the implant, Dr. Gray said, he brought him a visitor who had been just as sick when he received a ventricular assist device. The man also had a transplant and is now back working as a school principal. At its weekly meetings, a Hahnemann committee has been referring patients who are ineligible for heart transplants for consideration as AbioCor recipients, Dr. [Louis E. Samuels] said. The evaluation involves a number of tests, including CT scans of the chest to determine whether the AbioCor will fit. The chest must be large enough to hold a grapefruit-size artificial heart, an energy coil, battery and controller, totaling a little more than four pounds

The first recipient of a self-contained artificial heart had minor surgery this week to create an opening in his neck so a breathing tube could be passed into his windpipe and connected..

Yet no event, Mr. DePalma says, was more significant than passage of the North American Free Trade Agreement in 1993. Blending a rich history of the continent with a sharp eye for cultural observation, he shows how the leaders of Mexico, Canada and the United States overcame generations of prejudice and exploitation to devise a common economic strategy based on free trade, open borders and mutual respect. Many were alarmed by the agreement, of course. Nafta 'caused tremors in each country,' Mr. DePalma writes, 'but the fears each nation felt were something different.' Canada faced different concerns, Mr. DePalma says, and culture played the central role. Unlike the United States, where individual rights take precedence over community norms, Canada cherishes order, civility and the public good. The United Nation's quality-of-life rankings -- which include such things as health care, literacy rates and life expectancy -- place Canada at the top. Yet these benefits did not come cheaply. In seeking consensus and social comfort, Mr. DePalma notes, Canadians sacrificed the opportunities for personal advancement and creativity that are hallmarks of American-style competition. As a result free trade was long viewed as an alien concept in Canada, where people grew up believing in the virtues of collectivism and government protection. Mr. DePalma ends his elegant journey on an optimistic note. The economies of Mexico and Canada are stronger than before. Mr. DePalma contends that the openness required by free trade has lessened corruption in Mexico and increased the pressure for democratic reforms. In Canada, he writes, 'corporations were forced to streamline,' and the government followed suit, providing the first balanced budget in nearly 30 years. For Mexicans the major issue today is the creation of high-wage jobs; for Canadians it is the ability to stay competitive while retaining their generous welfare safety net. And for North Americans, Mr. DePalma concludes, it is the willingness to become 'a community of shared interest, common dreams and coordinated responses to problems that have no regard for borders.'

Dr. [Laman A. Gray Jr.] and his partner, Dr. Robert D. Dowling, said the man had a type of lung problem known as interstitial edema that they attributed to the malnutrition. Otherwise, they said, tests show that the man's lungs are exchanging oxygen and carbon dioxide well. The man's liver function is near normal, and a blood test for creatinine, a standard measure of kidney function, shows improvement to 2.2 today compared with about 3 before the implant, the doctors said. A normal creatinine is less than about 1, and the man's lowest creatinine in the last two years was 1.9 as his kidneys also failed. The AbioCor is much quieter than the Jarvik-7 and ventricular assist devices and makes a soft swishing sound as it beats, Dr. Gray said. The man's AbioCor is pumping about seven liters a minute, in the range of a normal heart's but four times the amount the patient's failing heart could pump before the implant. Now Dr. Gray said he expected that the man would probably stay on a ventilator for another two weeks or so. To improve the man's comfort and allow him to get up in that period, Dr. Gray said, surgeons might soon cut a hole in the man's windpipe (a tracheotomy) to avoid keeping a breathing tube in his throat