Using national databases of the Association of American Medical College, the authors employed logistic regression analysis to show the relative predictive influences of selected demographic, structural, attitudinal, and educational variables on the specialty careers choices of 1995 U.S. medical school graduates. Plans to pursue certification in family practice or an unspecified generalist career could be predicted with moderate success, while choices of general internal medicine and general pediatrics could not. The intentions of the 1995 graduates to pursue generalist specialty, were significantly associated with demographic factors such as female gender, older student age, and rural hometown; early interest in the generalist specialties; attitudes favoring helping people over seeking opportunities for leadership, intellectual challenge, or research; the presence of a department of family medicine in the medical school; and ambulatory care experiences in the third and fourth years. In the multiple-regression models used in this study, a number of factors widely touted as important to the cultivation of generalism were not significant predictors of generalist decisions; an institutional mission statement expressly addressing the cultivation of generalist careers; giving admission preferences to applicants who vowed an interest in generalism; public (versus private) school sponsorship; discrete organization units for general internal medical or general pediatrics; the proportion of institutional faculty in the general specialty of medicine and pediatrics; the level of educational debt; the students; clinical experiences in the first and second years of medical school. The authors acknowledge the danger of inferring causal relationships from analyses of this kind, and described how the power of previous associations--e.g., that between a required third-year clerkship in family medicine and graduates' family practice career choices--may be weakened when the independent variable spreads across institutional cultures that at present are less conductive to primary care. The findings of this analysis add to the evidence that generalist career intentions are largely carried on the tide of students' interests and experiences in family medicine and ambulatory primary care. In terms of the predictive values of the input variable in this study, career decisions for the other two generalist specialties--general internal medicine and general pediatrics--were essentially a crapshoot, either because the tactics to promote interest in these fields were ineffective (or confounded), or because the efforts were underdeveloped. Moreover, the statistical models of this study employed quantifiable variables that can be discerned and manipulated to guide the result, whereas medical students tend to identify less tangible elements as more powerful factors influencing their career choices. The results sharpen the strategic focus, but must be combined with those of other, descriptive analysis for a more complete understanding of graduating...

Medical schools must understand that verbal abuse correlates with students' confidence, regardless of their sex, race, age, or levels of ability and assuredness. School policies must address the problem of verbal abuse of students to avoid lowering students' self-confidence.

This chapter describes the creation, implementation, and assessment of a systematic program of inquiry‐guided learning and discusses some of the challenges posed.

Using national databases of the Association of American Medical Colleges, the authors have examined reasons for the rising indebtedness of U.S. medical students, looking across the past decade at the influence of tuition and fees (tuition-fees) alone and the total costs of attending school, the effects of the changing demographics of medical school enrollments and lengthened graduation times, the relationship between the availability of school-funded scholarships and the amount of student loan disbursements, the pattern of student financial aid, and the reliance on borrowing to cover the costs of medical education. In constant dollars, the average indebtedness of students graduating from public schools increased 59.2% between 1985 and 1995, and that for graduates of private schools increased 64.2%. The fraction of graduates bringing debt with them when they entered medical school declined from 42.1% in 1985 to 33.6% in 1995. Premedical debt as a fraction of total debt declined at public schools from 9% in 1985 to 7% in 1995, and at private schools from 7.8% in 1985 to 5.9% in 1995. For public schools, tuition-fees increased 60.1% between 1985 and 1995, and average medical school debt increased 60.9%; for private schools, tuition-fees increased 30.1% over that period, while average medical school debt increased 66.2%. On average, public school graduates accrued debt greater than their four-year tuition-fee payments, while the average debt accrued by private school graduates was less than tuition-fee amounts. In 1995, graduates of public schools had debt accumulations representing 62% of the average total cost of attendance (tuition, fees, books, supplies, equipment, and living expenses), and the indebtedness of private school graduates was 55% of the average total cost, findings suggesting that total costs were the stronger driver of the amounts borrowed. On a national scale, the influences on medical school debt of longer graduation times, the growing number of women students, greater racial-ethnic diversity, and the admission of more older students age were negligible or small. The average parental income, adjusted to constant dollars, actually increased between 1985 and 1995. For public schools, the aggregate amounts of student aid have climbed at a steeper rate than schools' tuition-fee revenues during the past decade. For public schools, tuition-fee revenues rose 66.7% between 1985 and 1995, while the amount of loans to students at public schools increased 92.7%. For private schools, tuition-fee revenues went up 36.5%, and the amount of loans to students rose 57.9% during the same period. Federal Stafford Loans represented the major financing source, increasing from 71.5% of public schools' tuition-fee revenue in 1985 to 92.2% in 1995, and from 23% of private schools' tuition-fee revenue in 1985 to 38% in 1995. Over the decade, scholarship support kept pace with tuition-fee increases at public schools, but lagged behind the increases at private schools. The recent escalation of student debt has coincided with...