Although many doctors and nurses presumably develop good working relationships, substantial problems are frequently reported. There is a large body of reports on physicians' attitudes toward and perceptions of nurses, but no systematic attempt has been made to develop a psychometrically sound instrument to measure attitudes towards nurses. This study reports steps in developing such an instrument and its psychometric characteristics. Based on a review of the literature, a preliminary list of 59 statements of attitudes toward nurses was prepared and subsequently reviewed by 26 medical educators, nurses, and physicians. 25 statements were judged to have adequate face validity and were included in a preliminary version of a questionnaire using a 4-point Likert-type format. Quantitative analyses were performed on the responses of two groups of medical students (67 freshmen and sophomores and 15 freshmen). Twenty statements yielded a significant and positive correlation with the total score. Statistical analyses of the 20-item version of the scale supported its psychometric characteristics.

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Despite concern over the concentration on science in pre-medical education and the selection of medical students in the United States, no major changes have been made. The present study compares attrition rates and clinical competence levels of medical students who vary in pre-medical training, age, and sex, in order to determine the risk attached to accepting applicants with different background characteristics. No differences were found in levels of clinical competence, although the groups varied in average science scores on the medical college admission tests (MCATs). Students with non-science undergraduate majors had lower scores on this test than science majors. Younger women had relatively high attrition rates, but high performance on the MCAT science sub-test and in medical school science course. It was concluded that all groups had adequate science preparation for medical school, and there was no greater risk of producing doctors with low levels of clinical competence associated with accepting students from groups with lower science performance.

A questionnaire was mailed to 2,521 Iranian and 2,938 Filipino physicians who were practicing medicine in the U.S. Six hundred ninety-five Iranians and 898 Filipinos responded. Data of a section of the questionnaire on perceived adjustment and psychosocial problems were analyzed in this study. Statistical analyses of the data (bivariate correlations, multiple regression, and factor analysis) indicated that the reported adjustment problem was related closely to psychopathological measures such as loneliness, anxiety, depression, homesickness, and low self-esteem in both nationality groups. Participation in social activities with Americans was inversely related to perceived adjustment problems. In both groups, those who had become naturalized US. citizens and those who planned to stay permanently in the US. were less likely to report adjustment problems. The relationships between perceived adjustment problems and age and total years in the US. were not significant for Iranian physicians; however, they were correlated significantly for the Filipinos, which indicates that older physicians in this group and those who had been in the U S . for a longer period of time were less likely to report adjustment problems. Other differences and similarities between the two nationality groups also were identified. , 135, 1525-1529. WORKNEH, F. (1973). The foreign medical graduate: The alienated minority of psychiatry. American Journal of Psychiatry. 130, 436-437. 54, 279-280. by region of residence and medical specialty. Delaware Medical Journal, 56, 553-557. college students. Educational and Psychological Measurement, 42, 917-925. Psychology, 38, 137-141. Medicine. 25-30. ECFMG certified physicians in the U.S. Medical Care, 13, 205-209. state hospitals. Hospital and Community Psychiatry, 27, 35-37. Journal of Psychiatry

In spite of higher disease and mortality rates, the poor and minority group sectors of the American population make fewer visits to physicians and are less likely to receive personal health counseling or preventive services than those at higher income levels. Hospital admissions are as high for the poor, however, and tend to be for longer lengths of stay. Pri vate physicians are the most common source of medical care at all income levels, but the poor and persons from minority groups make greater use of hospital clinics and emergency ser vices. Low-income patients are unlikely to receive comprehen sive care from private physicians, and few public clinics are designed to provide such care. Public clinics are also usually inconvenient to reach and unpleasant to utilize. The poor are also less aware of the concepts and practices of scientific medicine, and differences in many beliefs and values make com munication between patient and practitioner difficult. In order to bring the poor into the mainstream of American medicine, adequate public support for their health services, combined with inducements to provide comprehensive care, are required. A flexible system which permits continuing contact between patients and practitioners is also important for improving both the use of health services and the health practices of the poor.