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The literature on medical student career choice has identified several influences that can be categorized as student demographics, medical school characteristics, students' perceptions of specialty characteristics, and student-held values. A logistic regression model that included demographics, medical school, and student-rated influences as a proxy for perceptions and values was used to determine their relative contribution to student career choice for three consecutive cohorts of senior medical students attending two schools ( n ‫؍‬ 649). This model identified a positive relation between choice of primary care career and both student-rated influences and one student demographic characteristic, but not between career choice and school attended. Variables positively correlated with primary care career choice were related to working with people and marital status. Negatively correlated variables were related to income and prestige. rom 1992 to 1996, the percentage of medical students choosing primary care careers increased dramatically from 14.6% to 31.9%, 1,2 but the number of primary care physicians remains inadequate. 3 A need remains for better identification of factors that determine career choice. The literature on career choice has identified influences that can be broadly categorized as students' demographics, medical school characteristics, students' perceptions of specialty characteristics, and student-held values. 4 The latter two factors can be indirectly evaluated by asking students to rate influences on career choice.Although many variables have been investigated in studies of career choice, little research has been done comparing the relative importance of factors from the multiple categories. Therefore, the factors that have the greatest influence on career choice remain unclear. For example, many studies have correlated specific demographic characteristics with career choice, but school characteristics or student values may be of greater importance in the decision-making process.To determine the relative contribution of factors in these diverse categories to career choice, we surveyed senior medical students at two schools. Two questions were posed for this exploratory study: (1) What is the impact of student demographics, school attended, and studentrated influences on career choice? (2) Within the broader categories of demographics and student-rated influences, which specific factors are most influential?

This article provides evidence from five samples of different health professionals (family physicians, emergency medical technicians, hospital nurses, flight nurses, and emergency medicine residents) for the reliability and validity of the Work-Related Strain Inventory (WRSI). The inventory consists of 18 items and was designed to measure perceptions of strain in occupational settings. Internal consistency reliability ranged from .85 to .90 and, as predicted, was correlated with the Maslach Burnout Inventory and measures of depression, role ambiguity, job satisfaction, and work-group functioning. When compared with different measures of depression symptoms (eg, Zung Self-Rating of Depression Scale, Center for Epidemiologic Studies Depression Scale), the Work-Related Strain Inventory was found to measure a different and independent construct. This inventory, a short, easily administered measure with good reliability, may be useful for appraising levels of work-related strain in behavioral and organizational models of the consequences of stress in different work environments.

I ABSTRACTObjective: To determine the extent and effects of abuse and harassment, including sexual harassment and racial or ethnic discrimination, experienced by residents in emergency medicine (EM).Method: The study instrument was an anonymous, self-report survey administered to a national sample of EM residents. The survey was timed to coordinate with the American Board of Emergency Medicine's annual In-Service Examination in February 1993. The residents reported whether they had experienced nine types of abuse or harassment during their residency training, the sources of these incidents, the effects on the residents, and whether they chose to file a formal complaint regarding these events.Results: Surveys were returned by 1,774 (80%) of the 2,229 residents who sat for the examination-74.4% men and 24.6% women. Overall, 98% reported at least one occurrence of abuse or harassment, with patients being the most frequent source. More than half of the more senior residents reported having been physically hit or pushed. Other health care professionals were a frequent source of verbal abuse and sexual harassment. Women were significantly more likely than men to report unwanted sexual advances (63% vs 32%, p < 0.001), discomfort from sexual humor (66% vs 27%. p < 0.001). and unfair treatment because of gender (71% vs 15%, p < 0.001). Non-Caucasians reported a higher rate of racial or ethnic discrimination than did Caucasians (51% vs 23%, p < 0.001). As a result of these episodes, 19% of the respondents had questioned their decision to become a physician, 20% had questioned entering the specialty of EM, 11% had experienced emotional effects lasting over one month, and 11% had experienced disruption of their family lives. Only 56 (3.2%) had filed formal complaints.Conclusions: Residents frequently encounter abuse or harassment, particularly from patients. They also report adverse consequences from these episodes.Acad. Emerg. Med. 1995; 2:293-301.

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