The surgical internship and residency.
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The American Board of Psychiatry and Neurology eliminated the internship as a requirement for certification in psychiatry in 1970. Preliminary study on a psychiatric inpatient service of internship-trained first-year residents with that of a matched group of residents who entered the same program without the internship disclosed differences in patient care practices. The same group of residents in their subsequent years of training in a psychiatric outpatient service were compared. A chart review comparison disclosed differences in areas of management in psychiatric outpatient treatment, referral patterns, and use of medication. Supervisory ratings of the residents were found to differ substantially in nine of the 15 measured categories.
A SUNY-Upstate cohort was observed during the four-year matriculation (1974--1978) of the students for changes in their career choices. Medical school exposure seemed to increase students' interest in all major specialties, with the exception of family practice for which there was an overall 3% decrease. Internship and residency appointments accepted indicated that 75% entered primary care specialties, 8% more than the national average for 1978.
Ninety-nine medical and surgical house officers were prospectively evaluated during internship and residency for the development of hepatitis B virus (HBV) infection. The overall incidence of hepatitis B was 10.2% per year. Eighty-six percent of episodes were subclinical. The greatest risk factor appeared to be frequent hand-to-mouth activity such as smoking or licking requisition labels. The presence of a hemodialysis or transplantation unit may be an additional institutional risk factor. HBV infection was not associated with a history of needle-sticks or contact with known antigen-positive patients. Educational efforts to minimize HBV infection should concentrate on handwashing techniques and discouragement of hand-to-mouth activity in patient care areas.
The purpose of this paper is to examine similarities and differences between graduating medical students who do and do not match through the National Internship and Resident Matching Programme (NIRMP). Data from graduates of 3- and 4-year undergraduate curricula were examined separately. A two way analysis of variance was used; the two independent variables were (1) whether the student was a 3- or 4-year medical graduate, and (2) the students' matched vs unmatched status. The dependent variables used in this study were in the following five categories: (1) demographic and academic performance upon entrance to medical school, (2) academic performance during medical school, (3) future practice preferences projected during medical school, (4) internship/residency choices, and (5) clinical performance during internship/residency. On the basis of the data presented, it is clear that there are few differences between matched and unmatched students that could be detected in over seventy-five measures examined. Within the unmatched group, however, the 3-year graduates differ in some respects from their 4-year colleagues. It is likely, therefore, that a different constellation of factors appears to be operating in these two unmatched groups but not within the matched groups.
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A survey questionnaire about attitudes toward terminal illness was administered to all medical students, interns, and all medical, surgical, and psychiatric residents at the Downstate Medical Center. The majority of students and new physicians surveyed reported that patients with terminal illness should be told their diagnosis--a reversal of attitudes as compared with those revealed by studies done before 1970. Most of the respondents also expressed the view that they would want to be told of their own fatal illness. The attitudes at different levels in medical school, internship, and residency did not differ significantly despite the differences in formal education and clinical experience of the respondents. Implications of these findings are discussed with particular emphasis on the need to teach an individualized approach to the dying patient.
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