Best wishes from medical students

- G.Sivagnanam1, M. Rajasekaran2, P. Thirumalaikolundusubramanian3, K.Namasivayam4, C.Jayashree5 and C.Ravindranath6.
Department of Pharmacology 1, 2, 4 & 5, Medicine3, & Dean 6 (now at SMC, Chennai),
K A P Viswanatham Government Medical College, Trichirappalli- 620 001, India
E-mail: drsivagnanam@rediffmail.com
Eubios Journal of Asian and International Bioethics 12 (2002), 71-72.


Abstract

There is a prevalent view that medical education is having a detrimental influence on values of students, leading to production of selfish and distrustful doctors. One can assess the motivation of individuals by eliciting and analyzing their personal wishes. A questionnaire in English, consisting of statements with examples of wishes, under 18 different headings (or to express their own wishes in writing) were completed by the third and final year undergraduate medical students, of both sexes (n=259; males=138, females=121; aged between 20 and 22 years), to assess their motivation. Fischer exact test was used to analyse significant gender difference if any. In pooled data, the three most popular categories of wishes were; self-esteem (41%), happiness (40%) and health (35%). Significant gender difference existed only for wishes pertaining to sex, power and self-esteem. The rank order of the three most popular wishes for males were happiness (42%), health (34%) and intimacy (33%), while for females they were, self-esteem (54%) happiness (38%), health / intimacy (36% each). In this study there is no evidence that medical students were money oriented. However poor preference for altruistism was discouraging, pointing to the need for shaping the students' personal and professional career towards a non-cynical, person oriented approach.

Keywords: medical undergraduates, money, altruism, questionnaire, India.

Introduction

It is a great privilege to study medicine, a noble profession. It is expected that students who take up medicine not only be academically brilliant but also possess attributes like, unselfishness and courteousness, since they play a pivotal role in physician-patient relationship and patient care. Medical education has virtually no effect on attributes like; warmth, kindness, helpfulness etc1. Contrary to the general expectation, there are a few reports stating, medical students become money oriented during the course of their study2, though concern for patients and a tendency to help was also seen3. The personal wishes of individuals' relate to trait, and well-being2 but more importantly throws light on underlying motivation4. To our knowledge there is no report of studies eliciting medical students' wishes in developing countries, hence the present study was aimed at obtaining the personal wishes of medical students and to see how they varied with reference to gender, in a country like India.

Methods

The authors conducted the survey after getting due ethical clearance. An anonymous questionnaire was completed by 259 (94.5%) of the 274, third and final year medical undergraduate students, who were between 20 and 22 years. The sample comprised of 138 boys (53.3%) and 121 girls (46.7%), of two Government medical colleges, at Trichirappalli and Madurai cities, in the southern part of India. The questionnaire was completed at the end of the lecture and collected by the authors. The questions were in simple English and were structured based on a previous study4 with modification to the effect, the students were given the option to tick any three wishes given under 18 different headings (quoting an example under each heading) or prefer their own wish under the corresponding heading or under different headings of their choice. Details like gender, age and year of study were also elicited.

The data were entered in Microsoft Excel spread sheet. GraphPad InStat version 3.05 was used for statistical analysis (Fisher exact test) to find out any significant gender difference.

Results

The question of rating difference did not arise since either the students opted to tick three wishes, which were already quoted as examples or chose to write their wish under relevant heading. Table 1 shows the number of students with wishes under different categories according to the rank order. In the pooled data (total) the three most popular categories of wishes were self-esteem (41%), happiness (40%) and health (35%). When the results were analyzed gender wise the three most popular categories of wishes were different for boys and girls, which did not follow the same rank order. While boys wished for happiness (42%), health (34%) and intimacy (33%), girls were for self-esteem (54%) happiness (38%), health / intimacy (36% each).

Significant gender difference existed in wishes pertaining to sex; boys were more likely than girls to make sex wishes [17 (12%) Vs 0 (0%); OR (odds ratio) = 35, p < 0.0001], [power 12 (9%) Vs 2 (5.4%); OR = 5.67, p < 0.01] and it was the reverse with self-esteem [40 (29%) Vs 65 (54%); OR = 0.35, p < 0.0001].

Table.1: Rank order of wishes of medical students according to the total number (Proportion) expressing each wish.

Rank Wish category Example Male Female Total
1 Self-esteem To be more confident in the things I do 40 (29) 65 (54)** 105 (40.5)
2 Happiness I want to be the happiest person always 58 (42) 46 (38) 104 (40)
3 Health Healthy for ever - self and family 47 (34) 43 (36) 90 (35)
4 Intimacy To have good relationship with those I care about 45 (33) 43 (36) 88 (34)
5 Knowledge To answer any question in any subject 40 (29) 32 (26) 72 (27.8)
6 Achievement To be a Nobel laureate 27 (20) 25 (21) 52 (20.1)
7 Altruism To help the poor like mother Theresa 22 (16) 23 (19) 45 (17.4)
8 Donation To donate my organs after my death 18 (13) 24 (20) 42 (16.2)
9 Affiliation To have large circle of friends & relatives 25 (18) 15 (12) 40 (15.4)
10 Religious One religion for the whole world 14 (10) 11 (9.1) 25 (9.7)
11 Travel Travel across the world 9 (6.5) 15 (12) 24 (9.3)
12 Money To be the richest person ever 16 (12) 7 (5.8) 23 (8.8)
13 Sex Satisfactory sexual life till my last day of life 17 (12) 0 (0)** 17 (6.6)
14 Time Need more time every day to do more work 9 (6.5) 5 (4.1) 14 (5.4)
15 Power To be the ruler of the world 12 (8.7) 2 (1.7)* 14 (5.4)
16 Appearance To be the most attractive/ beautiful person in the world 6 (4.3) 3 (2.5) 9 (3.5)
17 Food Want high quality free food for life time 3 (2.2) 2 (1.7) 5 (1.9)
18 Undoing To appear and disappear as I like 2 (1.4) 1 (0.8) 3 (1.2)
n = 259 (boys 138; girls121). Figures in the table represent the number of respondents and those in parenthesis are %.

p < 0.01; ** p < 0.0001 when boys were compared with girls (Fisher exact test). The rank order is for pooled data (boys & girls taken together)

Discussion

In the present study there is no evidence that medical students were money oriented, since only about 10% of them had such wishes and rank wise it occupies the 12th position. One study has reported that happiness, money and altruism4, while another as achievement, affiliation, intimacy, power as well as happiness and money2 as most popular wishes of medical students. The present study, agreed with respect to happiness; but not with others, instead they were self-esteem and health. It is heartening to learn that there was less preference for money wish, the reason may be, and unlike in developed countries where they may have to self-support, students of developing countries are not burdened by the economic stress since it is mostly taken care of by the parents.

A depressing aspect of the present study is, the poor preference for altruistic wish. This aspect denotes that qualities like empathy, trustworthiness and unselfishness are probably not nurtured during their career as a medical student or earlier when they were children. The differences between the present study and the earlier ones are hard to explain, though one has to bear in mind the age, socio-cultural cross-country variations.

In the present study the wish for self-esteem was high in girls (54%) as against boys (29%) which was extremely significant, while in a previous report women preferred, improved appearance, happiness and health2. This may possibly be because, girls are less poised compared to boys. However since a large proportion of both boys and girls wished for self-esteem, may mean that their counter parts in developed countries are better placed in that aspect. There is an urgent need to improve the psychosocial, communication skills of students and to instill values like altruism. This aspect, practically doesn't find space in medical curriculum. An earnest effort in this direction would equip the present & future generations to face professional challenges.

The preference for sex wishes exclusively by boys is in concordance with earlier reports 2, 4, which has been explained on the basis of different adaptive problems during the process of human evolution5.

The prevailing socio-cultural factors, social security system, role model in living and learning environs and reinforcements due to religious beliefs, all shape the wishes of individuals, which in turn has a bearing on professional behaviour. In this context present study points to the need for shaping the students' personal and professional career towards a non-cynical, person oriented approach by driving ethical values in their mind.

Acknowledgements

The authors wish to acknowledge with thanks the role-played by the students of the two medical colleges by way of enthusiastic participation in the above study and the Deans of the respective colleges for encouragement and support.

References

  1. Zeldow PB, Daugherty SR. The stability and attitudinal correlates of warmth and caring in medical students. Med Edu 1987; 21:353-357
  2. King L, Broyles SJ. Wishes, gender, personality and well-being. J Person 1997; 65:49-76
  3. Wolf TM. A retrospective study of attitude change during medical education. Med Edu 1989; 23:19-23
  4. Petrie KJ, White GR, Cameron LD, Collins JP. Photographic memory, money and liposuction: survey of medical students' wish lists BMJ 1999; 319:1593-1595
Buss DM. Psychological sex differences: origin through sexual selection. Am Psychol 1995; 50:164-168


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