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Degree of commitment and patterns of change; a sociological study of first year medical students Stolar, Grace Elaine (Culley) 1960

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DEGREE OF COMMITMENT AND PATTERNS OF CHANGE A S o c i o l o g i c a l Study of F i r s t Year Medical Students  by GRACE ELAINE CULLEY STOLAR B.A., U n i v e r s i t y of B r i t i s h Columbia, 1957 B.S.W., U n i v e r s i t y of B r i t i s h Columbia, 1959  A Thesis Submitted i n P a r t i a l F u l f i l m e n t of the Requirements f o r the Degree of MASTER OF ARTS i n the Department of . Anthropology and Sociology  We accept t h i s t h e s i s as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA September, I960  In p r e s e n t i n g  t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of  the r e q u i r e m e n t s f o r an advanced degree a t the  University  o f B r i t i s h C o l u m b i a , I agree t h a t the L i b r a r y s h a l l make it  freely  a v a i l a b l e f o r r e f e r e n c e and  agree t h a t p e r m i s s i o n f o r e x t e n s i v e f o r s c h o l a r l y purposes may  study.  I further  copying of t h i s  be g r a n t e d by the Head o f  Department o r by h i s r e p r e s e n t a t i v e s .  g a i n s h a l l not  be a l l o w e d w i t h o u t my w r i t t e n  Department o f  Anthropology &  The U n i v e r s i t y of B r i t i s h Columbia, Vancouver 8, Canada. Date  September 2 6 , I 9 6 0  my  I t i s understood  t h a t c o p y i n g or p u b l i c a t i o n of t h i s t h e s i s f o r  Sociology  thesis  financial  permission.  ABSTRACT This study i s d i r e c t e d toward l e a r n i n g more about i n t e r v e n i n g v a r i a b l e s , or s o c i a l mechanisms of change, w i t h i n the process of s o c i a l i z a t i o n . s o c i a l mechanism:  I t focused upon one  "degree of commitment".  The contention  of the t h e s i s i s that "degree of commitment", w i t h i n  the  s o c i a l i z a t i o n process, i s d i r e c t l y connected w i t h (a) the experiences of l e a r n i n g during the process of becoming a member of a s o c i a l system; and (b) the " s o c i a l i z e d " r e s u l t a n t when the l e a r n i n g process i s complete. The concept of "degree of commitment" i s to be understood i n i t s r e l a t i o n to three other s o c i o l o g i c a l concepts: change.  decision-making, s o c i a l i z a t i o n , and s o c i a l Each of these bears d i r e c t l y upon the concept of  "degree of commitment".  The f a c t o r s which work together  to r e s u l t i n a d e c i s i o n , at the same time r e s u l t i n a'tiegree of commitment".  Once a "degree of commitment" i s  e s t a b l i s h e d , i t can not only be estimated at a point i n time, but i t can be examined as a s o c i a l mechanism e f f e c t i n g change. Of course, both decision-making and s o c i a l i z a t i o n i n v o l v e "change" and, t h i s concept as a disequilibrating  force, s i m i l a r to the f a m i l i a r physics  concept, i s of paramount importance. Five d i f f e r e n t stated "degree of commitment" groups were analyzed, f i r s t , whether or not t h e i r stated commitment changed over a period o f time; and second, according to d i f f e r e n t responses t o f a c t u a l and a t t i t u d i n a l questions by  commitment group.  Data v©re g a t h e r e d and examined, a c c o r d i n g  t o commitment group, i n areas such a s :  performance, age,  socio-economic c l a s s , s t u d e n t s ' s e l f - i m a g e and c a r e e r c h o i c e , c o n c e p t i o n s o f medicine as a c a r e e r , a t t i t u d e s  toward  faculty,  peers and toward c o m p e t i t i o n . The c o n s t e l l a t i o n  o f groups and t h e p a t t e r n s o f  change v a r y by commitment group.  As a s o c i a l mechanism,  degree o f commitment r e s t r i c t s and governs a c t i o n .  From t h i s  s t u d y , i t i s s u b m i t t e d t h a t degree o f commitment i s an i n t e g r a l p a r t o f t h e s o c i a l i z a t i o n p r o c e s s and, t h e r e f o r e , i t i s one of the s o c i a l mechanisms t h a t must be s t u d i e d i n any a n a l y s i s of s o c i a l i z a t i o n as a s o c i o l o g i c a l  concept.  The f i r s t y e a r m e d i c a l s t u d e n t s a t the o f B r i t i s h Columbia, i n t h e u n i v e r s i t y t h e sample.  University  y e a r 1959-60, comprised  A q u e s t i o n n a i r e was t h e main source o f d a t a .  I w i s h t o acknowledge my indebtedness t o P r o f e s s o r B. R. B l i s h e n f o r h i s d i r e c t i o n ; t o D r . K. D. Naegele f o r h i s s t i m u l a t i n g t e a c h i n g ; t o my husband, J e r r y , f o r h i s c o n s t a n t encouragement; and t o M i s s Inge Paulus f o r her conscientious t y p i n g .  I am i n d e b t e d a l s o  to the f i r s t year medical students a t the U n i v e r s i t y of B r i t i s h Columbia  1959-60  who s e r v e d as my sample, as w e l l  as t o t h e many m e d i c a l s t u d e n t s and p h y s i c i a n s who t a l k e d t o me and e x p r e s s e d t h e i r o p i n i o n s . I am g r a t e f u l , t o o , f o r a g r a n t from the Canada C o u n c i l w h i c h g r e a t l y f a c i l i t a t e d the w r i t i n g o f t h i s thesis.  TABLE OF CONTENTS CHAPTER  Pagj ABSTRACT  i i  ACKNOWLEDGEMENT  iv  TABLES  vi  I.  INTRODUCTION  1  II.  PROBLEM AND PERSPECTIVE  8  Decision-Making Process o f S o c i a l i z a t i o n S o c i a l Change S o c i a l Mechanisms Degree o f Commitment III.  THE DATA D e s c r i p t i o n o f t h e Sample  IV.  COMMITMENT DIFFERENTIALS AND COMMITMENT COMPONENTS  10 12 14 15 16 23 26 34  M i n o r i t y Groups W i t h i n t h e Sample Performance Age and Socio-Economic C l a s s  39 41 45  V.  STUDENTS' SELF-IMAGE AND CAREER CHOICE  55  VI.  CONCEPTIONS OF MEDICINE AS A CAREER  Si  VII.  FACTORS IN SOCIALIZATION  95  Faculty Peers Competition VIII.  DEGREE OF COMMITMENT AND PATTERNS OF CHANGE  IX.  CONCLUSIONS AND SUGGESTIONS FOR FURTHER STUDY APPENDIX A: The Q u e s t i o n n a i r e BIBLIOGRAPHY  95 97 104 110  127 139 157  vi  TABLES T a b l e No. I.  Page  PERCENTAGE DISTRIBUTION OF THE SAMPLE BY AGE, SEX, AND MARITAL STATUS.  28  II.  PERCENTAGE DISTRIBUTION OF THE SAMPLE BY OCCUPATIONAL CLASS.  30  III.  PERCENTAGE DISTRIBUTION OF CHANGES IN DEGREE OF COMMITMENT BETWEEN FALL, 1959 AND SPRING,  I960.  36  IV.  ABBREVIATIONS FOR STATEMENTS OF COMMITMENT.  3&  V.  FIRST YEAR MEDICAL STUDENTS, PERCENTAGE DISTRIBUTION OF FINAL EXAMINATION RESULTS ACCORDING TO CHANGE IN EXPRESSED DEGREE OF COMMITMENT.  43  VI.  EXAMINATION AVERAGES BY COMMITMENT GROUP.  44  VII.  FIRST YEAR MEDICAL STUDENTS, AGE OF DECISION TO STUDY MEDICINE, ACCORDING TO CHANGE IN DEGREE OF COMMITMENT AND CLASS.  47  PERCENTAGE DISTRIBUTION OF FIRST YEAR MEDICAL STUDENTS' EXPECTED ACHIEVEMENT.  6l  PERCENTAGE DISTRIBUTION OF STUDENTS' EXPECTATIONS COMPARED TO THEIR ACHIEVEMENT BY COMMITMENT GROUP.  64  PERCENTAGE DISTRIBUTION OF FIRST YEAR MEDICAL STUDENTS' PREFERENCE FOR THE WORK SITUATION IN WHICH THEY WOULD LIKE TO CARRY OUT THEIR PROFESSIONAL ACTIVITY.  68  FIRST YEAR MEDICAL STUDENTS' AVERAGE ESTIMATES OF YEARLY INCOME AT PEAK OF CAREER, BY COMMITMENT GROUP.  70  PERCENTAGE DISTRIBUTION OF STUDENTS' RANKING OF INFLUENCES ON DECIDING HOW WELL THEY ARE DOING.  77  PERCENTAGE DISTRIBUTION OF STUDENT CHOICES OF THE BEST DESCRIPTION OF THE MEDICAL PROFESSION.  82  VIII. IX.  X.  XI.  XII.  XIII.  Vll  T a b l e Mo. XIV.  Page  PERCENTAGE DISTRIBUTIONS, FALL AND SPRING, OF STUDENTS' CHOICES OF WHAT THEY WILL LIKE BEST ABOUT BEING A DOCTOR.  85  ORDER OF PREFERENCE OF WHAT STUDENTS THINK THEY WILL LIKE BEST ABOUT BEING A DOCTOR, BY COMMITMENT GROUP.  85  FIRST YEAR MEDICAL STUDENTS' CHOICES OF THE TWO CHARACTERISTICS MOST IMPORTANT I N MAKING A GOOD PHYSICIAN.  88  PERCENTAGE DISTRIBUTION OF FIRST YEAR MEDICAL STUDENTS' OPINIONS AS TO WHETHER THE FACULTY GIVES MEDICAL STUDENTS ENOUGH DIRECTION I N WHAT TO EMPHASIZE IN THEIR STUDIES.  96  PERCENTAGE DISTRIBUTION OF HOW MUCH COMPETITIVENESS FIRST YEAR MEDICAL STUDENTS FOUND AMONG THEIR CLASSMATES IN MEDICAL SCHOOL.  99  PERCENTAGE DISTRIBUTION OF THE HELPFULNESS THE FIRST YEAR MEDICAL STUDENTS EXPERIENCED FROM ONE ANOTHER.  101  PERCENTAGE DISTRIBUTION OF FIRST YEAR MEDICAL STUDENTS' FEELINGS ABOUT COMPETING WITH OTHER PEOPLE-FOR HIGH STAKES, BY COMMITMENT GROUP.  105  XXI.  PERCENTAGE DISTRIBUTION OF CHANGE IN SAMPLE'S FEELINGS ABOUT COMPETITION.  105  XXII.  PERCENTAGE DISTRIBUTION OF FIRST YEAR MEDICAL STUDENTS ACCORDING TO THEIR FEELINGS ABOUT COMPETING WITH OTHER PEOPLE FOR HIGH STAKES, FALL AND SPRING.  107  XV.  XVI.  XVII.  XVIII.  XIX.  XX.  CHAPTER I INTRODUCTION  Medical s o c i o l o g y i s now an e s t a b l i s h e d area of s p e c i a l i z a t i o n w i t h i n the d i s c i p l i n e of s o c i o l o g y . This i s a comparatively new area and, although accepted as " l e g i t i m a t e " by s o c i o l o g i s t s  themselves, i t more o f t e n  arouses s c e p t i c i s m than enthusiasm i n the m a j o r i t y of those w i t h i n the medical m i l i e u .  Much of t h i s pessimism seems to  be based on apprehension about what a s o c i o l o g i s t w i l l  "do"  when he gets " i n s i d e " the medical sanctuary or on unmet expectations when a s o c i o l o g i s t does not "do" whatever an i n d i v i d u a l or c o l l e c t i v i t y expected him to do.  However, i t i s  i n the t r a d i t i o n of medicine to take heed of the developments i n other s c i e n t i f i c d i s c i p l i n e s and to a s s i m i l a t e t h e i r knowledge i n t o the medical frame of reference. of b i o l o g y i s a good example.  "new"  The science  Medicine has not been a f r a i d  to adopt and adapt what might be u s e f u l f o r i t . I n f a c t , the medical f r a t e r n i t y gives encouragement to other d i s c i p l i n e s to continue t h e i r " b a s i c " research.  I n t h i s sense,  medicine  has the most open and supportive a t t i t u d e toward other d i s c i p l i n e s while maintaining a most e x c l u s i v e and covert a t t i tude toward i t s e l f as a d i s c i p l i n e . The s o c i a l sciences are coming to maturity as "scientific" disciplines.  Medicine i s aware of i t s need f o r  "knowledge" regarding the s o c i a l side of the human organism.  2  I t i s w i l l i n g t o meet s o c i a l s c i e n t i s t s "half-way" by prov i d i n g the raw data f o r s o c i a l science research.  The co-  operation between medicine and s o c i o l o g y has been extremely productive - p a r t i c u l a r l y i n the l a s t ten years. As medical s o c i o l o g y has developed, s p e c i f i c segments have congealed w i t h i n t h i s f i e l d . I  One of these i s the  s o c i o l o g y of medical education. What i s the s o c i o l o g y of medical education?  Super-  f i c i a l l y , i t i s a study of the processes, and a l l the elements of those processes, through which a medical student becomes a physician.  One of the f i r s t , and perhaps best known, attempts  to b r i n g together s t u d i e s on the s o c i o l o g y of medical educat i o n i s The Student P h y s i c i a n edited by Robert K. Merton ( S o c i o l o g i s t ) , George G. Reader (M.D.), and P a t r i c i a L. K e n d a l l (Sociologist).  I n terms of s o c i o l o g i c a l research, i t i s a  beginning and has been a source of f u r t h e r ideas and s t u d i e s . Why are medical educators p a r t i c u l a r l y i n t e r e s t e d i n the processes of medical education? f i v e " p r i n c i p a l " sources of t h i s 1.  Robert K. Merton l i s t s  interest:  2  The great and p o s s i b l y a c c e l e r a t e d advances of medical knowledge which r a i s e new problems  1. I t i s not the i n t e n t i o n here t o summarize, or l i s t , the problem areas of medical s o c i o l o g y . Such an attempt would be s u p e r f i c i a l i n t h i s paper because of time and space. For an e x c e l l e n t overview of the f i e l d see the sourcebook: E. G a r t l y Jaco, e d i t o r , P a t i e n t s , P h y s i c i a n s and I l l n e s s , Glencoe, 111., Free Press, 19W. 2 R.K. Merton, George G. Reader and P a t r i c i a L. K e n d a l l , eds., The Student P h y s i c i a n , Cambridge, Harvard U n i v e r s i t y Press, 1957, pp. 35-36.  3  of how to make t h i s knowledge an e f f e c t i v e part of the equipment of medical students; 2. Stresses on the a l l o c a t i o n of the l i m i t e d time a v a i l a b l e i n . t h e curriculum which l e a d . t o continued review of the bases f o r one r a t h e r than another arrangement; 3. Renewed r e c o g n i t i o n of the importance of the s o c i a l environment both i n the genesis and the c o n t r o l of i l l n e s s together w i t h growing r e c o g n i t i o n of the r o l e of the s o c i a l sciences i n p r o v i d i n g an understanding of t h a t environment; 4. A commitment to s c i e n t i f i c method which c a l l s f o r r e p l a c i n g howsoever s k i l l e d e m p i r i cism by the beginning of more systematic and r a t i o n a l a n a l y s i s of the process of education; and 5. As a p r e c i p i t a t i n g innovations i n medical systematic comparisons these innovations w i t h  factor, substantial education which r e q u i r e of the o b j e c t i v e s of t h e i r a c t u a l outcome.  Accepting the above as f a i r reason f o r the medical p r o f e s s i o n to be i n t e r e s t e d i n the s o c i o l o g y of medical educ a t i o n , the next question i s :  Why are s o c i o l o g i s t s i n t e r -  ested i n the processes of medical education?  To answer  t h i s question, medical s o c i o l o g y must be seen i n r e l a t i o n to the primary d i v i s i o n s of s o c i o l o g y out of which medical sociology has developed. The s o c i o l o g y of occupations and professions i s one of the'~"major f i e l d s of s o c i o l o g i c a l i n q u i r y drawn upon by medical s o c i o l o g y . Work, as i t i s c a r r i e d on by s o c i a l beings, has i n c r e a s i n g l y been an area of study f o r s o c i o l o gists.  The f a c t s , t h a t work occupies such a l a r g e percentage  of any i n d i v i d u a l ' s l i f e i n an i n d u s t r i a l s o c i e t y and that the economic arrangements are most s i g n i f i c a n t p o i n t s of  o r g a n i z a t i o n i n a s o c i e t y , make t h i s an important area i n the study of human behavior.  Who  choses - or i s chosen by -  which occupation, how neophytes l e a r n to become f u l l members of a p a r t i c u l a r occupation, and how candidates are s e l e c t e d and r e j e c t e d by an occupation are f o c a l points of study f o r sociologists.  P r o f e s s i o n s , because of t h e i r more e x p l i c i t  boundaries and terms of reference which make them more v i s i b l e f o r study, at l e a s t i n the beginning, have been a p r i n c i p l e t a r g e t f o r these s t u d i e s .  A l s o , the professions  themselves are anxious to turn out a p a r t i c u l a r k i n d of " p r o f e s s i o n a l person" from t h e i r schools.  Consequently  they are i n t e r e s t e d i n the ways t h e i r environments  and teach-  ings are r e l a t e d to t h e i r " f i n i s h e d " product - and whether or not they are producing what they intend to produce. The medical p r o f e s s i o n as a complex s o c i a l s t r u c ture i s i d e a l f o r s o c i o l o g i c a l study because:  (1)  i t has  a c a r e f u l l y f o r m a l i z e d set of r e l a t i o n s h i p s w i t h other prof e s s i o n s , w i t h c l i e n t s , with the community, and f o r medical colleagues;  (2)  these r e l a t i o n s h i p s are set down and, there  f o r e , are e x p l i c i t ;  (3)  the medical p r o f e s s i o n i s "accepted  by others - p r o f e s s i o n a l and l a y ; and (4) be examined w i t h i n l i m i t s .  i t i s w i l l i n g to  I n short, the p r o f e s s i o n of medi-  cine provides the nearest s o c i o l o g i s t s can get to a v i s i b l e , " i d e a l type" of work complex i n terms of recruitment, s e l e c t i o n , t r a i n i n g and s o c i a l s t r u c t u r e .  I n the development of  theory and the t e s t i n g of hypotheses such a prototype i s invaluable to the s o c i o l o g i s t .  5  Another major area of s o c i o l o g y which the s o c i o l o g y of medical education draws upon - and f o r t h i s study the most c r u c i a l - i s the process of s o c i a l i z a t i o n . ^  This i s the study  of how i n d i v i d u a l s l e a r n to become members of a s o c i e t y or any subsystem of a s o c i e t y .  I n Merton's words:  " I t involves  the a c q u i s i t i o n of a t t i t u d e s and values, of s k i l l s and behaviour patterns making up s o c i a l r o l e s e s t a b l i s h e d i n the s o c i a l structure."^  This i n c l u d e s the a d u l t a c q u i s i t i o n of s o c i a l  r o l e s as w e l l as those acquired by c h i l d r e n i n the process of  "growing up . ,r  Therefore, medical students are engaged i n  " l e a r n i n g how" to be t e c h n i c a l l y and s o c i a l l y acceptable as doctors.  Acceptable not only i n t h e i r community but - and  perhaps most importantly - acceptable to the e s t a b l i s h e d medical p r o f e s s i o n . Again, as the medical p r o f e s s i o n has r e l a t i v e l y c l e a r - c u t o b j e c t i v e s f o r i t s students, i t , thereby, provides s o c i o l o g i s t s w i t h a comparatively v i s i b l e model f o r developing and t e s t i n g  hypotheses.  Merton l i s t s " f i v e coordinate developments i n sociology (which) have brought about concerted beginnings of s o c i o l o g i c a l research on medical education: 1. The marked and cumulating i n t e r e s t i n the s o c i o l o g y of professions which i n c l u d e s , as a major component, studies of p r o f e s s i o n a l schools; 2. The growing u t i l i z a t i o n of s o c i a l science as composing part of the s c i e n t i f i c b a s i s f o r the p r o v i s i o n of h e a l t h care i n contemporary society;  3 This i s an important aspect of the t h e o r e c t i c a l perspective of t h i s study and we s h a l l r e t u r n to i t l a t e r i n some d e t a i l . 4  Merton, et a l , p_p_. c i t . , p. 41 •  6  3. The considerable recent growth i n the e m p i r i c a l study of complex s o c i a l organizat i o n , among which schools c o n s t i t u t e an important s p e c i a l c l a s s ; 4. The s i m i l a r growth of i n t e r e s t i n the process of a d u l t s o c i a l i z a t i o n i n general which, i n a p p l i c a t i o n to the f i e l d of medicine, i s concerned w i t h the processes by which the neophyte i s transformed i n t o one or another kind of medical man; and 5. The recent advances i n methods and techniques of s o c i a l i n q u i r y which make i t p o s s i b l e to examine these subjects and problems by means of systematic i n q u i r y . " 5 The s t u d i e s to date i n the sociology of medical education concentrate on the medical school, t h a t i s ; i t s s o c i a l s t r u c t u r e , what i t i s t r y i n g t o teach and what i t i s teaching, and on the experiences and changes of values and a t t i t u d e s t h a t the medical students undergo during t h e i r f o u r years i n medical school.  There are studies on the ecology of  the medical student but there are no published s t u d i e s which trace e c o l o g i c a l background and subsequent medical school experiences.  There are studies which discuss the i n t e n s i t y of  pre-medical students' f e e l i n g s about becoming a member of the medical p r o f e s s i o n , but t h i s "degree of commitment" or " d e d i c a t i o n " or "degree of emotional investment" has not been s y s t e m a t i c a l l y followed through t o determine i f i t changes or i f i t a f f e c t s other areas of the medical students' experiences. Many studies have followed a c l a s s or classes of medical students through a year or the f u l l four years of medical school i n d i c a t i n g the students' f e e l i n g s on p a r t i c u l a r matters  5  I b i d . , p. 5 2 .  7  at the beginning of t r a i n i n g and p e r i o d i c a l l y t h e r e a f t e r . However, most of these s t u d i e s have taken the class as an e n t i t y and regarded change i n a group or sub-group as being homogeneous.  That i s , f o r example, i f i n a c l a s s of t h i r t y -  s i x medical students a t Time 1, t e n students gave the same answer t o one p a r t i c u l a r question and then a t Time 2, ten students answered that same p a r t i c u l a r question the same way as i t was answered a t Time 1, there was no i n d i c a t i o n whether or not these were the same t e n students, a l l d i f f e r e n t students, or some combination of the two. Using an admittedly small sample of f i f t y students, t h i s t h e s i s intends to take account of some of these heretofore unexplored aspects of the medical student as a s o c i a l being undergoing change.  CHAPTER I I PROBLEM AND PERSPECTIVE  This study i s d i r e c t e d toward l e a r n i n g more about "intervening variables"  i n a s o c i a l s i t u a t i o n where the ob-  j e c t i v e i s to change - s o c i a l i z e - selected i n d i v i d u a l s  from  "something' ', e.g. c h i l d r e n or students, i n t o ''something" e l s e , 1  e.g.  adults or medical doctors.  I n t h i s t h e s i s the i n t e r -  vening v a r i a b l e s w i t h i n the process of s o c i a l i z a t i o n s h a l l be c a l l e d " s o c i a l mechanisms of change". The hypothesis of t h i s paper i s that the s o c i a l mechanism "degree o f commitment" i s d i r e c t l y connected w i t h (a)  the experiences of l e a r n i n g during the process of be-  coming a member of a s o c i a l system; and (b) the " s o c i a l i z e d " r e s u l t a n t when the l e a r n i n g process i s "complete". "Degree of commitment", therefore, has t o be examined i n two d i f f e r e n t respects:  f i r s t , as a r e s u l t a n t and,  second, as a s o c i a l mechanism of change. I n the f i r s t i n stance, when a candidate f o r s o c i a l i z a t i o n a r r i v e s a t the door of a s o c i a l i z a t i o n agency, he brings with him a l l the many things that he has experienced up to t h i s time: the manner i n which h i s parents taught him, h i s r e l a t i o n s h i p s and experiences w i t h other human beings, and so on. A p a r t i c u l a r constellation  of these "many t h i n g s " can be regarded as an  i n d i c a t i o n of the "degree of commitment" to become a graduate of the s o c i a l i z a t i o n agency. i n time.  This can be estimated a t a point  9  The "degree of commitment" to wanting to be a graduate of a l e a r n i n g experience, a t any one point i n time, however, i t s e l f w i l l i n f l u e n c e the experiences that f o l l o w . How "much" t h i s need i s f e l t w i l l determine the amount of energy and the perseverance;that a s o c i a l i z e e w i l l put i n t o the l e a r n i n g endeavour and the r e l a t i v e pain and pleasure he w i l l endure, and demand, t o see the experience through t o completion.  I f the degree of commitment of an i n d i v i d u a l i s  s l i g h t , i t i s assumed that high demands on energy and perseverance and high d e p r i v a t i o n w i t h r e l a t i v e l y few rewards w i l l r e s u l t i n withdrawal from the p a i n f u l s i t u a t i o n .  A  s i m i l a r experience t o a person w i t h a high degree of commitment would not l i k e l y r e s u l t i n withdrawal.  In f a c t , he  might f i n d pleasures where the l e s s committed d i d not, and he might take pride i n overcoming the d i f f i c u l t i e s experience.  These are two extremes on a continuum.  of the There  are "degrees" of commitment a l l along t h i s continuum. In t h i s l a t t e r instance, "degree of commitment" i s not a r e s u l t a n t , i t i s a "cause" - a s o c i a l mechanism.  The  "degree" of commitment w i l l make a d i f f e r e n c e to the e x p e r i ences w i t h i n the l e a r n i n g ( s o c i a l i z a t i o n ) process and t o the f i b r e of the f i n a l s o c i a l i z e d product.  The a v a i l a b l e i n s t r u -  ments of measurement i n the s o c i a l sciences cannot "measure" t h i s "degree" of commitment w i t h appreciable accuracy.  How-  ever, d i f f e r e n t degrees of commitment can be ranked i n order of i n t e n s i t y .  I m p l i c i t i n t h i s a n a l y s i s i s the knowledge that (l)  the subjects under study have made the d e c i s i o n to study  medicine of t h e i r own accord, t h a t i s , they were not f o r c i b l y inducted i n t o medical school, and (2)  once i n medical school,  the subjects were involved i n the process of s o c i a l i z a t i o n . The decision-making process and the f a c t o r s of s o c i a l i z a t i o n are i n t i m a t e l y and i r r e v o c a b l y wed to the process of change and consequently, to the "degree of commitment" as a mechanism of change.  The three concepts i n v o l v e many of the same elements:  past experience, self-image, s i g n i f i c a n t others, p o s s i b l e a l t e r n a t i v e s of a c t i o n .  I n f a c t , when a d e c i s i o n i s reached,  a degree of commitment to that d e c i s i o n (a p a r t i c u l a r  constel-  l a t i o n of the aforementioned elements) can be estimated.  Also,  w i t h i n the s o c i a l i z a t i o n process, degree of commitment i s a s o c i a l mechanism of change.  S o c i a l i z a t i o n i s a process;  commitment i s a mechanism w i t h i n t h a t process. constellation  degree of  A particular  of the aforementioned elements equals the degree  or impact of t h i s mechanism on the s o c i a l i z e e .  I t i s appro-  p r i a t e , t h e r e f o r e , to s p e l l out what i s meant by the " d e c i s i o n making process", " s o c i a l i z a t i o n " , and " s o c i a l change" f o r a more complete p i c t u r e of the frame of reference of t h i s study. Decision-making: Charles Kadushin process c l e a r l y .  0  has o u t l i n e d the decision-making  This concept i s important i n t h i s study  6 C. Kadushin, Individual Decisions to Undertake Psychotherapy, Bureau of Applied Social Research, Columbia University, Reprint 268, 195$.  because an i n d i v i d u a l does not become a s o c i a l i z e e (medical student) u n t i l he decides to do so.  Every i n d i v i d u a l has a  perception of a s i t u a t i o n - no matter whether i t i s a " t r u e " or " f a l s e \ r e a l or u n r e a l , perception - where choice i s i n T  volved.  At the same time the i n d i v i d u a l has a perception of  himself - a self-image - that f i t s or c o n f l i c t s with the perceived r e s p o n s i b i l i t i e s that go with the t a k i n g of any p a r t i c u l a r choice.  An i n d i v i d u a l must be able to imagine himself  w i t h i n a s i t u a t i o n , however f a n c i f u l l y , or he w i l l have d i f f i c u l t y "deciding" to move i n t o i t , and subsequently,  he  w i l l have d i f f i c u l t y remaining w i t h i n the s i t u a t i o n . A person's a t t i t u d e toward h i s d e c i s i o n to undertake c e r t a i n r e s p o n s i b i l i t i e s makes a considerable d i f f e r e n c e i n h i s approach to those r e s p o n s i b i l i t i e s .  Kadushin states there are  f o u r major f a c t o r s which determine a d e c i s i o n when an i n d i v i d u a l i s i n a s i t u a t i o n which necessitates choice.  F i r s t , the i n d i -  v i d u a l ' s o r i e n t a t i o n to a s i t u a t i o n , that i s ; h i s values, h i s standards, and h i s " m o t i v a t i o n a l o r i e n t a t i o n " which includes h i s cognitions and perceived a t t r i b u t e s of a s i t u a t i o n .  A  n  i n d i v i d u a l ' s t o t a l l i f e s i t u a t i o n at the moment of d e c i s i o n must be i n such an order as to make t h i s or that d e c i s i o n feasible.  The circumstances  and p o s s i b i l i t i e s of today  appear q u i t e d i f f e r e n t from the circumstances  and  may  possibili-  t i e s of one year ago or, l i k e l y , of one year hence.  Second,  the i n d i v i d u a l ' s e v a l u a t i o n of the s i t u a t i o n ; h i s judgment of the relevant a l t e r n a t i v e s . I t makes a marked d i f f e r e n c e when, f o r example, there i s a p o s s i b l e choice of f i v e d i f f e r e n t paths,  of two different paths, or a choice of no other path at a l l . One's values and standards which are the customary point of reference i n the choice of alternatives constitute an additional factor.  "Values", as well as rational standards, always have  t h e i r part to play, although i t i s often a subtle role.  Third,  the individual's relationships to others.? The various human relationships one maintains - and wishes to maintain - influence decision, often d i r e c t l y and f o r c i b l y .  Others' perceptions are  often an important aspect of choice. The fourth factor i s time, i n two dimensions;  how long has the choice been considered,  e.g., I decided to study medicine when I was seven years old; and how soon does the choice have to be made, e.g., I have two days to decide. Process of S o c i a l i z a t i o n Talcott Parsons  has outlined the sociological approach  to the process of s o c i a l i z a t i o n .  The following i s a restatement  of some of his ideas. The process of s o c i a l i z a t i o n i s a series of stages on the way to "becoming" socialized to a particular s o c i a l system. The classic example of s o c i a l i z a t i o n i s , of course, the child 7 This i s s i m i l a r to Merton's role-sets which he defines as "that complene nt of role relationships which persons have by virtue of occupying a particular s o c i a l status." R.K. Merton, Social Theory and Social Structure, revised and enlarged, Glencoe, 111., Free Press, 1957, p. 369. For his example of a role-set, Merton writes: "... the single status of medical student entails not only the role of a student i n r e l a t i o n to his teachers, but also an array of other roles relating the occupant of that status to other students, nurses, physicians, s o c i a l workers, medical technicians, etc." p. 3o9. 8" Talcott Parsons, The Social System, Glencoe, 111., Free Press, 1951, Chapter VI.  13 "becoming" an a d u l t .  L i k e the c h i l d , who has an " a d u l t " to  i n d i c a t e the way to become a "full-member" or adult i n any p a r t i c u l a r s o c i e t y , the student has h i s "teachers".  Also,  l i k e the c h i l d , the student learns not only what i s taught d i r e c t l y to him, but he "picks up" the f e e l i n g s , a t t i t u d e s , and mannerisms of h i s superiors as w e l l .  This not only i n -  volves the p a r t i c u l a r subject matter a t hand, i . e . , the r o l e of a "good" son w i t h regard to h i s parents, or the r o l e of the doctor w i t h a c l i e n t , but also involves the a t t i t u d e s and prejudices of h i s "teachers"  ( p o s i t i v e or negative) toward l i f e  i n general. Persons i n l i n e f o r s o c i a l i z a t i o n , " s o c i a l i z e e s " , have c e r t a i n c l a s s i c a t t r i b u t e s regardless of what they are being "trained" f o r .  They come to t h e i r " s o c i a l i z e r s " with a c e r t a i n  p l a s t i c i t y , that i s , they have the capacity t o l e a r n a l t e r n a t i v e patterns.  This implies that the s o c i a l i z e r s can s e l e c t  a pattern of t h e i r own choice (which may not be the "best" choice from someone else's point of view) and the s o c i a l i z e e w i l l attempt to l e a r n i t i n h i s r o l e of s o c i a l i z e e .  This  p l a s t i c i t y suggests how i t may be p o s s i b l e to "teach" dogma which "goes against the g r a i n " . The s o c i a l i z e e has the capacity to form attachments. D i r e c t l y connected with t h i s s e n s i t i v i t y f o r others, the s o c i a l i z e e i s dependent upon h i s s o c i a l i z e r as the agent of rewards and punishments.  These two l a t t e r c h a r a c t e r i s t i c s  are the l e v e r s the s o c i a l i z e r s can w i e l d as pressure i s r e quired i n order to f o r c e the s o c i a l i z e e to move onward, to l e a r n "more", and to perform as requested.  I t i s c l e a r that there are two s o c i a l systems i n volved i n the s o c i a l i z a t i o n of a neophyte.  One i s a super-  ordinate system which i s composed of f u l l y s o c i a l i z e d persons, i . e . , a d u l t s , parents, teachers, or medical r e p r e s e n t a t i v e s . These persons have acquired what those persons i n the subordinate system, i . e . , c h i l d r e n , students, " l e a r n e r s " i n a l l forms, wish to a c q u i r e . Members of the subordinate system have t h e i r own norms which they f o l l o w i n i n t e r a c t i o n with one another and w i t h others, j u s t as those i n the superordinate system have t h e i r own norms which they f o l l o w i n i n t e r a c t i o n w i t h one another and w i t h others.  However, those i n the subordinate system wish  to move out of t h e i r present system and to become what those i n the superordinate system are.  They wish to take on the norms of  the superordinate system. S o c i a l Change Inherent i n decision-making and s o c i a l i z a t i o n i s a t h i r d process:  the process of s o c i a l change. Both d e c i s i o n -  making, i n the sense of deciding upon a l t e r n a t i v e courses of a c t i o n , and s o c i a l i z a t i o n i n v o l v e r e p l a c i n g an o l d regime w i t h a new regime.  Change, by d e f i n i t i o n , n e c e s s i t a t e s a d i s r u p t i o n  of the p r e v a i l i n g e q u i l i b r i u m of an i n d i v i d u a l or of a s o c i a l system.  Change can only take place when there i s a r e j e c t i o n  or sublimation of the o l d , or some part of i t , i n order to assume the new, or some p a r t of i t . A s t a t e of change, then, i s i n d i c a t i v e of a s t a t e of disequilibrium.  To d i s r u p t a p r e v a i l i n g status quo r e q u i r e s  pushes and p u l l s , forces and pressures upon the changing body.  Therefore, change i s always p a i n f u l and enervating. I t i s usually costly also:  economically and i n terms of time  expended. S o c i a l i z e e s are undergoing a strenuous process of change as long as they are i n t r a i n i n g .  C e r t a i n l y , some of  them d e r i v e pleasure from what they are l e a r n i n g . not easy to " l e a r n " .  I t takes time and e f f o r t .  s o c i a l i z e e s " s u f f e r " during t h e i r  But i t i s Therefore, a l l  "learning".  These are the points of view adopted i n t h i s t h e s i s . S o c i a l Mechanisms S o c i a l mechanisms are i n t e g r a l elements i n s o c i a l change.  T a l c o t t Parsons has given a working d e f i n i t i o n of  s o c i a l mechanisms which i s employed i n t h i s t h e s i s .  He w r i t e s :  "A s o c i a l mechanism i s an e m p i r i c a l g e n e r a l i z a t i o n about motivat i o n a l processes stated i n terms of i t s relevance t o the funct i o n a l problems of an a c t i o n system", and, f u r t h e r ,  "accounts  f o r a t y p i c a l process of t r a n s i t i o n from one s t r u c t u r a l o to another."  pattern  7  This means that a s o c i a l mechanism i s an element i n s o c i a l change and an implement of s o c i a l change.  I t i s the  f u n c t i o n of a s o c i a l mechanism t o change a s o c i a l organism from one s o c i a l state i n t o a d i f f e r e n t s o c i a l s t a t e , much as heat and pressure are mechanisms of change on p h y s i c a l states of matter. S i m i l a r l y , too, the amount or"degree" of the mechanism of change, 9  Parsons, S o c i a l System, p. 6 f f .  s o c i a l or p h y s i c a l , makes a d i f f e r e n c e to what the r e s u l t a n t of the a p p l i e d mechanism w i l l  be.  Degree of Commitment "Degree of commitment" i s considered to be a s o c i a l mechanism.  "Degree of commitment" i s here intended to mean the  degree of importance ( m o t i v a t i o n a l investment) a student places on becoming a member of the medical p r o f e s s i o n . major concept i n t h i s study.  This i s a  We suggest t h a t the "degree of  commitment" to a l e a r n i n g s i t u a t i o n w i l l a f f e c t the manner i n which the subsequent l e a r n i n g process i s experienced. This brings us back to the e a r l i e r statements i n agreement w i t h Charles Kadushin on the f a c t o r s of d e c i s i o n making.  Every d e c i s i o n i n v o l v e s an assessment by the actor  of (a)  h i s o r i e n t a t i o n to the s i t u a t i o n , i t s perceived a t t r i -  butes;  (b)  h i s e v a l u a t i o n of p o s s i b l e a l t e r n a t i v e s ;  r e l a t i o n s h i p s to s i g n i f i c a n t others;  and (d)  the d e c i s i o n has been pending and/or made.  (c)  his  the l e n g t h of time  These considerations  put 'aecision-making".into a . s o c i a l as w e l l as a p s y c h o l o g i c a l framework.  Once the d e c i s i o n i s made, somewhere i n the de-  c i s i o n process, a person a l t e r s h i s self-image and takes on a new image appropriate t o h i s d e c i s i o n . That i s , when a d e c i s i o n i s made, a person sees himself as being compatible w i t h the decision.  I t i s " r i g h t " f o r the kind of person he i s . There-  f o r e , when one "decides" to become a doctor, the perception of the doctor as a capable, adequate, secure, and p r e s t i g e f u l person, must be conceivable as one's own s e l f - c o n c e p t i o n . I f not immed i a t e l y , i n the r e l a t i v e l y near f u t u r e .  Thinking of one's s e l f  as a c h i l d or as inadequate no longer makes sense.  The image  of the doctor and the image of the s e l f as a doctor must be i n harmony.  I f these two images become too widely divergent, one  of two things can happen:  the image of the doctor can be  changed to be more l i k e the self-image or, i f the self-image and the doctor-image  are not r e c o n c i l a b l e , the would-be doctor  sees i t as an i m p o s s i b i l i t y f o r him to become a doctor. Once the d e c i s i o n has been made and the self-image i s a p p r o p r i a t e l y i n l i n e w i t h the d e c i s i o n , i f f o r some reason the d e c i s i o n cannot be c a r r i e d through, e.g., poor grades, f a m i l y r e s p o n s i b i l i t i e s , the self-image must adapt i t s e l f to the set of circumstances - o f t e n r a p i d l y .  new  Every d e c i s i o n i s an  e v a l u a t i v e process, and as s a i d before, one of the primary elements to be evaluated i s the " s e l f " .  I f a d e c i s i o n aborts  because of a m i s c a l c u l a t i o n of the a t t r i b u t e s and powers of the s e l f , an i n d i v i d u a l may be overcome w i t h a sense of f a i l u r e . I f he cannot judge and know himself, what can he judge and know?  Therefore, i n order to "hold" themselves  together, i n d i -  v i d u a l s are "committed" to c a r r y out t h e i r d e c i s i o n s . I f they do not, they i n d i c a t e to themselves  and to t h e i r world t h a t  they are not what they s a i d they were. Of course, there are major and minor d e c i s i o n s and some choices which are hardly regarded as " d e c i s i o n s " at a l l . However, i n American s o c i e t y to go back on a d e c i s i o n , espec i a l l y a major one which has been widely c i r c u l a t e d , such as occupational or m a r i t a l choice, i s regarded as a kind of f r a u d . To go back on a d e c i s i o n i n d i c a t e s that an i n d i v i d u a l at one  time misrepresented himself as going to do a c e r t a i n t h i n g which i s taken as an i n d i c a t i o n that he t h i n k s he i s capable of such a c t i o n .  To not carry out the a c t i o n i s an i n d i c a t i o n  that he now thinks he i s "incapable" of i t .  A person who f r e -  quently changes h i s mind i s regarded as i r r e s p o n s i b l e . Therefore,  there are s o c i a l pressures  to personal d e s i r e - to carry out d e c i s i o n s .  - i n addition  A major d e c i s i o n  i s not taken l i g h t l y by the decider, who has a personal,  social,  and emotional investment i n i t - a commitment - nor by the s i g n i f i c a n t others of h i s environment.  I f external  pressures  or conditions n e c e s s i t a t e the change or d i s c a r d i n g of a d e c i s i o n , the i n d i v i d u a l concerned i s absolved from h i s r e s p o n s i b i l i t y to carry out h i s d e c i s i o n .  Because of t h i s , there i s often a  "search" from some " r a t i o n a l " extenuating e x t e r n a l when a d e c i s i o n i s not c a r r i e d out.  pressures  This search i s often by  s i g n i f i c a n t others as w e l l as the object of the d e c i s i o n . " ^  10 This s e c t i o n of the t h e s i s was w r i t t e n before Howard S. Becker's "Notes on the Concept of Commitment", American Journal of Sociology, J u l y I960, V o l . LXVI, No. 1, pp. 32-40, was i n c i r c u l a t i o n . Although the expression i s d i f f e r e n t , the two pieces of work are complementary - a t l e a s t i n the c l a r i f i c a t i o n of ideas. Becker regards the concept of commitment as "one s p e c i f i c s o c i a l p s y c h o l o g i c a l mechanism" (p. 35) i n a family of r e l a t e d mechanisms which operate t o produce consistent human hehaviour. He o u t l i n e s three major components of commitment: 1. the p r i o r actions of the person staking some o r i g i n a l l y extraneous i n t e r e s t on h i s f o l l o w i n g a consistent l i n e of a c t i v i t y ; 2. r e c o g n i t i o n of the involvement of t h i s extraneous i n t e r e s t i n h i s present a c t i v i t y ; and 3. the r e s u l t i n g consistent l i n e of a c t i v i t y . There are four mechanisms which operate to enforce a l l e g i a n c e to f o l l o w i n g a consistent l i n e of a c t i v i t y : a. generalized c u l t u r a l expectations; b. impersonal bureaucratic arrangements; c. i n d i v i d u a l adjustment to a p a r t i c u l a r s o c i a l arrangement; and d. face-to-face i n t e r a c t i o n .  To "decide" to become a doctor i s an important and consequential d e c i s i o n . ment.  I t denotes a l a r g e personal i n v e s t -  I t seems l i k e l y , t h e r e f o r e , t h a t medical students would  be r e l a t i v e l y s e l f - c o n f i d e n t and t h i n k t h a t they had the necessary a t t r i b u t e s to become a doctor.  To some extent they must  consider themselves to be capable, adequate, secure, worthy of p r e s t i g e , and/or able to give to and serve the s i c k and those needing medical a s s i s t a n c e . We assume (from observation only) that medical students do have at l e a s t some of these q u a l i t i e s . Frequently one hears i t s a i d about a medical student: "... w i l l make a good doctor."  he  The speaker knows nothing about the  student's medical knowledge.  He makes h i s judgment on the  apparent mannerisms, a t t i t u d e s , and appearance of the student and, of course, t h i s i s one way doctors are judged and  "chosen"  by t h e i r c l i e n t s . Self-images are important. sented to the world. change.  They are the f r o n t pre-  They are, however, i n a constant s t a t e of  As one i n t r i n s i c aspect of human beings, self-images  are incapable of being a b s o l u t e l y s t a t i c .  Each experience  I n t h i s t h e s i s i t i s assumed that g e n e r a l i z e d c u l t u r a l expectations and face-to-face i n t e r a c t i o n are considered to be the elements of the mechanism degree of commitment operating upon the medical student sample to ensure t h e i r consistency of behaviour. That i s , these are the elements of the degree of commitment mechanism which a i d a student to remain "committed" to a medical career - or a t l e a s t , make i t d i f f i c u l t to cons i d e r withdrawing h i s s t a t e d commitment. I n t h i s paper, Becker' f o u r mechanisms are considered as elements and subsumed under a • concept a t a higher l e v e l of g e n e r a l i z a t i o n : "degree of commitment".  of an i n d i v i d u a l adds t o , dents, strengthens or weakens h i s conception of h i m s e l f .  Not t h a t self-images are completely  malleable, l i k e putty.  By adulthood they are more a k i n to a  rock:  they can be chipped at or eroded by the constant flow  of wind and water.  Depending on the vigour and d i r e c t i o n s of  the f o r c e s at work, the rock may become rough w i t h sharp edges or smooth and even. To present oneself to the medical school f o r t r a i n ing n e c e s s i t a t e s a f a i r l y p o s i t i v e view of one's s e l f .  This  view has been b u i l t up and r e i n f o r c e d by the s i g n i f i c a n t others i n one's l i f e .  Once " i n " the medical school, the  medical p r o f e s s i o n takes over and endeavours to f u r t h e r r e i n f o r c e the p o s i t i v e aspects of the self-image, e.g., seeing oneself as competent, capable, i n t e l l i g e n t .  This i s not the  case i n some other p r o f e s s i o n a l schools where the f i r s t period of t r a i n i n g i s seemingly spent i n "breaking the students down" i n order that they might be b u i l t up i n a p a r t i c u l a r  way.  However, the medical p r o f e s s i o n , t y p i c a l l y , takes the p o s i t i v e approach and the students, t y p i c a l l y , have a high opinion and p o s i t i v e approach to a medical career. This " p o s i t i v e approach" on the part of the student i s an asset i n l e a r n i n g .  Robert Merton has expressed t h i s  idea i n a d i f f e r e n t context.  He t a l k s of the f u n c t i o n s of  p o s i t i v e o r i e n t a t i o n to non-membership groups and c a l l s i t "anticipatory socialization".  He w r i t e s :  "For the i n d i v i d u a l  who adopts the values of a group to which he a s p i r e s but does not belong, t h i s ( p o s i t i v e ) o r i e n t a t i o n may serve the twin  21  f u n c t i o n s of a i d i n g h i s r i s e i n t o that group and of easing h i s adjustment a f t e r he has become part of  it."^  Of course, medical students, l i k e any other group of students, do not have an i d e n t i c a l conception of themselves. They vary g r e a t l y .  What they have i n common i s t h a t they want  to become doctors, they t h i n k they can do i t , and they have decided t o t r y . This degree of d e s i r e to become a doctor and the degree to which the students are "sure" they can make the grade a l s o v a r i e s .  I t seems l i k e l y t h a t there i s some k i n d of  r e l a t i o n s h i p between the two. i s not known: here.  The nature of t h i s r e l a t i o n s h i p  nor i s i t intended to attempt to d i s c o v e r i t  This r e l a t i o n s h i p i s one of the assumptions of t h i s study. The self-image, comprised of how the " s e l f " has ex-  perienced the " s e l f " , and the d e c i s i o n to become a doctor, and a l l that that e n t a i l s as stated above, are the major o r i e n t a t i o n s to the a c t u a l problem of "becoming"a doctor.  This i s what  makes up how much a student wishes to become a member of the medical p r o f e s s i o n . The extent of t h i s d e s i r e - the degree of commitment - has been seen to make a great d i f f e r e n c e i n the approach to other l e a r n i n g s i t u a t i o n s , such as  psychotherapy.  The contention of t h i s paper i s that i t makes a d i f f e r e n c e i n approach and, consequently, a d i f f e r e n c e i n some of the experiences i n any l e a r n i n g experience.  The f i r s t year medical  student and the medical school w i l l serve as the test-model. 11 R.K. Merton,, S o c i a l Theory and S o c i a l S t r u c t u r e , rev. & enlarged, Glencoe, 111., Free Press, 1957, p. 265.  To sum up the problem at hand:  students come i n t o  medical school w i t h an image of themselves, an image of ''medic i n e " , and the d e c i s i o n to become a member of the medical profession.  I n the terms of t h i s paper, t h i s comprises  "degree of commitment".  their  The various degrees of commitment can  be ranked at t h i s i n i t i a l point of the s o c i a l i z a t i o n process. In a d d i t i o n , the i n i t i a l degree of commitment which the students "bring w i t h them" w i l l i n f l u e n c e t h e i r approach to l e a r n i n g i n the f i r s t year of medical school.  The degree of commitment, i n  t h i s l a t e r sense, wiH.be a mechanism i n the l e a r n i n g process. At the end of the f i r s t year, the degrees of commitment, as s o c i a l f a c t s , can again be ranked.  The r e l a t i v e  p o s i t i o n s w i l l subsequently a f f e c t the approach t o l e a r n i n g during the second year of medical school, and so on.  The  constancy or change i n students' degree of commitment and i t s operation as a mechanism are important both p r a c t i c a l l y , t o medical students and the medical school, and t h e o r e t i c a l l y , as an aspect of the l e a r n i n g o r s o c i a l i z a t i o n process. are the ones who "change"? Why?  Who  CHAPTER I I I THE DATA  I n September 1957, the F a c u l t y of Medicine a t the U n i v e r s i t y of B r i t i s h Columbia introduced a s u b s t a n t i a l l y r e organized program of studies to t h e i r f i r s t year medical s t u dents.  I n conjunction with t h i s new curriculum, and f o l l o w i n g  the example of l e a d i n g medical schools i n the United States, s o c i o l o g i s t s from the Department of Anthropology and Sociology were i n v i t e d to a s s i s t i n an e v a l u a t i o n of t h i s new program of studies.  At the end of the f i r s t year of assessment, those i n -  volved i n both departments agreed that f u r t h e r systematic assessment would be valuable.  Up to May I960, data have been c o l l e c t e d  on the f i r s t year medical students during the u n i v e r s i t y terms  of 1957-58, 1958-59, 1959-60. One of the measurement t o o l s of the s o c i o l o g i s t s was a f a i r l y lengthy, c o n f i d e n t i a l questionnaire given to the medical students.  Every student i n the f i r s t year of medicine  at the U n i v e r s i t y of B r i t i s h Columbia during the Septembers of 1957, 1958, and 1959, was asked t o complete the questionnaire. ^ 1  Then, i n an e f f o r t t o evaluate "change", every  student was asked t o complete the same questionnaire i n l a t e A p r i l of 1958, 1959, and I960.  The d i f f e r e n c e i n response  12 C o r n e l l , Western Reserve and Pennsylvania Medical Schools were the three schools Merton et a l . concentrated upon f o r The Student P h y s i c i a n . 13  The questionnaire appears as Appendix A.  between Time 1 (September) and Time 2 ( A p r i l ) i s the estimate of  change o c c u r r i n g d u r i n g the s c h o o l term.  ween the two of  Any  'change' b e t -  time p e r i o d s i s a t t r i b u t a b l e t o a l l experiences  the f i r s t year medical s t u d e n t s , not s o l e l y t o the medical  school. The q u e s t i o n n a i r e was thoughts devoted  devised to r e v e a l students'  and a t t i t u d e s towards medicine.  The f i r s t  t o the students' e x p e c t a t i o n s and how  these e x p e c t a t i o n s .  section i s  they a r r i v e d a t  I n the f i r s t s e c t i o n , there are questions  d e a l i n g w i t h the a c t u a l d e c i s i o n t o study medicine:  how  other occupations were considered, the i n f l u e n c e and  support  of  others and the i n t e n s i t y of the f i n a l d e c i s i o n .  many  Another  s e r i e s of q u e s t i o n s d e a l s w i t h the student's s e l f - i m a g e with regard t o becoming a d o c t o r .  How  " c l o s e " or how  " f a r away"  does the student f e e l h i m s e l f t o be from h i s u l t i m a t e g o a l a t t h i s p a r t i c u l a r p o i n t of h i s l i f e ? for,  What are the m o t i v a t i o n s  and rewards o f , becoming a d o c t o r as viewed from the out-  s i d e of the medical m i l i e u by the p r o s p e c t i v e student, and sequently, by the p r o s p e c t i v e doctor? how  Once one i s a student,  does one handle h i s r e l a t i o n s with others?  does one  one a l l o t h i s time t o i n c l u d e the piany persons how  does one  e x p e c t a t i o n s towards the student; how  That i s , how  experience competition w i t h other s t u d e n t s ;  time must i n c l u d e ;  sub-  does  one's l i m i t e d  see the f a c u l t y and and, very  how  their  important,  does one experience and deal with the a n x i e t y engendered  by p a t i e n t contact? The second s e c t i o n of the q u e s t i o n n a i r e concerns experiences d i r e c t l y connected w i t h being a medical  student  and the opinions the medical student forms through these experiences.  Perhaps the main concern of the student, i n the  f i r s t instance at l e a s t , i s the s c a r c i t y and allotment of h i s time.  This n e c e s s a r i l y i n v o l v e s pressures which a r i s e not only  from the s c a r c i t y of time but from the very nature of the s t u dent's work.  The problem of the management of u n c e r t a i n t y must  be resolved i n one way or another by a l l students who are to become doctors.  Both how pressure or u n c e r t a i n t y i s experienced  and how i t i s d e a l t w i t h comes i n t o t h i s q u e s t i o n n a i r e . Quest i o n s are a l s o concerned w i t h what a t t r i b u t e s medical students b e l i e v e make up a "good" doctor.  P r e d i s p o s i t i o n s and p r e f e r -  ences towards p a t i e n t types are considered.  The extent to which  the d i f f e r e n t d i f f i c u l t i e s a doctor i s l i k e l y to encounter have been thought about i s a l s o looked at i n t h i s s e c t i o n . In the next s e c t i o n the p r e v a i l i n g p r o f e s s i o n a l plans of the students are questioned.  These questions centered around  which s p e c i a l t i e s or types of p r a c t i c e s are p r e s e n t l y considered as goals and what f u t u r e income the students expected. The ecology of the students was a l s o explored.  Ques-  t i o n s were asked regarding age, sex, m a r i t a l s t a t u s , f a t h e r ' s occupation, community background, undergraduate  majors,  l e i s u r e - t i m e a c t i v i t i e s , and s o c i a l p a r t i c i p a t i o n . In i t s e n t i r e t y the questionnaire was d i r e c t e d towards the students' d e c i s i o n to study medicine,  t h e i r expectations,  a t t i t u d e s and f e e l i n g s upon entry i n t o medical school, t h e i r experiences and opinions of the f i r s t year i n medical s c h o o l , t h e i r current p r o f e s s i o n a l plans, and t h e i r perspectives a f t e r the completion of the f i r s t year i n medical school.  I n a d d i t i o n , i n the s p r i n g of 1958, 1959, and I960, a f u r t h e r s e c t i o n was added t o the questionnaire dealing w i t h a C l i n i c a l Sessions Program.  This program's aim was to i n t r o -  duce the student t o the " s o c i a l " side of the p r a c t i c e of medicine and t o l a y the foundation f o r "comprehensive", medic a l care i n the future p r a c t i t i o n e r s .  An e v a l u a t i o n of the  impact of t h i s program was requested by the medical f a c u l t y . The. a n a l y s i s of the data accumulated w i l l proceed f o r some time. overwhelming.  Needless to say, the quantity of the data i s For the purpose of t h i s t h e s i s , those  questions  which bear d i r e c t l y on the problem a t hand were s e l e c t e d out of the questionnaire."'"' '' These are the primary source of i n f o r 1  mation f o r a l l that i s t o f o l l o w , supplemented only by informal i n t e r v i e w s with doctors and students. S o c i a l s c i e n t i s t s are aware of the drawbacks and inadequacies of data.  of research using only questionnaires f o r sources  However, o f t e n that i s " a l l " there i s i n the beginning.  Aware of the l i m i t a t i o n s of questionnaire questions and answers, the students' responses are, nevertheless, here considered w i t h i n W.I. Thomas' theorem of the s o c i a l sciences:  " I f men  define s i t u a t i o n s as r e a l , they are r e a l i n t h e i r consequences." D e s c r i p t i o n of the Sample - F i r s t Year Medical Students, U n i v e r s i t y of B r i t i s h Columbia, 1959-60. For the purpose of t h i s study i t was necessary to have " p a i r e d " questionnaires f o r the two time periods, September  14  Questions used i n t h i s t h e s i s are s t a r r e d i n Appendix A.  27  and A p r i l .  That i s , the September questionnaire of a student  had to be matched to the A p r i l questionnaire of that same student.  As p r e v i o u s l y stated the questionnaire was  confi-  d e n t i a l and no names were required on the completed documents. I n 1957-58 and 1958-59 i t was not p o s s i b l e to " p a i r " a student; s 1  questionnaires. Therefore,  This was  a d e f i n i t e drawback i n a n a l y s i s .  i n 1959-60 i d e n t i f y i n g questions were b u i l t i n .  These were such things as student's b i r t h d a t e , sex and father's occupation. 15 naires.  I t was then p o s s i b l e to " p a i r " the 1959-60 questionOnce paired, the questionnaires were known by symbol  only. Because of the requirement of "paired"  questionnaires,  i t was not possible to use the classes of 1957-58 and 1958-59 f o r t h i s study.  In A p r i l I960, there were f i f t y - n i n e r e g i s -  tered f i r s t year students at the U n i v e r s i t y of B r i t i s h Columbia i n medicine.  A l l of these students d i d not complete both  questionnaires because of absence at one or the other session. Thus, when the questionnaires were " p a i r e d " f o r f a l l and spring there were f i f t y sets which met the requirements.  The  authors  of these sets comprise our sample. In September of 1959  the study sample ranged i n age  from under twenty to over t h i r t y years of age.  The  class age was  and 22.4  23.9 years:  24.1 years f o r men  average years  f o r women. 15 I t should be stated that those persons who d i d the " p a i r ing" d i d not know any of the members of the f i r s t year medical c l a s s . As soon as the questionnaires were paired, numbers were s u b s t i t u t e d f o r names and henceforth a l l responses were completely anonymous. 16  In The Ecology of the Medical Student, a Report of the  TABLE I : PERCENTAGE DISTRIBUTION OF THE SAMPLE BY AGE, SEX, AND MARITAL STATUS.17 Male  Age  Total  Female  16-20  years  1 4 . 0 ( 7)  6.0  (3)  20.0  (10)  21-25  years  54.0  8 . 0 (4)  62.0  (3D  26-30 years 31-35  (27)  -  1 2 . 0 ( 6)  ( 2)  4.0  years  84.0 (42) M a r i t a l Status  Male  Single  64.0  (32)  Married  20.0  (10)  -  Engaged 84.O  (42)  2.0  1 2 . 0 ( 6) (1)  6.0  ( 3)  1 6 . 0 (8)  100.0  (50)  Total  Female 1 2 . 0 (6)  76.0  (38)  2.0  (1)  22.0  (11)  2.0  (1)  2.0  ( 1)  1 6 . 0 (8)  100.0  (50)  No member of t h i s sample was married or divorced during h i s f i r s t year a t medical s c h o o l . One young man was engaged when the term began, but was disengaged by the time the term ended.  His was the only change of s t a t u s i n the e n t i r e  sample. F i f t h Teaching I n s t i t u t e , A s s o c i a t i o n of American Medical C o l leges, Evanston, 111., 1958, i t i s stated t h a t i n a representat i v e sampling of United States medical students, t h e i r average age was 25 years f o r males (range from 19 to 44 years) and 25.5 years f o r females (range from 20 to 45 y e a r s ) . 17 A l l tables i n t h i s t h e s i s are s e t up i n percentages w i t h the whole numbers appearing i n brackets beside the percentage.  In the f a l l o f 1959, twenty-two per cent (11) of the c l a s s was married. 3.1 years.  They had been married an average of  The range i n years married was from eight years  (one male) t o one year (three males).  F  i v e o f the eleven  married students had one c h i l d when the f a l l questionnaire was administered.  No one had more than one c h i l d , nor was  any c h i l d born during the school term.  The married woman had  been married two years, and had no c h i l d r e n . Seventy-eight per cent of the students - t h i r t y ^ t w o men and seven women,'- received t h e i r undergraduate t r a i n i n g a t the U n i v e r s i t y of B r i t i s h Columbia. leges attended were:  Other undergraduate c o l -  s i x per cent from M c G i l l (3 men);  ten  per cent from United States c o l l e g e s (4 men and 1 woman); and s i x per>cent from other f o r e i g n colleges (3 men).  (If terri-  t o r i a l i t y makes a d i f f e r e n c e i n a t t i t u d e s , i t i s probable that the questionnaire r e s u l t s w i l l have a strong B r i t i s h Columbia bias.) In an e f f o r t t o determine what kinds of backgrounds these medical students came from, the occupations of t h e i r fathers were rated according t o a Canadian Occupational Class 1$  Scale.  This s c a l e was developed e s p e c i a l l y f o r Canada.  Occupations are ranked i n Classes from I , the highest c l a s s , to V I I , the lowest c l a s s , according t o combined standard scores f o r income and years of s c h o o l i n g , by sex. 1$ B.R. B l i s h e n , "The Construction and Use of an Occupat i o n a l Class S c a l e " , Can. J . o f Ec. and P o l . Sc., V o l . XXIV, No. 4, November 1958, pp. 519-531.  TABLE I I :  PERCENTAGE DISTRIBUTION OF SAMPLE BY OCCUPATIONAL CLASS  Class  Male  Total  Female  I  1 6 . 0 ( 8)  4.0  ( 2)  20.0  (10)  II  42.0  (21)  8.0  ( 4)  50.0  (25)  4.0  ( 2)  4.0  ( 2)  2.0  ( 1)  III IV  -  V  1 S . 0 ( 9)  VII  2.0  -  VI 4.0  (1)  2.0  ( 2)  84.O (42)  18.0 ( 9) (1)  1 6 . 0 (8)  2.0  ( 1)  4.0  ( 2)  100.0  (50)  The f i r s t three classes represent p r o f e s s i o n a l and upper-income f a m i l i e s . largest representation.  The "managerial" category has the Eleven of the students' f a t h e r s are  i n t h i s v o c a t i o n a l group. the  Eight fathers are M.B.'s - s i x of  c h i l d r e n are male and two are female. Other occupational  groups represented i n the Classes I to I I I are school teachers ( 4 ) , accountants ( 3 ) , engineers ( 2 ) , r e a l estate agents ( 2 ) , armed s e r v i c e s o f f i c e r s ( 2 ) , a s o c i a l welfare worker, a draughtsman, a chemist, and an u n l i s t e d p r o f e s s i o n a l .  The  Classes IV to V I I are comprised f o r t h i s sample of farmers ( 3 ) , a t r a n s p o r t a t i o n foreman, a plumber, a furnaceman, two o f f i c e c l e r k s , a metal f i t t e r , a policeman, a guard, a cook, and a longshoreman.  C l e a r l y , the backgrounds of the student sample are diverse.  However, there are a t l e a s t three major groupings  about which some observations can be made. F i r s t , those students who are f o l l o w i n g i n t h e i r f a t h e r s ' occupational footsteps have some advantages over the other students.  They a l s o may be under a d d i t i o n a l pressure  to "succeed" as students, and to maintain the f a m i l y ' s name and p r e s t i g e before the f a t h e r ' s colleagues - the c h i l d ' s teachers.  However, doctor's c h i l d r e n have a model to f o l l o w ,  presumably a l l t h e i r l i f e .  They have a c t u a l l y watched a'.doctor  at work and, i n a way, have l i v e d w i t h i n the medical m i l i e u . Their expectations, t h e r e f o r e , are l i k e l y to be more r e a l i s t i c than those o f many of t h e i r student peers.  They are more  o r i e n t a t e d t o t h e i r new l e a r n i n g s i t u a t i o n and,  consequently,  i t i s l i k e l y t h a t they w i l l s u f f e r l e s s d i s i l l u s i o n and use up l e s s '^energy" seeking t o f i n d out j u s t what being a doctor ( i n the widest sense) i s a l l  about.  Another student group that i s numerically outstanding i n our sample i s the c h i l d r e n of managers (22$ o f the sample). There are no data t o e x p l a i n why businessmen's c h i l d r e n chose a medical career.  However, i t might be kept i n mind that  medicine always r a t e s higher than managerial p o s i t i o n s on occupational r a t i n g s c a l e s .  Medicine might be seen by these  c h i l d r e n and t h e i r f a t h e r s as a prestigeful occupation, economi c a l l y and s o c i a l l y , without many o f the competitive pressures of business. irrelevant.)  (Whether t h i s preconception i s true or f a l s e i s  I f Table I I i s a r b i t r a r i l y dichotomized to group Classes I to I I I and Classes IV to V I I together, twenty-six per cent of the sample f a l l s i n t o the bottom h a l f of the t a b l e . This i s i n t e r e s t i n g when one considers that i t i s a common p u b l i c b e l i e f t h a t doctors are p r i m a r i l y doctors' sons, or, at l e a s t , the sons of r i c h men.  Although seventy per cent  of the sample does come from the f i r s t two upper c l a s s e s , approximately one quarter of the sample comes from the l a s t three c a t e g o r i e s . I t i s apparent t h a t the main body of medical s t u 19 dents at the U n i v e r s i t y of B r i t i s h Columbia  does not come  from the f a m i l i e s i n the middle occupational groups, but from the highest and the lowest groups according to t h i s r a t i n g . This s c a l e c o r r e l a t e s h i g h l y w i t h p r e s t i g e rankings.  M.D.'s  are rated prestige-wise and o c c u p a t i o n a l l y as being i n the highest group i n our s o c i e t y . They are, perhaps, one of the few unanimous "high" choices of the population at l a r g e . Occupational m o b i l i t y i n our s o c i e t y has been thought to be d e c l i n i n g but these f i g u r e s i n d i c a t e t h a t , r a t h e r than s l i g h t s o c i a l m o b i l i t y , one quarter of t h i s sample of medical  students  i s jumping up f o u r or f i v e Class steps by going through medical t r a i n i n g .  A medical degree i s the surest - perhaps the  only sure - manner by which one may gain p r e s t i g e and s o c i a l acceptance from our e n t i r e population. 19 This d i s t r i b u t i o n of students by f a t h e r ' s occupation was a l s o true f o r the f i r s t year medical students i n 1957-58 and 1958-59.  Another p o i n t regarding the students i n the Classes V, V I , and V I I i s that they are at the opposite extreme to the doctors' c h i l d r e n .  I t i s not l i k e l y that they have had an  immediate model t o t r y to d u p l i c a t e .  Nor i s i t l i k e l y that  they have been exposed to the wider, but i n f l u e n t i a l ,  'social'  aspects of being a member of the medical p r o f e s s i o n . These remarks suggest that the choice of medicine as a career by students may vary by socio-economic background. This problem w i l l not be taken up i n t h i s t h e s i s , but i t does suggest some i n t e r e s t i n g questions f o r f u r t h e r study. In any d i s c u s s i o n of t h i s sample of f i r s t year medical students i t should be kept i n mind that the F a c u l t y of Medicine a t the U n i v e r s i t y of B r i t i s h Columbia i s a s e l e c t i v e school.  I t does not accept a l l a p p l i c a n t s .  A l l students  who are accepted i n t o the medical school have had good scholas t i c standing i n t h e i r u n i v e r s i t y undergraduate  years.  also have been i n d i v i d u a l l y interviewed t o determine s u i t a b i l i t y f o r the medical program.  They their  I t can be assumed that  a l l members of the sample are reasonably i n t e l l i g e n t , and that they have the i n t e l l e c t u a l p o t e n t i a l t o become members of any occupation.  CHAPTER I V COMMITMENT DIFFERENTIALS AND COMMITMENT COMPONENTS  A degree o f commitment r e s u l t s f r o m a d e c i s i o n t o c a r r y out a c e r t a i n l i n e o f a c t i o n .  T h e r e f o r e , t o examine  a "degree" o f commitment, i n t h e f i r s t i n s t a n c e , the e x a m i n a t i o n o f t h e components t h a t go i n t o making. entails: the  necessitates decision-  From t h e statement o f t h e t h e o r e t i c a l s e c t i o n an a c t o r ' s o r i e n t a t i o n t o a s i t u a t i o n ,  this  including  s i g n i f i c a n t f o r c e s w h i c h h e l p e d d i r e c t and form t h i s  orientation; h i s evaluation  of s i g n i f i c a n t alternatives;  h i s r e l a t i o n s h i p t o s i g n i f i c a n t o t h e r s , such a s , h i s f a m i l y , t e a c h e r s , p e e r s ; and t h e l e n g t h o f time t h e d e c i s i o n has been p e n d i n g . For a complete p i c t u r e  i t i s obvious t h a t a g r e a t  many components should be examined.  Unfortunately, the  d a t a a t hand do n o t meet i d e a l s p e c i f i c a t i o n s .  The r e -  sponses t o t h e q u e s t i o n n a i r e s sometimes were t o o ambiguous to draw m e a n i n g f u l c o n c l u s i o n s . do i n d i c a t e  clear pictures  However, t h e u s a b l e d a t a  even though t h e background d e t a i l  cannot always be f i l l e d i n . I n t h e body o f t h e t h e s i s , t h e q u a n t i t a t i v e are p r e s e n t e d  data  first.  I n o r d e r t o examine t h e concept "degree o f commitment" as a s o c i a l mechanism, an e s t i m a t e o f v a r y i n g degrees o f commitment i s n e c e s s a r y .  To determine the "degree" of commitedness of each f i r s t year medical student i n the f a l l of 1959,  the responses to the  f o l l o w i n g questions were tabulated: Which one of the f o l l o w i n g statements best describes the way you f e e l about a career i n medicine? (Check one) .... I t ' s the only career that could r e a l l y s a t i s f y me • .... I t ' s one of s e v e r a l careers which I could f i n d almost e q u a l l y s a t i s f y i n g .... I t ' s not the most s a t i s f y i n g career I can think of, everything considered .... A career I decided on without considering whethe I would f i n d i t the most s a t i s f y i n g The f i r s t statement:  " I t ' s the only career...", was  taken as an expression of deep commitment to a medical career; the second statement as being a l e s s e r commitment than the f i r s t the t h i r d statement as being of l e s s commitment than the second; and the f o u r t h statement was considered as the l e a s t expression of commitment.  forceful  No student during the three years  t h i s question has been asked has responded i n the f o u r t h category.  The three students i n t h i s sample who responded that  medicine i s "not the most s a t i s f y i n g career I can t h i n k of  ..."  are the only students who have so responded during the three years the questionnaire has been administered. As the primary focus of t h i s t h e s i s i s on "change", the commitment question was tabulated f o r f a l l and s p r i n g , and the students were then grouped according to t h e i r combined answers f o r the two time periods. grouping.  Table I I I i n d i c a t e s t h i s  TABLE I I I : PERCENTAGE DISTRIBUTION OF CHANGES IN DEGREE OF COMMITMENT BETWEEN FALL, 1959 AND SPRING, I960. Spring I960  F a l l 1959  Only career that could s a t i s f y me One of several equally satisfying careers Not most satisfying career I can think of Did not consider satisfaction i n career choice Total  Total  Only One of career several careers  70*0  5A-.0  (35)  (27)  (8)  24.0  8.0  16.0  (12)  (4)  (S)  6.0  2.0  2.0  2.0  6.0  (3)  (1)  (1)  (1)  (3)  -  -  -  -  -  16.0  Not most satisfying  Did not consider satisfaction  -  -  Total  70.0 (35)  -  -  24.0 (12)  100.0  64.0  34.0  2.0  (50)  (32)  (17)  (1)  100.0 (50)  Throughout t h i s t h e s i s the terms "changers" and "non-changers" w i l l be employed.  "Changers" are those people  who stated one degree of commitment i n the f a l l and a d i f f e r e n t degree o f commitment i n the s p r i n g .  These are the students who  are i n c o n s i s t e n t i n t h e i r expression of degree of commitment f o r the two time periods.  "Non-changers" are those people who  s t a t e the same degree of commitment to medicine as a career i n the f a l l as they do i n the s p r i n g .  These students are c o n s i s t e n t  i n t h e i r expression of degree of commitment f o r the two periods.  Who  time  maintains a c o n v i c t i o n or commitment i s j u s t as  important as who  changes h i s c o n v i c t i o n or commitment.  The "changers" are represented by the eight people who  s t a t e medicine i s "the only career that could r e a l l y s a t i s -  f y me"  i n the f a l l upon entering medical school, but i n the  spring have changed t o :  medicine i s "one of s e v e r a l careers  which I could f i n d almost e q u a l l y s a t i s f y i n g ; " plus the four people who s t a t e medicine i s "one of s e v e r a l careers which I could f i n d almost equally s a t i s f y i n g " i n the f a l l , but i n the spring have changed t o :  medicine i s "the only career that  could r e a l l y s a t i s f y me;"  and the two people who  s t a t e medicine  i s "not the most s a t i s f y i n g career I can t h i n k of, everything considered" i n the f a l l , but i n the s p r i n g , one changed t o : medicine  i s "the only career that could r e a l l y s a t i s f y  and one changed t o :  me"  medicine i s "one of s e v e r a l careers  which I could f i n d almost equally s a t i s f y i n g . "  Fourteen  students, twenty-eight per cent {28%) of the sample of f i f t y students, r e v i s e t h e i r statement regarding how they f e e l about a career i n medicine during the u n i v e r s i t y school year. The "non-changers" i n the sample are the twentyseven students who  s t a t e that medicine, i s "the only career  t h a t could r e a l l y s a t i s f y me" both i n the f a l l and i n the s p r i n g ; the eight students who  s t a t e t h a t medicine i s "one of s e v e r a l  careers which I could f i n d almost e q u a l l y s a t i s f y i n g " both i n  the f a l l and i n the s p r i n g ; and the one student who states that medicine i s "not the most s a t i s f y i n g career I can think of, everything considered" both i n the f a l l and i n the s p r i n g . Thirty-six  students, seventy-two per cent (72$) of the sample  of f i f t y students, remain constant i n t h e i r statements regarding t h e i r degree of commitment t o a career i n medicine. The a n a l y s i s of the data proceeds from ( l ) the "change" and "non-change" groupings, and (2) the combined f a l l and s p r i n g responses t o the degree o f commitment question.  To make the  t e x t l e s s cumbersome, the f o l l o w i n g terms w i l l be employed f o r the commitment groups: TABLE IV:  ABBREVIATIONS FOR STATEMENTS OF COMMITMENT.  COMBINED FALL AND SPRING STATEMENTS OF COMMITMENT  ABBREVIATION  PER CENT OF SAMPLE  "Only career that could r e a l l y s a t i s f y me", non-change  Unconditional  54.0 (27)  "One of s e v e r a l careers which I could f i n d almost equally s a t i s f y i n g " , non-change  Qualified  16.0 ( a)  "Not the most s a t i s f y i n g career I can think of", non-change  Conditional  2.0 ( 1)  From:  "One of s e v e r a l careers which I could f i n d almost equally s a t i s f y i n g " "Not the most s a t i s f y i n g career I can think o f " "Only career that could r e a l l y s a t i s f y me"  Unconditional Changers  8.0 (4 )  "Only career that could r e a l l y s a t i s f y me" "Not the most s a t i s f y i n g career I can t h i n k o f " "One o f s e v e r a l careers which I could f i n d almost "Squally s a t i s f y i n g  Qualified Changers  and To: From: and To:  2.0 ( 1)  16.0 ( 8) 2.0 ( 1)  39  M i n o r i t y Groups Within the Sample I t w i l l now be apparent that there are two groups w i t h i n the sample who are conspicuous because they are deviant i n some important respect from the r e s t of the sample. "Deviant" i s used here to mean d i f f e r e n t from the majority on a v a r i a b l e that might bear on the f i n d i n g s of t h i s t h e s i s . The f i r s t group i s the three students who, u n l i k e t h e i r forty-seven peers, i n the f a l l of 1 9 5 9 stated that medicine was "not the most s a t i s f y i n g c a r r e r I can think o f , everything considered". I n the body of t h i s essay often they are  not r e f e r r e d to s p e c i f i c a l l y .  this.  There are two reasons f o r  F i r s t , taking the expressed commitment f o r both f a l l  and s p r i n g , each of the three students stands alone i n h i s group.  I n the spring the three responses are a l l d i f f e r e n t  from each other.  One student now s t a t e s medicine i s "the  only career" f o r him; the second student states medicine i s now "one of s e v e r a l careers" he could f i n d equally s a t i s f y i n g ; and the t h i r d student remains constant i n expressed commitment and again states that medicine i s "not the most s a t i s f y i n g career I can think of".  I t i s very d i f f i c u l t , as w e l l as unre-  l i a b l e , t o attempt g e n e r a l i z a t i o n s from a s i n g l e case. The second reason these three young men are not always r e f e r r e d to s p e c i f i c a l l y , and s i g n i f i c a n t l y f o r t h i s t h e s i s , I s t h a t , except where i n d i c a t e d i n the t e x t , they f o l l o w the patterns of t h e i r peers according to whether they ^change" i n t h e i r expression of commitment or are constant. Thus, there are two students who f o l l o w the "changers'" patterns  and one s t u d e n t who f o l l o w s t h e "non-changers'" p a t t e r n s . When t h e r e i s no s p e c i f i c r e f e r e n c e t o these t h r e e  students  i n t h e a n a l y s i s o f a q u e s t i o n , i t may be assumed t h a t t h e y have t h e i r contemporaries'  c h a r a c t e r i s t i c s and f o l l o w t h e i r  change o r non-change p a t t e r n . The students.  second m i n o r i t y group i s comprised o f t h e female  There a r e e i g h t women i n t h e sample - s i x t e e n p e r  cent o f t h e sample.  I t i s s i g n i f i c a n t that s i x of the eight  women s t a t e t h a t m e d i c i n e i s t h e " o n l y c a r e e r " t h a t c o u l d them, b o t h f a l l and s p r i n g . an a c c e p t a b l e  satisfy  I n c r e a s i n g l y , medicine i s c o n s i d e r e d  c a r e e r f o r women.  However, many persons s t i l l do  not c o n s i d e r i t e n t i r e l y a p p r o p r i a t e .  The woman's p l a c e i s  o f t e n thought t o be " i n t h e home" and t h e l o n g t r a i n i n g  required  to b e g i n a m e d i c a l  c a r e e r i s o f t e n c o n s i d e r e d a "waste" f o r  women.  i t does n o t seem o u t o f p l a c e t h a t  Therefore,  these  women s h o u l d be determined and c o n s i d e r medicine t o be the " o n l y c a r e e r " f o r them.  L e s s d e t e r m i n a t i o n , and they might  have been d e f l e c t e d o u t o f t h i s f i e l d . one  Of t h e o t h e r two women,  s t a t e s f a l l and s p r i n g t h a t m e d i c i n e i s "one o f s e v e r a l  careers I could f i n d e q u a l l y s a t i s f y i n g " ,  and t h e o t h e r changes  from m e d i c i n e i s t h e " o n l y c a r e e r " i n t h e f a l l t o m e d i c i n e i s "one  o f s e v e r a l careers I could f i n d equally s a t i s f y i n g " .  This  l a t t e r woman i s t h e o n l y female t o change h e r e x p r e s s i o n o f commitment.  A l l o f t h e women passed t h e i r f i r s t y e a r  s c h o o l , b u t t h i s g i r l had t h e lowest Six of the eight g i r l s ' i c a l l y i n Classes I or I I .  medical  standing.  f a t h e r s rank socio-econom-  O t h e r w i s e , i n terms o f age a t f i r s t  c o n s i d e r i n g m e d i c i n e as t o become a d o c t o r , are  a career,  and v a l u e s ,  at d e f i n i t e l y deciding  other careers considered  s i m i l a r t o t h e i r male  tions  age  counterparts.  Rosenberg  found:  and so o n ,  they  I n a study of  occupa-  20  . . . that the o c c u p a t i o n a l values of the career woman a r e a l m o s t i d e n t i c a l w i t h t h o s e o f t h e c a r e e r - o r i e n t e d man . . . s e x r o l e s a r e f a c t o r s of importance i n determining occupational values b u t n o t among women who h a v e a d o p t e d a " m a l e " a t t i t u d e toward t h e i r occupations. The c a r e e r woman t e n d s t o w a n t t o s a t i s f y t h e v a l u e s w h i c h men c h o o s e i n w o r k r a t h e r t h a n t h e v a l u e s s e l e c t e d b y o t h e r women. These d a t a b e a r out t h i s s t a t e m e n t . used f o r  this  The women i n t h e  sample  s t u d y do n o t c l u s t e r d i f f e r e n t l y f r o m t h e m e n .  For t h i s  reason  i n the body of the t e x t  there  are  few s p e c i a l  t o t h e women members  They f o l l o w t h e same t r e n d s questionnaire  are  as  t h e men.  n o t s i g n i f i c a n t by  references  of the  sample.  Responses to  the  sex.  Performance It  is  the object  of t h i s thesis  a "degree o f commitment" i s it  o p e r a t e s as  to demonstrate  c o m p r i s e d o f many e l e m e n t s  a s o c i a l mechanism.  However, a  that  and  "common-sensetl  e x p l a n a t i o n o f t h e commitment t h e s e s t u d e n t s e x p r e s s m i g h t that  t h e y s t a t e a d e g r e e o f commitment - a n d change o r do  change - a c c o r d i n g t o how w e l l t h e y a r e according to the grades they  especially  actually doing.  be not  That  is,  receive.  In North America there sonal achievement,  that  is  a marked s t r e s s upon  occupational  20 M o r r i s R o s e n b e r g , O c c u p a t i o n s Free P r e s s , 1957, p . 50.  achievement.  and V a l u e s ,  Glencoe,  perThere  111.,  i s a l s o a marked s t r e s s on s c h o o l achievement, and t h e r e i s a g r e a t d e a l o f a n x i e t y from the v e r y f i r s t grade, on t h e p a r t of b o t h p a r e n t s and c h i l d r e n , t h a t t h e c h i l d s h o u l d well.  "perform"  F i r s t on h i s l i s t o f "major v a l u e - o r i e n t a t i o n s " i n  America, R o b i n M. W i l l i a m s He w r i t e s :  p l a c e s "achievement and s u c c e s s " .  "The c o m p a r a t i v e l y s t r i k i n g f e a t u r e s o f American  c u l t u r e ( w i t h o t h e r s o c i e t i e s ) i s i t s tendency  to identify  standards of personal e x c e l l e n c e w i t h competitive o c c u p a t i o n a l 22  achievement."  W i t h i n such a m i l i e u i n d i v i d u a l s seem t o  " l i k e b e s t " what they can do b e s t .  Therefore, i t i s a l o g i c a l  p o s s i b i l i t y t h a t t h e s t u d e n t s who want "most" t o become members of  t h e m e d i c a l p r o f e s s i o n a r e those s t u d e n t s who, from  their  grades and achievements t o d a t e , f e e l most c e r t a i n t h a t they are,  i n f a c t , g o i n g t o make t h e grade.  The more c e r t a i n t h e y  are o f t h e i r achievement, t h a t i s , the h i g h e r t h e i r  performance,  the "more" committed t h e y might be expected t o be t o the reward for  t h e i r achievement. A f t e r the f i n a l e x a m i n a t i o n s , r e s u l t s o f the f i r s t  y e a r m e d i c a l s t u d e n t s were c l a s s i f i e d a c c o r d i n g t o the 23 s t u d e n t s ' expressed degree o f commitment. 21 R o b i n M. W i l l i a m s , J r . , American S o c i e t y , New Knopf, 1957, pp. 388-442. 22'  York,  I b i d . , p. 389.  23 The m e d i c a l s t u d e n t s a t t h e U n i v e r s i t y o f B r i t i s h Columb i a must have an average o f s i x t y p e r cent o r b e t t e r i n o r d e r to c o n t i n u e w i t h t h e i r m e d i c a l s t u d i e s . I f they have an average of s i x t y p e r c e n t , t h e y can w r i t e s u p p l e m e n t a l e x a m i n a t i o n s i n  TABLE V:  FIRST YEAR MEDICAL STUDENTS, PERCENTAGE DISTRIBUTION OF FINAL EXAMINATION RESULTS ACCORDING TO CHANGE IN EXPRESSED DEGREE OF COMMITMENT. Examination R e s u l t s  Degree o f Commitment Above Average  Below Average  To r e p e a t or w i t h d r a w  Total  Unconditional  40.7  (11) 44.4 (12) 14.8  (4)  100.0 (27)  Qualified  50.0  ( 4) 37.5  (1)  100.0  ( 8)  100.0  ( 1)  100.0  ( 4)  100.0  ( 1)  100.0  ( 8)  100.0  ( 1)  Conditional  100.0  ( 1)  Unconditional Changers: One of s e v e r a l careers Not most s a t i s f y ing career  100.6  ( 4)  100.;.0 ( 1 )  Q u a l i f i e d Changers: Only c a r e e r Not most s a t i s fying career  ( 3) 12.5  75.0 100.0  ( 1)  ( 6) 25.0 (2)  up t o t h r e e s u b j e c t s i f the m e d i c a l f a c u l t y agrees t h a t t h e s t u d e n t i s capable o f t h e work. The o b t a i n e d average f o r t h i s s t u d e n t sample was 7 4 * 1 3 p e r c e n t , w i t h a s t a n d a r d d e v i a t i o n of 5 . 6 4 . N i n e t e e n s t u d e n t s i n t h e sample were above the average. The median s c o r e f o r t h i s sample was 7 2 p e r c e n t . Members o f the sample who f a i l e d ( o b t a i n e d l e s s t h a n 6 0 p e r cent) o r d i d not w r i t e f i n a l e x a m i n a t i o n s were not t a k e n i n t o account i n the percentage c o m p i l a t i o n s o f c e n t r a l tendency because marks were not a v a i l a b l e f o r a l l s t u d e n t s who a r e t o r e p e a t o r w i t h d r a w from t h e f i r s t y e a r ; of- m e d i c i n e . Seven s t u d e n t s i n the sample were r e q u i r e d t o w r i t e s u p p l e mental e x a m i n a t i o n s , f i v e o f t h e u n c o n d i t i o n a l l y committed, and two o f the q u a l i f i e d changers ( o n l y c a r e e r ) .  44 TABLE V I : EXAMINATION AVERAGES BY COMMITMENT GROUP. No. o f Students  Average i n Percent  Standard Deviation  Not most s a t i s f y i n g career (grouped f o r anonymity)  79.0  3.6  3  Qualified  74.0  3.1  7  Unconditional  71.4  4.9  23  Unconditional Changers (one of s e v e r a l careers)  69.3  2.8  4  Q u a l i f i e d Changers (only career)  67.3  2.3  6  Degree o f Commitment  Obviously, from these f i g u r e s , there i s no simple c o r r e l a t i o n between statements of the ''greatest* commitment and performance. of expressed  The top f i v e students come from a v a r i e t y  commitments:  Rank 1  Degree of Commitment Q u a l i f i e d Changer (not most s a t i s f y i n g career) - male  2  Unconditional - female  3  Unconditional - male  4  Q u a l i f i e d - female  5  C o n d i t i o n a l - male  Although there i s no d i r e c t c o r r e l a t i o n between s t a t e ments of the g r e a t e s t commitment and marks received, there i s some connection between statements of commitment and marks  received.  The range of marks does d i f f e r by commitment group.  The highest group marks are achieved by those three students who  stated i n the f a l l that medicine i s "not the most s a t i s f y -  ing  career I can t h i n k of".  This group i s followed by the two  non-change groups, who are followed by the change groups. same p a t t e r n i s apparent f o r i n d i v i d u a l students. achievement i s a student who  First in  said medicine was "not the most  s a t i s f y i n g career I can t h i n k of" i n the f a l l . by non-changers.  The  The student who  He i s followed  stood twentieth i n the medical  c l a s s i s the f i r s t changer to appear on the l i s t .  The nine-  teenth student i s i n the middle of the c l a s s standings.  Changers,  then, with the exception of the three "not most s a t i s f y i n g career" students, a l l stand i n the bottom h a l f of the c l a s s . This i s so even though one group of students becomes more committed between f a l l and s p r i n g .  Degree of commitment i s not  simply an expression of the students' expected performance level. Age and Socio-Economic Class In seeking to d i s c o v e r the b a s i s of i n d i v i d u a l s ' ideas and a t t i t u d e s , s o c i o l o g i s t s have often, and f r e q u e n t l y p r o f i t ably, examined s o c i a l and economic f a c t s .  Therefore, the group-  ings by "degree of committedness" have been tabulated w i t h socio-economic  f a c t o r s p e r t a i n i n g to the student sample.  The  c l a s s i f i c a t i o n of the students' f a t h e r s ' occupations by Blishen's Canadian-occupation  scale was explained p r e v i o u s l y . In t h i s  t h e s i s the f i r s t upper three classes are grouped together and the l a s t f o u r classes are a l s o grouped together.  This c l u s t e r i n g  serves the purpose here where the interest i s to determine whether or not coming from a "higher" or "lower" economic and s o c i a l background has any influence on f i r s t , the l i k e l i h o o d of one's becoming a medical student and, second, students' expectations of, and t h e i r experiences i n , medical school. There i s no p a r t i c u l a r interest here i n the s p e c i f i c the students represent.  "class"  Rather, the interest i s i n t h e i r  general orientation to t h e i r "world'* a r i s i n g out of t h e i r environment to d a t e . ^ In order to determine the length of time the decision to study medicine has been settled i n the students' minds, they were asked:  "At what age did you d e f i n i t e l y decide to  study medicine?"  The answers to this question were tabulated  against the stated "degree of committedness" and students' fathers' occupations. The present age of the students i s also set out i n Table VII.  By "present age" i s intended the age given by the  student upon entry into f i r s t year medical school.  In t h i s  way i t can be estimated how long i t has taken students to reach t h e i r goal to enter medical school.  This length of time,  as stated previously, i s d i r e c t l y related to the depth or committedness of a decision.  2A As the sample size i s small, grouping also f a c i l i t a t e s analysis. Therefore, when "upper" and "lower" classes are referred to i t i s not intended i n the usual categorical sociol o g i c a l sense. The reference w i l l be to the a r b i t r a r y dichotomy employed f o r this study of classes I - III as "upper" and classes IV - VII as "lower". This w i l l make the text less cumbersome.  TABLE V I I :  FIRST YEAR MEDICAL STUDENTS, AGE OF DECISION TO STUDY MEDICINE ACCORDING TO CHANGE IN DEGREE OF COMMIT- . MENT AND CLASS.  Degree o f Commitment  Per cent of Students  Class  Mean Age at ' f i n a l ' Decision  P r e s e n t Age ( F a l l 1959)  Unconditional  42.0 (21) 12.0 ( 6)  upper lower  18.1 y r s , 18.2 "  23.0 y r s , 23.8 "  Q u a l i f i e d Changers (only career)  14-0 ( 7) 2.0 ( 1)  upper lower  19.1 19.0  tt tt  22.2 23.6  " "  Qualified  6.0 ( 3) 1 0 . 0 ( 5)  upper lower  22.0 20.8  tt tt  24.7 25.0  tt tt  U n c o n d i t i o n a l Changers 8 . 0 ( 4) (one o f s e v e r a l careers)  upper  20.0  "  24.3  ( 1)  lower  19.0  "  23.0  Q u a l i f i e . d Changers (not o n l y c a r e e r )  2.0 ( 1)  upper  19.0  "  23.0  Conditional  2.0 ( 1)  upper  22.0  "  23.0  (not  only career)  2.0  Taken as groups, t h e s t u d e n t s i n c l a s s e s I - I I I a r e younger upon e n t r y t o f i r s t y e a r m e d i c a l s c h o o l than those i n classes IV-VII.  However, those who come from t h e l o w e r c l a s s e s  ( I V - V I I ) made t h e i r " f i n a l " d e c i s i o n t o study m e d i c i n e a t an e a r l i e r age t h a n those who come from t h e upper c l a s s e s T h i s g e n e r a l i z a t i o n h o l d s t r u e b o t h f o r comparisons commitment group and w i t h i n t h e c l a s s as a whole.  (I-III).  w i t h i n each Taking t h e  c l a s s as a whole, on the average, members o f t h e l o w e r c l a s s e s make t h e i r d e c i s i o n t o s t u d y medicine n i n e months ( a t 19.0 y e a r s ) b e f o r e t h e i r upper c l a s s c l a s s m a t e s .  Time strengthens a d e c i s i o n . That i s , the longer a person has held a d e c i s i o n , the more often he i s l i k e l y to have v e r b a l i z e d t h i s d e c i s i o n t o others and thought about i t himself.  I n our s o c i e t y occupational choice probably i s r e -  garded as the i n d i v i d u a l ' s major l i f e t i m e d e c i s i o n - at l e a s t f o r boys, marriage may be f o r g i r l s .  A r e c u r r i n g question put  to c h i l d r e n and young people i s : "What are you going to be when you grow up?" Therefore, there i s ample opportunity to v e r b a l i z e and t o t h i n k about one's occupational choice.  The  more o f t e n the same choice has been s t a t e d , the more l i k e l y one i s to maintain and carry out that d e c i s i o n . I t should a l s o be kept i n mind t h a t medicine i s r e garded w i t h high esteem and p r e s t i g e i n our s o c i e t y ,  therefore,  those who a s p i r e to become members of the medical p r o f e s s i o n are given every encouragement by r e l a t i v e s , f r i e n d s , and even strangers who hear of t h e i r s o c i a l l y acceptable and s o c i a l l y 'Worthy" i n t e n t i o n .  A  s c h i l d r e n we 'learn'' i n our s o c i e t y to  earn the love of relevant others by doing what they consider "acceptable",  t h e r e f o r e , the would-be medical student, i n being  ''encouraged'' i n a c e r t a i n behaviour, goes through a patterned sequence that i s f a m i l i a r to him. H  e  ''knows'' the rewards  (praise) and punishments (disappointment, withdrawal) that relevant others w i l l give t o him f o r h i s performance.  There-  fore , i n t h i s case, there i s f a i r l y strong pressure and r e i n forcement to help the lower c l a s s student to achieve h i s ambition.  I t i s an honour to him, h i s f a m i l y , h i s f r i e n d s ,  and sometimes to h i s community, f o r him to become a medical  student.  I t i s l i k e l y that the student from the lower classes  has to overcome many obstacles - economic and s o c i a l - and that many who wish t o , do not make i t as f a r as the f i r s t year of medical school.  However, i t i s also l i k e l y that those who  do are f a i r l y determined and committed t o succeed - both f o r themselves and f o r others.  T h i r t e e n students i n the sample  come from classes I V - V I I . Only two of these students are 25  "changers" i n t h e i r expression of commitment. While the lower class group has pressures to '"help" them develop a degree o f committedness  and, thus, a d e s i r e t o  l e a r n t o become a doctor, the upper c l a s s group has d i f f e r e n t " a i d s " to a s s i s t t h e i r s e l e c t i o n and achievement of a g o a l . F i r s t , i f a f a t h e r i s i n the upper socio-economic classes of our s o c i e t y , i t i s l i k e l y that he can " g i v e " h i s c h i l d r e n , i n the f i n a n c i a l sense, what they want i n the way of an education i f they have the i n t e l l e c t u a l p o t e n t i a l .  Second, there i s  pressure on c h i l d r e n from the upper classes t o choose a s u i t able p r o f e s s i o n .  S u i t a b l e from the point of view of t h e i r  family's s o c i a l position.  For upper classes, as f o r the lower,  medicine i s an acceptable career. Managerial p o s i t i o n s may be p r e f e r r e d i n some u p p e r - f a m i l i e s over medical p o s i t i o n s ;  still,  medicine i s a "good" choice and one that i s l i k e l y supported. C h i l d r e n of upper c l a s s parents l i k e l y have l e s s pressure on them to choose a career before i t i s almost time to a c t u a l l y embark upon a chosen path.  I n lower classes,  25 One student changed from "not most s a t i s f y i n g " t o "only career" and one changed from "only career" to "one of s e v e r a l " . Therefore, only one lower c l a s s student becomes l e s s committed.  choosing an occupation  i s a major d e c i s i o n because i t deter-  mines the s t y l e of l i f e one w i l l be able t o achieve.  There  i s l i k e l y more and e a r l i e r tension around t h i s d e c i s i o n f o r lower c l a s s e s . I n the upper classes i t i s a question of maintaining, r a t h e r than having t o achieve, a s t y l e of l i f e .  The s t y l e of  l i f e of the upper classes prepares a c h i l d more adequately than the s t y l e of l i f e of the lower classes f o r entry i n t o any of the p r o f e s s i o n s .  The upper classes provide t h e i r c h i l d r e n with  an environment t h a t i s f i l l e d w i t h l e a r n i n g s t i m u l i and knowledge.  They have the means to obtain books, music, a r t , t r a v e l  and have greater access to mass communication media.  A l s o , the  f a m i l y associates are l i k e l y l a r g e l y from the upper c l a s s e s . These people often have had wide experience i n t h e i r l e a r n i n g endeavours and they are able t o communicate t h e i r experiences to others.  Coming from an upper c l a s s background implies that  an i n d i v i d u a l has had greater o p p o r t u n i t i e s f o r experience and l e a r n i n g , and, importantly, ''understands" the language of h i s teachers and professors because t h i s i s the language he has grown up w i t h .  I n short, the student from an upper c l a s s back-  ground has the s o c i a l background t o ready him f o r l e a r n i n g and to f a c i l i t a t e that l e a r n i n g .  For him, l e a r n i n g to be a  p r o f e s s i o n a l i n v o l v e s l e a r n i n g a p r o f e s s i o n a l body of knowledge For a lower c l a s s student of a p r o f e s s i o n i t may include much more:  the s o c i a l a t t r i b u t e s of the r o l e ( i n the widest sense,  how t o t a l k , give orders t o subordinates,  and so on) being more  d i f f i c u l t to master than the a c t u a l body of knowledge.  To sum up, when t h e f i r s t y e a r s t u d e n t s p r e s e n t e d themselves t o t h e m e d i c a l s c h o o l , t h e members o f t h e l o w e r s t r a t a had d e c i d e d a t an e a r l i e r age than t h e members o f t h e upper c l a s s e s t o become d o c t o r s and a r e l i k e l y , to be more d e e p l y committed  i n t h i s regard,  t o become d o c t o r s because o f t h e  p r e s s u r e s o f time and t h e r e i n f o r c e m e n t o f the c h o i c e from s i g n i f i c a n t others.  On t h e o t h e r hand, t h e members o f t h e upper  c l a s s e s w i l l have chosen medicine as a c a r e e r when a l l c a r e e r s are r e l a t i v e l y open t o them and when t h e y have known about d i f f e r e n t k i n d s o f o p p o r t u n i t i e s , e.g., academic p r o f e s s i o n s a l t h o u g h they might know o f fewer j o b s - t h a t t h e l o w e r c l a s s e s might n o t know e x i s t . to f a c i l i t a t e  They w i l l  a l s o have t h e s o c i a l  background  learning.  A l t h o u g h t h e members o f t h e l o w e r c l a s s e s d e c i d e ' d e f i n i t e l y t o s t u d y m e d i c i n e " a t an e a r l i e r age than t h e i r upper c l a s s c o n t e m p o r a r i e s , t h e i r c h r o n o l o g i c a l age, on t h e average, when t h e y f i r s t e n t e r m e d i c a l s c h o o l i s o l d e r . A l t h o u g h t h e y d e c i d e sooner, i t t a k e s them l o n g e r t o g e t t h e r e . T h i s s u g g e s t s t h a t t h e l o w e r c l a s s e s have more " t o overcome" a l t h o u g h i t may o n l y be t i m e . From Table V I I i t can be seen t h a t t h e o l d e s t group, a t e n t r y i n t o m e d i c a l s c h o o l , s e g r e g a t e d by degree o f commitment, a r e t h e q u a l i f i e d  committed.  The age d i s t i n c t i o n  f o r b o t h upper and l o w e r c l a s s groups. o l d e s t when t h e y made t h e i r f i n a l  applies  They were a l s o t h e  d e c i s i o n t o study m e d i c i n e .  From these f a c t s a l o n e i t appears t h a t perhaps t h e most  r e a l i s t i c assessment of a medical career has been made by the q u a l i f i e d committed group.  They ''decided ' on t h i s career a f t e r 1  7 6  considering other careers. °  As they are o l d e r than t h e i r  classmates, presumably they had a chance f o r a longer l o o k , a t , and exposure to, more occupations.  Their d e c i s i o n , t h e r e f o r e ,  i s more l i k e l y to be supplemented by, or even based on, a more r a t i o n a l , r e a l i s t i c a p p r a i s a l of what would be involved i n the choice of medicine as a career than the d e c i s i o n of t h e i r younger classmates whose d e c i s i o n s were made at an age of l e s s experience. The group t h a t made t h e i r " f i n a l " d e c i s i o n to study medicine at the e a r l i e s t age are the u n c o n d i t i o n a l l y committed. Numerically they are the l a r g e s t group:  twenty-seven students  which represents over h a l f (54 per cent) of the t o t a l sample. S i g n i f i c a n t l y , twenty-one of these students, forty-two per cent of the sample, come from backgrounds where t h e i r f a t h e r i s i n one of the upper three c l a s s e s . S i x students come from backgrounds where t h e i r f a t h e r i s i n one of the lower f o u r c l a s s e s . G e n e r a l i z i n g , those who make t h e i r d e c i s i o n to study medicine " e a r l y " and come from the upper c l a s s e s , express the greatest degree of commitment to a medical career.  As Oswald H a l l  has w r i t t e n , commitment to a career choice such as medicine i s r e i n f o r c e d through time and the example of " p r o f e s s i o n a l " parents. 26 A l l members of t h i s commitment group considered at l e a s t one other occupation s e r i o u s l y . Some of the u n c o n d i t i o n a l l y committed stated that they d i d not consider any other occupation seriously.  Of those f o u r t e e n s t u d e n t s who  change i n t h e i r  p r e s s i o n of commitment, t w e l v e a r e from upper c l a s s and two are from l o w e r c l a s s backgrounds. more committedness  Those who  ex-  backgrounds express  i n the s p r i n g t h a n i n the f a l l a r e younger  both i n a t t a i n e d age and age a t f i n a l d e c i s i o n than thenonchangers who,  l i k e them, s t a t e d medicine was  equally satisfying  careers".  Those who  "one o f s e v e r a l  express l e s s  committed-  ness i n t h e s p r i n g t h a n i n the f a l l were o l d e r a t age o f f i n a l d e c i s i o n b u t are now younger i n a t t a i n e d y e a r s t h a n t h o s e changers who,  l i k e them, s a i d medicine was  f o r them i n t h e  non-  the " o n l y c a r e e r "  fall.  The s t u d e n t s who s c h o o l are the q u a l i f i e d  are youngest upon e n t r y i n t o m e d i c a l  changers  (only career).  e i g h t s t u d e n t s come from the upper c l a s s  Seven of thes  group.  From t h i s evidence i t seems t h a t age and c l a s s do i n f l u e n c e degree o f commitment. The younger s t u d e n t s are more a p t t o s t a t e a g r e a t e r commitment t o a m e d i c a l c a r e e r b u t t h e y are  a l s o more apt t o change t h e i r statement d u r i n g the s c h o o l  y e a r t h a n the o l d e r s t u d e n t s .  A l l change groups a r e younger  than the group which t h e y were a f f i l i a t e d w i t h i n the  fall.  S e v e n t y - f o u r p e r c e n t o f t h i s sample comes from the upper classes.  An e x a m i n a t i o n o f degree o f commitment by c l a s s i n -  d i c a t e s t h a t , p r o p o r t i o n a t e l y , the upper c l a s s s t u d e n t s s t a t e a g r e a t e r commitment t o t h e i r proposed m e d i c a l c a r e e r , but t h e y change t h e i r statements d u r i n g the e n s u i n g y e a r t w i c e as o f t e n as t h e i r l o w e r c l a s s p e e r s .  I n t h i s s e c t i o n degree of commitment has been analyzed i n connection with some s o c i a l f a c t s : socio-economic  performance, age, and  c l a s s by f a t h e r ' s occupation.  degree of commitment v a r i e s with these f a c t s .  I t i s apparent that A c e r t a i n arrange-  ment o f these f a c t s comprises a c e r t a i n degree of commitment. S o c i a l f a c t s have been the data so f a r . They a r e s p e c i f i c , t a n g i b l e , and they can be "measured'' according to some standard.  Q u a n t i t a t i v e measurement i s l e s s a t t a i n a b l e f o r  conceptions, a t t i t u d e s , and experiences.  The next sections  deal with' these l e s s s p e c i f i c s o c i a l e n t i t i e s and degree of commitment as a s o c i a l mechanism.  CHAPTER V STUDENTS' SELF-IMAGE AND  The  relationship  CAREER CHOICE  between s e l f - i m a g e and  been d e l i n e a t e d p r e v i o u s l y .  choice  has  I n t h i s s e c t i o n the d i s c u s s i o n  f o c u s e s on t h e s e l f - i m a g e and t h e c h o i c e o f a m e d i c a l c a r e e r . E v e r y i n d i v i d u a l has an image o f h i m s e l f , a p r e c o n c e p t i o n o f the v a r i o u s a t t r i b u t e s e.g.,  and drawbacks o f a p a r t i c u l a r  choice,  a m e d i c a l c a r e e r , and a c o n c e p t i o n o f how he would f i t  in with a particular  c h o i c e . , Here the i n t e r e s t i s on how  s t u d e n t s v i e w themselves  i n r e l a t i o n t o medicine  t r a i n i n g , w i t h the emphasis on how  the  and t o m e d i c a l  these c o n c e p t i o n s v a r y by  commitment group. To become a m e d i c a l d o c t o r r e q u i r e s a l o n g , concentrated  period of t r a i n i n g .  r e q u i r e s even l o n g e r .  To become a m e d i c a l  specialist  Many p r o f e s s i o n a l d i s c i p l i n e s r e q u i r e  a s i m i l a r l y l o n g p e r i o d o f t r a i n i n g from t h e i r  socializees;  but t h i s i s n o t a g e n e r a l l y acknowledged f a c t .  The m a j o r i t y  o f people today have p e r s o n a l c o n t a c t w i t h m e d i c a l However, many never meet a PhD. a r e f a m i l i a r w i t h , medicine training period.  personnel.  Of the o c c u p a t i o n s most people  r e q u i r e s the l o n g e s t most s u s t a i n e d  I t seems l i k e l y t h a t m e d i c a l s t u d e n t s , i n the  b e g i n n i n g a t l e a s t , would have a c o n c e p t i o n o f medicine t o the p u b l i c image.  similar  They would l i k e l y c o n s i d e r medicine  r e q u i r e a l o n g e r p e r i o d of t r a i n i n g than most o c c u p a t i o n s c o n s i d e r i t t o be "tough"  course.  to and  To t e s t these assumptions,  the sample was  asked  whether t h e y expected m e d i c a l s c h o o l t o be a " b a s i c a l l y or a " b a s i c a l l y enjoyable" experience.  I n the f a l l ,  tough"  twenty-four  p e r cent o f the group expected t h e i r m e d i c a l t r a i n i n g t o be " b a s i c a l l y tough"; s e v e n t y - s i x per cent o f t h e group expected t h e i r m e d i c a l t r a i n i n g t o be " b a s i c a l l y e n j o y a b l e " .  By  spring,  e i g h t e e n p e r c e n t o f the group expected t h e remainder o f t h e i r m e d i c a l t r a i n i n g t o be " b a s i c a l l y tough" and e i g h t y - t w o cent expected i t t o be " b a s i c a l l y e n j o y a b l e " . per cent o f t h e group who,  per  However, e i g h t  i n t h e s p r i n g , expected t h e i r  train-  i n g t o be " b a s i c a l l y tough" expected i t t o be " e n j o y a b l e " i n the f a l l .  Only t e n p e r cent o f the sample s t a t e d t h a t i t would  be " b a s i c a l l y tough" b o t h f a l l  and  spring.  Degree and constancy o f commitment have no  obvious  r e l a t i o n t o t h e enjoyment - o r l a c k o f enjoyment - expected d u r i n g m e d i c a l s c h o o l , except i n one c a t e g o r y . t i o n a l changers  The  uncondi-  ( o n l y c a r e e r ) are e v e n l y d i v i d e d i n September  as t o whether o r not m e d i c a l s c h o o l i s g o i n g t o be a " b a s i c a l l y enjoyable" experience. remainder  By s p r i n g a l l of t h i s group expect the  o f t h e i r m e d i c a l s c h o o l i n g t o be " b a s i c a l l y e n j o y a b l e " . A l t h o u g h the sample g e n e r a l l y expects m e d i c a l s c h o o l  t o be a " b a s i c a l l y e n j o y a b l e " e x p e r i e n c e , t h e y do not c o n s i d e r i t t o be an easy c o u r s e .  The sample was  c i n e w i t h law, e n g i n e e r i n g , d e n t i s t r y , p h y s i c s PhD.,  and a p s y c h o l o g y PhD.,  m e d i c a l s t u d i e s ' a r e more d i f f i c u l t ,  asked t o " r a t e " medi-  o f f i c e r i n t h e army,  a c c o r d i n g t o whether less d i f f i c u l t ,  o r about  57  the same i n degree o f d i f f i c u l t y fields.  as s t u d i e s i n these o t h e r  The m a j o r i t y o f t h e m e d i c a l s t u d e n t s c o n s i d e r e d the  s t u d y o f medicine t o be more d i f f i c u l t than s t u d i e s i n t h e above-named f i e l d s ,  except a p h y s i c s PhD., w h i c h t h e y con-  s i d e r e d t o be "about t h e same" i n d e g r e e of d i f f i c u l t y obtain.  to  This s u b s t a n t i a t e s the c o n t e n t i o n t h a t medical s t u -  dents t h i n k m e d i c a l t r a i n i g i s more d i f f i c u l t compared t o other t r a i n i n g courses.  T h i s statement s h o u l d be p u t a l o n g  w i t h t h e p r e v i o u s statement t h a t t h e m a j o r i t y o f m e d i c a l s t u dents expect t h e i r s c h o o l i n g t o be " b a s i c a l l y e n j o y a b l e " . I t would seem t h a t t h i s sample of m e d i c a l s t u d e n t s i d e n t i f i e s w i t h t h i s " s e l e c t i v i t y " aspect of medicine.  M e d i c i n e i s t h e most  d i f f i c u l t t o " l e a r n " ; t h a t which i s more d i f f i c u l t t o a t t a i n *Ls b e t t e r t h a n " t h a t w h i c h i s a c c e s s i b l e t o a l l , and, f u r t h e r , t h o s e t h a t a r e c a p a b l e o f u n d e r t a k i n g t h e b e s t " and t h e "most lf  d i f f i c u l t " a r e somehow b e t t e r t h a n , o r a t l e a s t d i s t i n c t those t h a t do n o t .  from,  T h i s r e l a t e s back t o s t u d e n t s e l f - i m a g e ,  and t h e d e c i s i o n t o undertake t h e s t u d y o f m e d i c i n e .  Students  who e n r o l i n m e d i c a l s c h o o l c o n s i d e r medicine t o be the "most d i f f i c u l t ' * o f t h i s s o c i e t y ' s o c c u p a t i o n s , except p h y s i c s which i s equal i n d i f f i c u l t y , surmounting  and t h e y t h i n k they a r e c a p a b l e o f  t h i s b a r r i e r t o become members o f the "most d i f f i -  c u l t " and, c o n s e q u e n t l y , a c c o r d i n g t o our s o c i e t y ' s v a l u e s , the b e s t o c c u p a t i o n . c u l t experience.  F u r t h e r , they expect t o enjoy t h i s  diffi-  T h e r e f o r e , i t seems r e a s o n a b l e t o propose  t h a t , as a group, m e d i c a l s t u d e n t s a r e t h e most s e l f - c o n f i d e n t  s o c i a l i z e e s o f any v o c a t i o n a l t r a i n i n g group.  This s e l f - c o n f i -  dence i s r e i n f o r c e d i n t h i s a r e a by the m e d i c a l s t u d e n t s ' knowl e d g e t h a t n o t o n l y d i d t h e y choose medicine as a c a r e e r , and not o n l y do they t h i n k they can succeed, but o t h e r s , who b e l o n g t o t h i s p r e s t i g e f u l p r o f e s s i o n , chose the s t u d e n t s t o become members o f t h e i r p r o f e s s i o n because t h e y a l s o t h i n k  the students  can succeed i n t h i s endeavour. An e x a m i n a t i o n o f t h e sample by degree o f commitment h i g h l i g h t s t h e d i f f e r e n c e s , r a t h e r than t h e s i m i l a r i t i e s , among the m e d i c a l s t u d e n t group.  The u n c o n d i t i o n a l l y committed  indi-  c a t e t h e g r e a t e s t d i s c r e p a n c y between t h e i r c o n c e p t i o n o f t h e d i f f i c u l t i e s i n v o l v e d i n m e d i c a l t r a i n i n g and o t h e r t r a i n i n g programs.  They c o n s i d e r m e d i c i n e t o be more d i f f i c u l t  than  any o t h e r d i s c i p l i n e , except p h y s i c s which f o r t y p e r cent o f t h i s commitment group c o n s i d e r t o be e q u a l i n d i f f i c u l t y , w h i l e t w e n t y - t h r e e p e r c e n t c o n s i d e r medicine more d i f f i c u l t  and  t h i r t y - t h r e e p e r cent c o n s i d e r medicine l e s s d i f f i c u l t  (four  per cent "don't know"). The u n c o n d i t i o n a l changers q u a l i f i e d changers  ( o n l y c a r e e r ) and the  (one o f s e v e r a l c a r e e r s ) f o r e v e r y  occupa-  t i o n have more r e p r e s e n t a t i v e s s t a t i n g m e d i c a l t r a i n i n g i s " l e s s d i f f i c u l t " t h a n o t h e r t r a i n i n g s i n t h e s p r i n g than t h e y had i n t h e f a l l .  T h i s i s p a r t o f a g e n e r a l p a t t e r n on the p a r t  o f a l l commitment groups t o d e v a l u a t e t h e " d i f f i c u l t y ' ' o f m e d i c a l t r a i n i n g i n t h e s p r i n g compared t o t h e i r f a l l The q u a l i f i e d committed  statements.  c o n s i d e r m e d i c a l t r a i n i n g t o be o f t h e  same d i f f i c u l t y as o t h e r t r a i n i n g s more o f t e n than t h e i r peer groups.  T h i s i s p a r t i c u l a r l y so f o r d e n t i s t r y and p h y s i c s .  Although i n the s p r i n g a l l groups see medical t r a i n i n g as being more l i k e other t r a i n i n g , there i s a higher percentage of t h i s movement among the "changers" and the l e s s committed (the  q u a l i f i e d committed) than among the more committed ^ l o n -  changers".  This may be i n d i c a t i v e of 1. a d e c l i n e i n the  i d e a l i s m surrounding medical school when i t i s found to be much l i k e the pre-med years i n content and study-drudgery, and 2. i f medicine i s considered as "one of s e v e r a l careers" from the beginning, i t i s l i k e l y t h a t i t i s not thought t o be so very d i f f e r e n t from other careers one can imagine himself engaged i n . When t h i s idea i s confirmed through course content during the experience of the f i r s t year, more students s t a t e medicine i s of the same d i f f i c u l t y as other t r a i n i n g . As stated before, t h i s d e c l i n e i n the image of medicine as being "better t h a n " because i t i s "harder than" other careers i s general.  I f "something" i n the l e a r n i n g process  i s not s u b s t i t u t e d f o r t h i s damage t o the s e l f - c o n f i d e n c e , one would expect 1. the students to be l e s s e n t h u s i a s t i c , 2. l e s s confident, 3. something i n the l e a r n i n g process happening to buoy or s u b s t i t u t e f o r t h i s l o s s , or 4« some combination of the f i r s t three.  This p o i n t s h a l l be considered again l a t e r .  In the f a l l the students were asked what t h e i r expectations were regarding s e v e r a l p o s s i b l e s t r e s s s i t u a t i o n s inherent i n the l e a r n i n g process.  E x a c t l y f i f t y per cent of  the students f e l t they would f i n d i t d i f f i c u l t to keep up with the other students during the f i r s t year of medical s c h o o l .  The o t h e r f i f t y p e r cent expected no d i f f i c u l t y i n t h i s r e g a r d . Seven o f the e i g h t women i n the c l a s s expected t o have t r o u b l e k e e p i n g up. was  Only one o f t h e t h r e e s t u d e n t s who  stated  medicine  "not t h e most s a t i s f a c t o r y c a r e e r I can t h i n k o f " , ex-  p e c t e d t o have d i f f i c u l t y .  The o n l y commitment group whose  m a j o r i t y expected t o have d i f f i c u l t y was the q u a l i f i e d  changers  ( o n l y c a r e e r ) group. F i f t y p e r cent of t h e members o f the non-change groups do not expect t o have d i f f i c u l t y l e a r n i n g what i s expected o f them.  However, the m a j o r i t y o f the changers do expect t o ex-  perience d i f f i c u l t y i n t h i s area.  "Learning to think f o r your-  s e l f was not c o n s i d e r e d t o be a problem by the l a r g e m a j o r i t y of s t u d e n t s ( e i g h t y per cent - two s t u d e n t s d i d n o t answer the q u e s t i o n ) . Ten p e r cent of t h o s e who  d i d expect t o have d i f f i -  c u l t y l e a r n i n g t o t h i n k f o r themselves were changers.  Fifty-  e i g h t p e r cent o f t h e s t u d e n t s d i d expect t o have d i f f i c u l t y not a l l o w i n g themselves t o become o v e r l y t e n s e o r nervous t h e i r work.  about  Of the r e m a i n i n g f o r t y - t w o p e r c e n t , t h i r t y - t w o  p e r cent were non-changers and f o u r p e r cent d i d not answer the question.  The u n c o n d i t i o n a l l y committed  were the o n l y group  whose m a j o r i t y d i d n o t expect t o have d i f f i c u l t y . d i v i d e d i n t o t w e l v e s t u d e n t s who who  d i d not.  They were  expected t r o u b l e and  T h e r e f o r e , t h e s t r e s s was  thirteen  f e l t more s t r o n g l y i n  t h e change g r o u p s . I f the above s i t u a t i o n s are c o n s i d e r e d as s t r e s s s i t u a t i o n s , i t i s f a i r l y c l e a r t h a t , f o r some r e a s o n , the non-changers e x p e r i e n c e l e s s s t r e s s than t h e changers.  In  a d d i t i o n , the u n c o n d i t i o n a l l y committed  experience  l e s s s t r e s s t h a n the q u a l i f i e d committed. d i f f e r e n c e between the u n c o n d i t i o n a l  proportionately  There i s no g r o s s  and q u a l i f i e d changers.  S t u d e n t s were a l s o asked how w e l l they expected t o do i n t h e i r s t u d i e s compared t o the r e s t o f t h e i r c l a s s .  The  o b j e c t o f t h i s q u e s t i o n was  was  t o a s s e s s whether o r not t h i s  a l s o e x p e r i e n c e d as an a r e a o f s t r e s s .  TABLE V I I I :  PERCENTAGE DISTRIBUTION OF FIRST YEAR MEDICAL STUDENTS' EXPECTED: ACHIEVEMENT.  Expected Achievement  FALL  SPRING  B e t t e r t h a n average  48.0  (24)  42.0  (21)  Average  30.0  (15)  44.0  (22)  2.0  ( 1)  4.0  ( 2)  20.0 100.0  (10) (50)  10.0 100.0  ( 5) 150)  Below average Don't know  Of the t w e n t y - f o u r s t u d e n t s i n the f a l l who  state  t h e y expect t o do " b e t t e r t h a n average", seventeen s t u d e n t s (69.7  p e r cent) are u n c o n d i t i o n a l l y committed.  dents (61.8  Thirteen  stu-  p e r cent) i n the s p r i n g a r e from the same commit-  ment group.  12.3  p e r cent i n the f a l l and 14*3 per c e n t i n the  s p r i n g o f the s t u d e n t s who  expected to do " b e t t e r than a v e r a g e "  come from t h e q u a l i f i e d commitment group. The commitment groups a r e most i n t e r e s t i n g when examined w i t h r e g a r d t o how t h e y changed.  By s p r i n g , none o f  t h e q u a l i f i e d changers average.  ( o n l y c a r e e r ) e x p e c t s t o do b e t t e r t h a n  l l o t h e r commitment groups haye some r e p r e s e n t a t i o n  A  i n t h i s category.  By s p r i n g , the t h r e e s t u d e n t s who  f a l l s a i d m e d i c i n e was  i n the  "not t h e most s a t i s f y i n g c a r e e r , I can  t h i n k o f " , a l l s t a t e t h e y e x p e c t t o do b e t t e r than average i n their studies. The u n c o n d i t i o n a l changers  (one o f s e v e r a l c a r e e r s )  are outstanding f o r the consistency of t h e i r e x p e c t a t i o n s .  There  i s a g r e a t d e a l o f movement i n the o t h e r commitment groups among the e x p e c t a t i o n c a t e g o r i e s . T h i s as not so f o r the group. and  aforementioned  These s t u d e n t s t e n d t o remain i n the same c a t e g o r y f a l l  spring. Twenty p e r cent o f t h e sample b e g i n by s a y i n g they  "don't know" how  t h e y w i l l do compared t o the r e s t o f the c l a s s .  When t h e f a l l q u e s t i o n n a i r e was a d m i n i s t e r e d , s t u d e n t s had t l e b a s i s f o r comparisons  between themselves and t h e i r  mates except the p r e v i o u s y e a r ' s performance, t h e r e was d i f f e r e n t i a l knowledge. t h e twenty per cent who  lit-  class-  about which  I t might be suggested t h a t  d i d not w i s h t o commit themselves i n  the f a l l were w a i t i n g t o see how t h e y a c t u a l l y were g o i n g t o compare i n performance. " r e a l i s t i c " approach,  A l t h o u g h t h i s might be regarded as a  i t might a l s o be regarded as an i n d e x o f  i n s e c u r i t y , o r a t l e a s t a p r o t e c t i v e mechanism.  Once one  has  v e r b a l i z e d what one e x p e c t s t o do t h e n o t h e r s have a b a s i s f o r j u d g i n g whether o r not one, i n f a c t , "makes i t " .  I t i s more  d i f f i c u l t t o be p l e a s e d w i t h d o i n g l e s s t h a n one expected t o do than i t i s t o be p l e a s e d w i t h d o i n g as w e l l as was done when no  p r e v i o u s g o a l was s e t up.  I n t e r e s t i n g l y , i n the f a l l  five  s t u d e n t s ( f i f t y p e r cent) o f the"don't knows" a r e from t h e u n c o n d i t i o n a l l y committed, none i s q u a l i f i e d committed, f i v e a r e changers  i n commitment.  I n the spring there are f i v e per-  sons who s t a t e they "don't know" how they expect t o do.  Only  one o f these s t u d e n t s was i n t h i s c a t e g o r y i n t h e f a l l . The responses t o t h i s q u e s t i o n i n d i c a t e t h a t i n the area of achievement-expectations,  t h e t h r e e s t u d e n t s who b e g i n  s t a t i n g " n o t o n l y c a r e e r t h a t can s a t i s f y " a r e t h e most o p t i m i s t i c group;  the q u a l i f i e d changers  the l e a s t o p t i m i s t i c ;  (only career) are  the u n c o n d i t i o n a l changers  are the  most c o n s i s t e n t ; t h e q u a l i f i e d committed a r e t h e most del i b e r a t e ; and t h e u n c o n d i t i o n a l l y committed a r e h i g h l y m i s t i c b u t p r o p o r t i o n a l l y most undecided groups.  opti-  o f the commitment  I t would seem t h a t a n t i c i p a t e d achievement was an  a r e a o f s t r e s s , b u t t h a t t h i s s t r e s s was e x p e r i e n c e d d i f f e r e n t i a l l y by commitment groups. S t u d e n t s ' e x p e c t a t i o n s were compared t o t h e i r 27  a c t u a l achievement t o see how r e a l i s t i c they were.  27 The t o p o n e - t h i r d o f t h e c l a s s i s c o n s i d e r e d t o be " b e t t e r than average"; t h e m i d d l e t h i r d i s c o n s i d e r e d t o be "average"; and t h e bottom t h i r d o f t h e c l a s s i s c o n s i d e r e d t o be "below average".  64  TABLE I X :  PERCENTAGE DISTRIBUTION OF STUDENTS' EXPECTATIONS COMPARED TO THEIR ACHIEVEMENT BY COMMITMENT GROUP. Marks  Commitment Group  B e t t e r t h a n Average average Exp. Ach. Exp. Ach. Unconditional Unconditional Changers: from one o f several careers from n o t most s a t isfying  Qualified Changers: from o n l y career  Conditional  3 7 . 0  4 4 . 4 -  1 4 . 3  3 . 7  4 8 . 1  Don't know Exp. Ach. 3 . 7  ( 1 3 )  ( 1 0 )  ( 1 2 )  ( 4 )  5 0 . 0  —  5 0 . 0  7 5 . 0  ( 2 )  ( 3 )  2 5 . 0  5 0 . 0  1 2 . 5  1 2 . 5  2 5 . 0  ( 2 )  ( 4 )  ( 1 )  ( 1 )  ( 2 )  7 5 . 0  5 0 . 0  5 0 . 0  2 5 . 0  ( 4 )  ( 2 )  (2) 1 0 0 . 0  Qualified  from n o t most s a t isfying  4 8 . 1  Below average Exp. Ach.  ( 1 )  3 7 . 5  3 7 . 5  ( 3 )  ( 3 )  —  —  ( 1 )  1 0 0 . 0  ( 1 )  ( 1 3 )  —  2 5 . 0  —  4  ( 1 )  ( 1 )  1 0 0 . 0  ( 1 )  1 0 0 . 0  ( 1 )  Failure's Nos.  (6)  —  ( 4 )  —  1  —  2  1 0 0 . 0  ( 1 )  1 0 0 . 0  ( 1 )  The t h r e e s t u d e n t s who s t a t e d i n t h e f a l l t h a t  "medi-  c i n e was n o t t h e most s a t i s f y i n g c a r e e r I can t h i n k o f " a r e a l l accurate average".  i n t h e i r p r e d i c t i o n s t h a t t h e y w i l l do " b e t t e r than Of t h e two major non-change groups, the Q u a l i f i e d  committed group p r e d i c t s most a c c u r a t e l y .  The u n c o n d i t i o n a l  changers (one o f s e v e r a l c a r e e r s ) a r e somewhat c l o s e r i n t h e i r  e x p e c t a t i o n s than t h e o t h e r major change group.  E x c e p t f o r the  t h r e e s t u d e n t s mentioned and t h e q u a l i f i e d committed, a l l o t h e r groups o v e r - e s t i m a t e d  themselves.  They expected  to place higher  i n t h e i r c l a s s than t h e y d i d .  No one s t a t e d they expected t o  f a i l , b u t seven s t u d e n t s d i d .  There were no f a i l u r e s among t h e  u n c o n d i t i o n a l changers (one o f s e v e r a l c a r e e r s ) .  I n the three  groups where t h e r e were f a i l u r e s , p r o p o r t i o n a l l y , t h e h i g h e r p e r c e n t a g e was among t h e q u a l i f i e d changers ( o n l y c a r e e r ) . The s t u d e n t s ' a c t u a l achievement t u r n s o u t t o be r e f l e c t i v e o f t h e g e n e r a l i z a t i o n s r e g a r d i n g t h e achievementexpectations.  The t h r e e s t u d e n t s who s t a t e d medicine was " n o t  the o n l y c a r e e r t h a t c o u l d s a t i s f y " were t h e most o p t i m i s t i c w i t h good r e a s o n : were r e a l i z e d .  t h e i r " b e t t e r t h a n average" e x p e c t a t i o n s  The q u a l i f i e d changers ( o n l y c a r e e r ) , who were  l e a s t o p t i m i s t i c , had t h e h i g h e s t p r o p o r t i o n o f f a i l u r e s . The u n c o n d i t i o n a l changers (one o f s e v e r a l c a r e e r s ) , who were c o n s i s t e n t i n t h e i r e x p e c t a t i o n s , a l l passed.  The q u a l i f i e d  committed, t h e most d e l i b e r a t e and d e l i b e r a t i n g , p r e d i c t e d most a c c u r a t e l y o f the two non-change groups.  The u n c o n d i -  t i o n a l l y committed, h i g h l y o p t i m i s t i c b u t undecided, b o t h h i g h and l o w on the achievement l i s t . commitment  place  The d i f f e r e n t  groups a r e i n d i c a t i v e o f d i f f e r e n t degrees o f  realism. Students were a l s o asked t o p r o j e c t themselves i n t o the f u t u r e i n o r d e r t o r e v e a l how they c o n c e p t u a l i z e d thems e l v e s as p r a c t i s i n g p h y s i c i a n s i n t h e i r chosen c a r e e r o f medicine.  In the f a l l ,  f i f t y - e i g h t p e r cent o f the c l a s s t h i n k  they w i l l " t h i n k o f themselves as d o c t o r s " by t h e i r i n t e r n year.  Twenty-two p e r cent expect t o t h i n k o f themselves as  d o c t o r s b e f o r e t h e i r i n t e r n y e a r , and twenty p e r cent do n o t expect t o have t h i s s e l f - c o n c e p t i o n u n t i l a f t e r t h e i r i n t e r n year.  By s p r i n g , f o r t y - s i x p e r cent o f the c l a s s expect t o  t h i n k o f themselves as d o c t o r s d u r i n g t h e i r i n t e r n y e a r , t h i r t y - t w o p e r cent expect t o have t h i s  self-conception  e a r l i e r , and twenty-two p e r c e n t expect t o have i t l a t e r than t h e i r i n t e r n year. S i g n i f i c a n t l y , the u n c o n d i t i o n a l l y committed expect t o t h i n k o f themselves as d o c t o r s e a r l i e r t h a n t h e o t h e r s t u dent groups. to expecting  The movement, i n t h e s p r i n g , o f some s t u d e n t s t o t h i n k o f themselves as d o c t o r s sooner t h a n  t h e y had expected i n t h e f a l l ,  comes p r i m a r i l y from two groups:  the u n c o n d i t i o n a l l y committed and the u n c o n d i t i o n a l (one  of several careers).  changers  No q u a l i f i e d changer ( o n l y c a r e e r )  e x p e c t s t o t h i n k o f h i m s e l f as a d o c t o r b e f o r e h i s i n t e r n y e a r . I n t h e s p r i n g o f I960, t h e r e were f o u r s t u d e n t s i n the sample who expected t o t h i n k o f themselves as d o c t o r s w i t h i n t h e n e x t two  years:  t h r e e non-changers, two who a r e u n c o n d i t i o n a l l y  committed and one who i s q u a l i f i e d committed; and one u n c o n d i t i o n a l changer (one o f s e v e r a l c a r e e r s ) .  From the f o r e g o i n g  i t i s a p p a r e n t t h a t the more i n t e n s e the v e r b a l  allegiance  t o t h e p r o f e s s i o n o f m e d i c i n e , t h e sooner one expects t o t h i n k o f h i m s e l f as a member o f t h a t  profession.  A l l s t u d e n t s would l i k e t o have s u b s t a n t i a l p a t i e n t contact i n t h e i r t h i r d year or before. both f a l l and s p r i n g .  T h i s was  indicated (66.7  However, the m a j o r i t y o f changers  per cent) would l i k e s u b s t a n t i a l c o n t a c t i n t h e i r next y e a r (second y e a r o f m e d i c a l s c h o o l ) .  In contrast, 4 5 . 8  per cent  o f the non-changers s t a t e t h e y would l i k e t o w a i t u n t i l  their  t h i r d year f o r t h e i r f i r s t s u b s t a n t i a l p a t i e n t contact.  Third  y e a r i s t h e y e a r when s t u d e n t s are g i v e n s u b s t a n t i a l p a t i e n t contact. school.  The s t u d e n t s know t h i s b e f o r e they e n t e r m e d i c a l T h i s response  general impatience.  seems t o be an e x p r e s s i o n o f t h e i r  Impatience  i s more l i k e l y t o be h e l d i n  check when t h i n g s a r e g o i n g w e l l r a t h e r than when they a r e not P r o j e c t i o n i s a common defense mechanism a g a i n s t f r u s t r a t i o n . I n t h i s i n s t a n c e the s t u d e n t s - p r i m a r i l y the changers  - seem  t o be s a y i n g t h a t the m e d i c a l s c h o o l i s not d o i n g t h i n g s " r i g h t " , t h e y w i t h h o l d p a t i e n t s from s t u d e n t s too l o n g . may  This  be e a s i e r t o say than: " M e d i c a l s c h o o l and my e x p e c t a t i o n s  o f m e d i c a l s c h o o l are not the same - I'm time o f i t . "  having a f r u s t r a t i n g  T h i s f r u s t r a t i o n c o u l d be i n any one o r a number  o f areas - d i s p a r a t e e x p e c t a t i o n s r e g a r d i n g course c o n t e n t , p a t i e n t c o n t a c t , s c h o l a s t i c performance, f i c a n t d i f f e r e n c e s i n response  and so on.  The  signi  t o t h i s q u e s t i o n i s by change  and non-change groups, r a t h e r than by commitment groups. change groups a r e the more i m p a t i e n t . L o o k i n g even f a r t h e r ahead, s t u d e n t s were asked what k i n d o f a working s i t u a t i o n they would p r e f e r .  The  TABLE X:  PERCENTAGE DISTRIBUTION OF FIRST YEAR MEDICAL STUDENTS' PREFERENCES FOR THE WORK SITUATION IN WHICH THEY WOULD LIKE TO CARRY OUT THEIR PROFESSIONAL ACTIVITY. Spring.  Fall Own  professional o f f i c e with hospital a f f i l i a t i o n  Own  professional o f f i c e without hospital a f f i l i a t i o n  Large p r i v a t e S m a l l group  c l i n i c or  60.0  hospital  clinic  60.0  (30)  -  (30)  4.0  (  2)  18.0  (  9)  12.0  (  6)  12.0  (  6)  14.0  (  7)  Medical school  6.0  (  3)  6.0  (  3)  Other  4.0  (  2)  4.0  (  2)  100.0  (50)  A l t h o u g h the p e r c e n t a g e s f o r f a l l  (50)  100.0  and s p r i n g  are  f a i r l y s i m i l a r , f o r t y per cent of the sample gave a d i f f e r e n t response i n the  s p r i n g than they d i d i n the f a l l .  In  quantity  o f movement, the non-changers are l e s s a c t i v e t h a n the One  q u a r t e r o f the u n c o n d i t i o n a l l y  committed and  one  half  the q u a l i f i e d committed changed t h e i r mind d u r i n g the t e r m about the k i n d of work s e t t i n g t h e y p r e f e r r e d . h a l f o f each o f the f a l l and  spring.  changers. of  school Over  one  change groups gave d i f f e r e n t responses  A g a i n , the  changers are more u n s e t t l e d  than  the non-change g r o u p s . The settings:  own  c h o i c e s r e v o l v e p r i m a r i l y around t h r e e o f f i c e with hospital a f f i l i a t i o n , a  alternate  large  p r i v a t e c l i n i c or h o s p i t a l , and a small group c l i n i c .  It is  not s u r p r i s i n g t h a t s i x t y per cent of the students i n the f a l l and againihthe s p r i n g chose as t h e i r preference "own p r o f e s s i o n a l o f f i c e with h o s p i t a l a f f i l i a t i o n " . the doctor:  This i s the usual image of  a man i n a white coat i n h i s own o f f i c e .  Like  asking students what s p e c i a l t y f i e l d they would p r e f e r to pract i c e , t h i s question, i n v o l v e s an issue to which they may have not given much thought and which requires no immediate answer. A l s o , students do not know the advantages and disadvantages one s e t t i n g over another,  of  The choice at t h i s time, t h e r e f o r e ,  has l i t t l e d i r e c t s i g n i f i c a n c e f o r the f u t u r e .  However, there  i s a tendency f o r p r o p o r t i o n a l l y more of those who belong to some other group than the u n c o n d i t i o n a l l y committed to i n d i c a t e at one time or the other a preference f o r group and practice.  clinic  I n c l i n i c p r a c t i c e there can be a "sharing" of time  and r e s p o n s i b i l i t y .  A l s o , a number of s p e c i a l i s t s can l o c a t e  under one roof f o r speedier r e f e r r a l s and l i k e l y more e f f i c i e n t communication of information regarding p a t i e n t s . On the other hand, the man who p r a c t i c e s alone, bears the f u l l r e s p o n s i b i l i t y for his patient himself.  However, h i s work - triumphs  and  e r r o r s - are much l e s s v i s i b l e to others than they might be i n a group p r a c t i c e .  This "weighing" of s e t t i n g s against one  another could go on.  For the purpose of t h i s t h e s i s , however,  i t i s i n d i c a t e d t h a t the u n c o n d i t i o n a l l y committed have a greater wish to do i t " a l l alone", a greater s e l f - r e l i a n c e , and are more constant i n t h e i r choice w i t h regard to  themselves  as m e d i c a l p r a c t i t i o n e r s .  The u n c o n d i t i o n a l l y committed are  more sure o f t h e i r p l a c e i n the m e d i c a l m i l i e u x than t h e i r peers.  They have thought out - o r a t l e a s t i d e n t i f i e d w i t h -  the e x t e r n a l and v i s i b l e symbols o f t h e m e d i c a l d o c t o r . To e s t i m a t e the rewards the s t u d e n t s expected  from  medicine i n terms o f f i n a n c i a l r e t u r n s , t h e s t u d e n t s were asked "What y e a r l y income do you r e a l i s t i c a l l y expect a t the peak o f your c a r e e r ? "  TABLE X I :  FIRST YEAR MEDICAL STUDENTS' AVERAGE ESTIMATES OF YEARLY INCOME AT PEAK OF CAREER BY COMMITMENT GROUP  Commitment Group  Fall Estimate  Spring Estimate  U n c o n d i t i o n a l l y committed  $ 15,923  #  Q u a l i f i e d committed Q u a l i f i e d changers  (only career)  U n c o n d i t i o n a l changers several careers)  (one o f  Not most s a t i s f y i n g c a r e e r i n f a l l (three students)  16,884  15,625  14,375  17,500  15,313  17,500  17,500  19,166  14,166  The average expected income a t the peak o f t h e i r c a r e e r s f o r the sample as a whole i n the f a l l was and i n the s p r i n g was $ 1 5 , 2 2 5 .  $17,172  A c r o s s - s e c t i o n of United State  f i r s t y e a r m e d i c a l s t u d e n t s i n 1 9 5 6 s t a t e d t h e y expected t o be making $ 2 2 , 3 4 0 a  2$  y e a r a t t h e peak o f t h e i r c a r e e r s .  D. Cahalan, P. C o l l e t t e , and N.A.  Hilmar,  "Career  I n t h i s sample, those s t u d e n t s who, s t a t e medicine  i s the " o n l y c a r e e r " f o r them, r a t e t h e i r f u t u r e  e a r n i n g s h i g h e r . t h a n do t h e i r contemporaries medicine  i n the s p r i n g ,  , who  do not  see  as the " o n l y " s a t i s f y i n g c a r e e r t h e y can t h i n k o f .  In  f a c t , t h e u n c o n d i t i o n a l l y committed are the o n l y group t h a t t h i n k s by s p r i n g t h a t they w i l l earn more t h a n they had p r e v i o u s l y p r o p h e s i z e d i n the  fall.  2Q The Canadian Department o f N a t i o n a l Revenue p u b l i s h e d the t o t a l "earned and surgeons i n Canada who #157,240,000.  in  1959  income a s s e s s e d " o f m e d i c a l d o c t o r s "work f o r themselves  f o r g a i n " as  T h i s i s an average y e a r l y income, o f #13,376.  The average t o t a l earned  income assessed f o r m e d i c a l  and surgeons i n B r i t i s h Columbia was  doctors  $16,133 i n 1959.  From  these f i g u r e s i t would appear t h a t the s t u d e n t s i n the sample have a r e a l i s t i c p i c t u r e o f t h e i r f u t u r e income a c c o r d i n g t o present  standards. The  e s t i m a t e s by commitment group, however, i n d i c a t e  t h a t t h e group which so f a r has shown the g r e a t e s t d e l i b e r a t i o n , t h e q u a l i f i e d committed, expect t o earn l e s s than t h e i r mates.  class-  I n the s p r i n g , t h e t h r e e "not most s a t i s f y i n g c a r e e r "  i n the f a l l s t u d e n t s made a s i m i l a r l y low e s t i m a t e .  L i k e the  I n t e r e s t s and E x p e c t a t i o n s o f U.S. M e d i c a l S t u d e n t s " , J . o f M e d i c a l E d u c a t i o n , Aug. 1957, V o l . 32, No. 8, p. 560. 29 T a x a t i o n D i v i s i o n , T a x a t i o n S t a t i s t i c s , 1959. P r i n t e r , Ottawa, 1959.  Queens  q u a l i f i e d committed, these three students made an a c c u r a t e estimate o f t h e i r performance - which was  high.  From these  estimates i t would seem t h a t the more single-minded about a c a r e e r i n medicine, expects.  one i s  the more f i n a n c i a l r e t u r n s one  That i s , f o r t h i s sample, the greater the v e r b a l en-  dorsement of a m e d i c a l c a r e e r , the h i g h e r the expected  financial  returns. There has been some c o n j e c t u r e equating o c c u p a t i o n a l choice and p e r s o n a l i t y , e.g.,  p e d i a t r i c i a n s are persons  s u f f e r e d s i b l i n g r i v a l r y - they want t o work w i t h  who  children  because they are, a t l a s t , b i g g e s t and s t r o n g e s t ( v i s - a - v i s a patient).  T h i s presumably could be one b a s i s f o r a student's  p r e f e r e n c e f o r one s p e c i a l t y f i e l d  or another,  or i n the  early  stages of t r a i n i n g p a r t i c u l a r l y , students might chose f o r thems e l v e s the c a r e e r they considered most p r e s t i g e f u l w i t h i n the p r o f e s s i o n , or, perhaps, i z e d s u b j e c t matter  a student might be drawn t o the  of a s p e c i a l t y .  In an e f f o r t to uncover  p a t t e r n s of choice, students were asked which f i e l d they would p r e f e r to e n t e r . The  connection.  of  medicine  No o u t s t a n d i n g p a t t e r n s emerged.  choices were s c a t t e r e d both f a l l  apparent  special-  In the f a l l ,  and s p r i n g w i t h no  surgery was  chosen by  twenty-six per cent of the sample - twenty-two per cent being from the u n c o n d i t i o n a l l y committed group. surgery was  I n the s p r i n g ,  chosen by twenty-two per cent of the sample -  f o u r t e e n per cent from the u n c o n d i t i o n a l l y committed group. P e d i a t r i c s was  mentioned by f o u r t e e n per cent of the c l a s s i n  the f a l l ,  e i g h t e e n p e r cent i n t h e s p r i n g ;  cent i n t h e f a l l ,  m e d i c i n e by s i x p e r  e i g h t e e n p e r cent i n t h e s p r i n g .  These t h r e e  s p e c i a l t i e s a r e p r e s t i g e f u l w i t h i n the m e d i c a l p r o f e s s i o n . S u r g e r y , p a r t i c u l a r l y , has an a u r a o f glamour s u r r o u n d i n g i t . An unexpected  c h o i c e o f t h i s sample, however, was made by the  two p e r cent o f t h e sample i n t h e f a l l , b u t twenty-two p e r cent i n t h e s p r i n g , who s t a t e d p u b l i c h e a l t h was t h e i r c a r e e r c h o i c e . T h i s was unexpected  because p u b l i c h e a l t h as a m e d i c a l c a r e e r 30  r a t e s low on t h e p r e s t i g e s c a l e .  Neophytes g e n e r a l l y i d e n t i f y  w i t h t h e most p r e s t i g e f u l p o s i t i o n o r p e r s o n . S i x t y - t w o p e r cent o f t h e s t u d e n t s gave a d i f f e r e n t c h o i c e i n t h e s p r i n g from t h e i r f a l l  choice.  Of t h e remainder,  t w e n t y - f o u r p e r cent were from the u n c o n d i t i o n a l l y  committed.  T h i s would seem t o i n d i c a t e t h a t , f i r s t , g e n e r a l l y t h e s t u d e n t s are n o t s e t t l e d i n t h e i r c h o i c e o f s p e c i a l t y w i t h i n t h e f i e l d of  medicine and, second, w i t h i n an u n s t a b l e a r e a , t h e u n c o n d i -  t i o n a l l y committed of  are r e l a t i v e l y stable.  F o r t y - f o u r p e r cent  t h i s l a t e r group do n o t change i n s p e c i a l t y c h o i c e d u r i n g  t h e i r f i r s t year i n medical s c h o o l . I t seems t h a t n o t o n l y d i d t h e u n c o n d i t i o n a l l y comm i t t e d group d e c i d e t o become d o c t o r s a t an e a r l i e r age than t h e i r c o n t e m p o r a r i e s , b u t they have a l s o d e c i d e d on what k i n d of  d o c t o r t h e y want t o become.  T h i s suggests t h a t t h e i r  i d e n t i f i c a t i o n w i t h a c a r e e r i n medicine i s i n t e n s e . 30 I n t h e A.A.M.G.'s, The E c o l o g y o f t h e M e d i c a l S t u d e n t , where s t u d e n t s and m e d i c a l f a c u l t y r a t e d s p e c i a l t i e s , p u b l i c h e a l t h appears o n l y i n t h e " l e a s t l i k e d " column, p. 177.  For most m e d i c a l s t u d e n t s  i n t h e i r f i r s t year the  question of s p e c i a l t y choice i s i r r e l e v a n t ,  ^hey do n o t know  enough about the v a r i o u s s p e c i a l t i e s t o make a c h o i c e .  That  members o f t h i s sample s t i l l s t a t e a s p e c i f i c c h o i c e , i s n o t out o f c h a r a c t e r .  As c h i l d r e n , t h e y responded when asked:  "What a r e you g o i n g t o be when you grow up?" C h i l d r e n go t h r o u g h v a r i o u s phases when they respond t o t h i s a d u l t "game" w i t h an " I don't know".  U s u a l l y , however, t h e c h i l d has an  answer - o f t e n v a r y i n g w i t h the day. the a d u l t s and " p l a y the game".  I t i s simpler to s a t i s f y  Medical students, l i k e a l l  s t u d e n t s , have had ' ^ p r a c t i c e " s t a t i n g o c c u p a t i o n a l These a r e f o r c e d c h o i c e s - made w i t h o u t knowing - t h e a l t e r n a t i v e s .  considering - or often  They are i n no way regarded  b i n d i n g u n t i l t h e c h o i c e i s repeated of time.  choices.  as  o f t e n and over a l e n g t h  Then, b o t h t h e a s k e r and t h e respondent, b e g i n t o  take t h e answer s e r i o u s l y .  So f a r , i t would seem t h a t t h e  m a j o r i t y o f o u r sample have n o t s e t t l e d t o one r e s p o n s e . The d a t a a t hand do n o t c o n t i n u e t o t h e time when s t u d e n t s g r a d u a t e and have t o make a d e c i s i o n o f consequence regarding t h e i r f i e l d of s p e c i a l t y y  T h i s would be a f t e r t h e  required year of i n t e r n s h i p . F o r t h i s q u e s t i o n c o n s i s t e n c y o f answers between two time p e r i o d s p e r t a i n s t o o n l y the one group o f non-changers The  q u a l i f i e d committed may be i n c o n s i s t e n t i n t h e i r response  to t h i s q u e s t i o n , b u t they a r e a c t i n g c o n s i s t e n t l y i n accordanc with t h e i r general pattern.  I f t h i s group " d e f i n i t e l y  decided"  t o study m e d i c i n e a t a l a t e r age t h a n t h e o t h e r groups, t h e n i t  is  i n c h a r a c t e r t h a t t h e y s h o u l d d e f i n i t e l y d e c i d e upon t h e i r  c h o i c e o f s p e c i a l t y a t a l a t e r age.  T h i s <gives them an  oppor-  t u n i t y t o l o o k around, t o see where t h e r e are o p p o r t u n i t i e s , what a p p e a l s and what does n o t , where one would f i t i n and where one would n o t . Why  do m e d i c a l s t u d e n t s s t a t e t h e p a r t i c u l a r s p e c i a l t y  t h e y do, when asked?  A medical student pondering t h i s question  s a i d t h a t s t u d e n t s gave a s p e c i a l t y because " p e o p l e a r e  always  a s k i n g . . . you don't know y e t * , , i t d e v e l o p s as you go a l o n g . " T h i s s t u d e n t s t a t e d f u r t h e r t h a t " c h o i c e s " were a r r i v e d a t s i m i l a r l y to children's choices.  The most r e c e n t s t i m u l a t i n g  r e p r e s e n t a t i v e o r v i s u a l p r e s e n t a t i o n o f an o c c u p a t i o n ( o r s p e c i a l t y ) i s the c l e a r e s t model a t hand, so t h a t i s "what 1 want t o do." Even fewer s t u d e n t s remain c o n s t a n t i n t h e i r s t a t e ments o f t h e f i e l d s t h e y would l e a s t l i k e t o e n t e r .  Seventy-  f o u r p e r c e n t o f the s t u d e n t s g i v e a d i f f e r e n t c h o i c e i n the s p r i n g than t h e y d i d i n the f a l l .  Again, the u n c o n d i t i o n a l l y  committed  have t h e o n l y s i g n i f i c a n t segment r e m a i n i n g c o n s t a n t .  Seventeen  p e r c e n t o f t h i s group (Ten p e r cent o f the sample)  s t a t e t h e y would l e a s t l i k e t o be a p s y c h i a t r i s t .  An  e i g h t p e r c e n t from o t h e r commitment groups share t h i s for  psychiatry.  additional dislike  Dermatology i s t h e o n l y o t h e r s p e c i a l t y t h a t  any number o f s t u d e n t s say t h e y would not l i k e t o p r a c t i c e six  p e r cent o f t h e sample i n t h e f a l l ,  t w e l v e p e r cent i n the  s p r i n g ( f o u r p e r c e n t are c o n s t a n t on t h i s c h o i c e , b o t h xfomen). L i k e t h e i r s p e c i a l t y p r e f e r e n c e , but t o an even g r e a t e r degree,  is  i n c h a r a c t e r t h a t t h e y s h o u l d d e f i n i t e l y d e c i d e upon t h e i r  c h o i c e of s p e c i a l t y a t a l a t e r age.  T h i s g i v e s them an  oppor-  t u n i t y t o l o o k around, t o see where t h e r e are o p p o r t u n i t i e s , what a p p e a l s and what does n o t , where one would f i t i n and where one would n o t . Why  do m e d i c a l s t u d e n t s s t a t e the p a r t i c u l a r s p e c i a l t y  t h e y do, when asked?  A m e d i c a l s t u d e n t pondering t h i s q u e s t i o n  s a i d t h a t s t u d e n t s gave a s p e c i a l t y because "people are  always  a s k i n g . . . you don't know y e t . . . i t d e v e l o p s as you go a l o n g . " T h i s s t u d e n t s t a t e d f u r t h e r t h a t "choices'' were a r r i v e d a t s i m i l a r l y to children's choices.  The most r e c e n t s t i m u l a t i n g  r e p r e s e n t a t i v e o r v i s u a l p r e s e n t a t i o n o f an o c c u p a t i o n ( o r s p e c i a l t y ) i s the c l e a r e s t model a t hand, so t h a t i s "what I want t o do." Even fewer s t u d e n t s remain c o n s t a n t i n t h e i r ments o f the f i e l d s t h e y would l e a s t l i k e t o e n t e r .  state-  Seventy-  f o u r per c e n t o f the s t u d e n t s g i v e a d i f f e r e n t c h o i c e i n the s p r i n g than they d i d i n the f a l l .  Again, the u n c o n d i t i o n a l l y  committed  have t h e o n l y s i g n i f i c a n t segment r e m a i n i n g c o n s t a n t .  Seventeen  per cent o f t h i s group (Ten per cent o f the sample)  s t a t e t h e y would l e a s t l i k e t o be a p s y c h i a t r i s t .  An  e i g h t per cent from o t h e r commitment groups share t h i s for  psychiatry.  additional dislike  Dermatology i s the o n l y o t h e r s p e c i a l t y t h a t  any number of s t u d e n t s say t h e y would not l i k e t o p r a c t i c e six  per cent o f t h e sample i n the f a l l ,  t w e l v e p e r cent i n the  s p r i n g ( f o u r p e r cent are c o n s t a n t on t h i s c h o i c e , b o t h women). L i k e t h e i r s p e c i a l t y p r e f e r e n c e , but to an even g r e a t e r degree,  76  i t seems t h a t t h e m a j o r i t y o f s t u d e n t s have n o t " d e f i n i t e l y d e c i d e d " on t h e i r s p e c i a l t y o f l e a s t p r e f e r e n c e .  Again, a l l  s t u d e n t s make a c h o i c e - t h e y do n o t s a y , "don't know", o r r e f r a i n from answering. process: of for  T h i s seems t o be p a r t o f t h e l e a r n i n g  what i s l i k e d b e s t - o r l e a s t - o r t h e development  neutrality.  To b e g i n t o answer t h i s dilemma r e q u i r e s d a t a  a t l e a s t the f o u r medical school years. S e v e n t y - e i g h t p e r cent o f t h e s t u d e n t sample i n t h e  f a l l a n d • e i g h t y - s i x p e r cent i n t h e s p r i n g express l i t t l e o r no a n x i e t y r e g a r d i n g whether o r n o t t h e y w i l l be a b l e t o have the k i n d o f m e d i c a l c a r e e r they d e s i r e . two p e r cent i n t h e f a l l ,  Of t h e r e m a i n i n g  t e n p e r cent a r e women.  thirty-  Proportionately,  the non-changers e x p r e s s more a n x i e t y t h a n t h e changers.  How-  e v e r , by s p r i n g t h e r e i s l i t t l e expressed a n x i e t y from any group. F o r a l l s t u d e n t s , t h e a c t u a l p r a c t i c e o f medicine seems f a r distant at this point.  There a r e many p r e s s i n g problems which  have t o be t a k e n care o f i m m e d i a t e l y , n o t f o u r o r f i v e y e a r s hence, such as p a s s i n g term e x a m i n a t i o n s . G e n e r a l l y , t h e q u e s t i o n s d e a l i n g w i t h t h e f u t u r e seem to  e l i c i t r a t h e r tenuous responses from many s t u d e n t s . D e a l i n g w i t h t h e p r e s e n t , each s t u d e n t r a t e d t h e im-  p o r t a n c e o f 1.  f e l l o w s t u d e n t s ' comments, 2.  the f a c u l t y , and 3.  i n f o r m a t i o n from  personal s e l f - e v a l u a t i o n i n determining  how w e l l he thought he was d o i n g i n f i r s t y e a r m e d i c a l s c h o o l . No s t u d e n t i n t h e sample ranked h i m s e l f t h i r d ( l a s t ) i n importance for  s e l f - e v a l u a t i o n i n the f a l l .  I n the s p r i n g , f o u r students  ranked t h e sequence 1. f a c u l t y , 2. s t u d e n t s , 3. s e l f .  TABLE X I I :  PERCENTAGE DISTRIBUTION OF STUDENTS' RANKING OF INFLUENCES ON DECIDING HOW WELL THEI ARE DOING Spring  Influences  • Fall  S e l f - f a c u l t y - other students  18.0  ( 9)  38.0  (19)  S e l f - other students - f a c u l t y  30.0  (15)  36.0  (18)  Faculty - s e l f - other students  30.0  (15)  18.0  ( 9)  8 . 0 ( 4)  F a c u l t y - other students - s e l f Other s t u d e n t s - s e l f - f a c u l t y  12.0  ( 6)  No answer  10.0  ( 5)  100.0  (50)  100.0  (50)  At b o t h p o i n t s i n t i m e , t h e s e l f i s t h e most i m p o r t a n t source o f e v a l u a t i o n f o r t h i s sample;  f o r t y - e i g h t p e r cent i n  t h e f a l l ranked ! ' s e l f " f i r s t , and s e v e n t y - f o u r p e r cent d i d s i m i l a r l y i n the spring. f i d e n c e of t h e sample.  This, again, points t o the s e l f - c o n They a r e n o t l o o k i n g t o o t h e r s f o r  a p p r a i s a l - w h i c h i s o f t e n accompanied by t h e s e a r c h f o r p r a i s e , or at l e a s t , support.  G e n e r a l l y , the m e d i c a l s t u d e n t c o n s i d e r s  h i m s e l f t h e b e s t judge o f how w e l l he i s d o i n g . Examining t h e d i s t r i b u t i o n by commitment group, f o r t h e non-changers t h e " s e l f " i s t h e i r main e v a l u a t o r . However, the second most i m p o r t a n t i n f l u e n c e i n e v a l u a t i o n a r e f e l l o w s t u d e n t s f o r t h e u n c o n d i t i o n a l l y committed, and the f a c u l t y f o r the q u a l i f i e d committed.  One group seems t o r e l y more on i t s  p e e r s , t h e o t h e r group more on i t s s u p e r i o r s .  Among the changers, ingly  a l s o , the " s e l f " was  the major e v a l u a t o r of performance.  overwhelm-  However, o t h e r  s t u d e n t s ' o p i n i o n s d i d not rank h i g h f o r any o f the change groups. From the d a t a i t seems t h a t the m e d i c a l s t u d e n t i s a fairly self-reliant socializee. Compared w i t h t r a i n i n g f o r o t h e r p r o f e s s i o n s , the f i r s t y e a r m e d i c a l s t u d e n t s t h i n k t h a t m e d i c a l t r a i n i n g i s more d i f f i c u l t - except f o r a Ph.D.  i n p h y s i c s , which they c o n s i d e r to be  e q u a l or s l i g h t l y more d i f f i c u l t than m e d i c i n e . t h i s d i f f e r e n c e narrows between f a l l and s p r i n g .  The e x t e n t of A l s o , the  c o m p a r a b i l i t y o f medicine to o t h e r c a r e e r s d i f f e r s by commitment group.  Those s t u d e n t s who  b e g i n w i t h an u n c o n d i t i o n a l  commitment t o m e d i c i n e , see the c a r e e r as h a v i n g more unique a s p e c t s than do the s t u d e n t s who  b e g i n w i t h a q u a l i f i e d commitment.  W h i l e t h e s t u d e n t s t h i n k of m e d i c a l t r a i n i n g as a "tough" a t the same time, the m a j o r i t y of t h i s sample expect  course,  their  m e d i c a l t r a i n i n g t o be b a s i c a l l y an e n j o y a b l e e x p e r i e n c e . I n s t r e s s s i t u a t i o n s the changers d i f f i c u l t y than the non-changers.  expect t o have more  I n e s t i m a t i n g what t h e i r  a c t u a l achievement l e v e l w i l l be, t h e r e i s a f a i r amount of movement between f a l l and s p r i n g f o r a l l commitment groups except f o r t h e u n c o n d i t i o n a l changers.  However, o n l y two  students  i n the sample e s t i m a t e t h a t t h e i r performance w i l l be "below average".  I n f a c t , e i g h t e e n per cent of the sample f a i l ,  and  an a d d i t i o n a l f o r t y - f o u r per cent s c o r e below the c l a s s average mark.  79  The -majority o f t h e sample expect t o t h i n k o f thems e l v e s as d o c t o r s by t h e i r y e a r o f i n t e r n s h i p o r b e f o r e . e v e r , t h e u n c o n d i t i o n a l l y committed, on t h e average, t h i n k o f themselves The  as d o c t o r s sooner than t h e i r  How-  expect t o  contemporaries.  f i r s t s u b s t a n t i a l p a t i e n t c o n t a c t i s hoped f o r d u r i n g t h e  t h i r d y e a r o f m e d i c a l s c h o o l by most s t u d e n t s .  I t i s common  knowledge among t h e s t u d e n t s t h a t i t i s d u r i n g t h e i r t h i r d t h a t t h e y a r e scheduled t o be i n v o l v e d w i t h p a t i e n t s .  year  There-  f o r e , i t i s s i g n i f i c a n t t h a t two t h i r d s o f t h e changers s t a t e t h a t they would l i k e s u b s t a n t i a l p a t i e n t c o n t a c t b e f o r e t h e t h i r d year of medicine. The s t u d e n t s a r e q u i t e u n s e t t l e d as t o what k i n d o f a work environment t h e y would l i k e t o e n t e r i n t o upon g r a d u a t i o n . There i s a g r e a t d e a l o f movement between f a l l and s p r i n g .  This  seems t o be one o f those q u e s t i o n s whose answer i s n o t i m p o r t a n t t o t h e s t u d e n t s j u s t now.  T h i s i s one d e c i s i o n t h a t can be put  off f o r at least four years.  However, t h e m a j o r i t y i n d i c a t e d  t h a t t h e y c o u l d l i k e an o f f i c e o f t h e i r own w i t h a h o s p i t a l affiliation.  The u n c o n d i t i o n a l l y committed were t h e most con-  stant i n t h i s statement,  w h i l e t h e o t h e r groups were more  i n c l i n e d t o c o n s i d e r group p r a c t i c e  set-ups.  As a group, the sample has r e a l i s t i c f i n a n c i a l expectations.  The s t u d e n t s ' e s t i m a t e o f t h e i r expected  financial  income a t t h e peak o f t h e i r c a r e e r s c o i n c i d e s w i t h t h e p r e s e n t income o f d o c t o r s i n B r i t i s h Columbia. however, by commitment group.  The e s t i m a t e s d i f f e r ,  The g r e a t e r t h e v e r b a l  endorse-  ment o f a m e d i c a l c a r e e r , t h e h i g h e r t h e expected f i n a n c i a l r e t u r n .  P r o j e c t i o n o f c a r e e r p l a n s s e v e r a l y e a r s i n t o the f u t u r e i s not f i n a l i z e d i n t h i s sample. of  There i s a g r e a t d e a l  change between f a l l and s p r i n g p r e f e r e n c e s and d i s l i k e s o f  specialty fields.  A t t h i s s t a g e i n t h e i r t r a i n i n g , few  stu-  dents e x p r e s s a n x i e t y t h a t they w i l l not be a b l e t o have the k i n d of  medical career they d e s i r e . In  t h e e v a l u a t i o n o f how w e l l he i s d o i n g i n m e d i c a l  s c h o o l t o the end of t h e f i r s t y e a r , of most importance t o the student i s h i s s e l f - e v a l u a t i o n .  The second most i m p o r t a n t i n -  d i c a t o r d i f f e r s by commitment group.  The u n c o n d i t i o n a l l y com-  m i t t e d value t h e i r f e l l o w - s t u d e n t s ' opinions next to t h e i r w h i l e t h e o t h e r groups v a l u e the f a c u l t y ' s o p i n i o n s next t o their  own.  own,  CHAPTER VI CONCEPTIONS OF MEDICINE AS A CAREER  To see o n e s e l f i n r e l a t i o n to a p a r t i c u l a r c a r e e r e n t a i l s not o n l y a c o n c e p t i o n o f o n e s e l f i n r e l a t i o n t o the c a r e e r , but a l s o a c o n c e p t i o n o f what i s i n v o l v e d w i t h i n the c a r e e r i t s e l f . himself.  He  A p o t e n t i a l c a n d i d a t e a s s e s s e s not o n l y  " a s s e s s e s " the c a r e e r .  I f a c a r e e r i s embarked  upon w i t h a f a l s e i m p r e s s i o n o f the s e l f , i t appears t o make a difference.  I n the l a s t s e c t i o n t h e r e i s a c o n s i s t e n t  d i f f e r e n c e i n response a c c o r d i n g t o whether o r not changes one's "degree o f commitment" or remains i n "commitment".  constant  Change i m p l i e s a reassessment o f a  formerly held conviction. change, and  one  I n t h i s s e c t i o n , change,  non-  "degree o f commitment* groups are examined  w i t h the f o c u s on t h e c o n c e p t i o n o f medicine  as a c a r e e r  r a t h e r t h a n , as i n the l a s t s e c t i o n , on the  conception  of the s e l f i n a m e d i c a l The  career.  s t u d e n t s were asked:  " I n your o p i n i o n , which  one o f (the f o l l o w i n g ) phrases b e s t d e s c r i b e s the profession?"  The  medical  sample responses are shown i n Table  XIII.  TABLE X I I I :  PERCENTAGE DISTRIBUTION OF STUDENT CHOICES OF THE BEST DESCRIPTION OF THE MEDICAL PROFESSION Spring  Fall  Description A p r o f e s s i o n w h i c h has h i g h i n the community  standing  A p r o f e s s i o n o f s e r v i c e t o the community A p r o f e s s i o n which Is secure lucrative  10.0  (  54.0  (27)  and  10.0  (  50.0  (25)  (15)  A p r o f e s s i o n i n which r e a l a b i l i t y i s r e c o g n i z e d by one's c o l l e a g u e s  —  A p r o f e s s i o n r e q u i r i n g harder work than o t h e r s  4.0  (  2)  No  2.0  (  1)  answer  100.0  5)  —  —  30.0  A p r o f e s s i o n which helps individuals directly  5)  (50)  30.0  (15)  2.0  (  1)  8.0  (  4)  —  100.0  (50)  S i g n i f i c a n t l y , by s p r i n g , of those t e n s t u d e n t s  who  t h i n k m e d i c i n e i s b e s t d e s c r i b e d n e i t h e r by "A p r o f e s s i o n o f s e r v i c e t o the community" nor "A p r o f e s s i o n which h e l p s v i d u a l s d i r e c t l y " , s i x are u n c o n d i t i o n a l l y committed.  indiThey  r e f e r m e d i c i n e back to what i t can do f o r them r a t h e r t h a n g i v i n g the normative response of the sample which i s s t a t e d i n terms o f what medicine can do f o r o t h e r s .  I n any event, e i g h t y  per cent o f t h e sample see m e d i c i n e as a " s e r v i c e " and  "helping  profession.  be  No  student  d e s c r i b e d as " s e c u r e and  t h i n k s the p r o f e s s i o n can b e s t lucrative".  Seen as a group, t h e r e i s l i t t l e change i n o p i n i o n as t o what b e s t d e s c r i b e s the m e d i c a l p r o f e s s i o n , between f a l l and s p r i n g .  I t i s , o f c o u r s e , s i g n i f i c a n t and i n t e r e s t i n g t o  note t h e o r d e r i n w h i c h s t u d e n t s endorse t h e s e  statements.  More p e r t i n e n t t o t h i s s t u d y , however, i s the f a c t t h a t , a l t h o u g h these f i g u r e s f o r f a l l and. s p r i n g a r e almost i d e n t i c a l , s i x p e r cent ( t w e n t y - e i g h t s t u d e n t s ) g i v e a d i f f e r e n t i n the s p r i n g t o what they d i d i n the f a l l .  fiftyresponse  This i n d i c a t e s  t h a t , a l t h o u g h the g e n e r a l areas o f consensus do not change, the s t u d e n t s do.  The t o t a l s o f the responses  for their stability;  are noteworthy  the s t u d e n t s ' i n d i v i d u a l responses  noteworthy f o r t h e i r i n s t a b i l i t y .  are  F u r t h e r , the p r o p o r t i o n o f  change v a r i e s w i t h i n a commitment group.  I f the commitment  groups are arranged a c c o r d i n g t o s t u d e n t s ' expressed  change  w i t h i n t h e i r commitment group, the l e a s t change f i r s t ,  one  f i n d s the f o l l o w i n g : P e r cent o f s t u d e n t s who  change  25.0  Commitment group U n c o n d i t i o n a l changers  (one  of s e v e r a l careers) 37.5  Q u a l i f i e d committed  62.5  Q u a l i f i e d changers ( o n l y career) U n c o n d i t i o n a l l y committed "Not most s a t i s f y i n g c a r e e r " i n the f a l l - two changed in spring.  62.9 66.6  The low percentage  o f change i n the top two  groups  i n d i c a t e s l e s s s t r e s s t h a n i n the o t h e r t h r e e groups i n a t l e a s t t h e a r e a p e r t a i n i n g t o these q u e s t i o n s .  W i t h r e g a r d t o these same s t a t e m e n t s , t h e s t u d e n t s were asked i f they c o n s i d e r e d them t o be a " v e r y good desc r i p t i o n " , a ' T a i r d e s c r i p t i o n " , o r a "poor d e s c r i p t i o n " o f the m e d i c a l p r o f e s s i o n .  Many s t u d e n t s d i d n o t mark any o f  the s t a t e m e n t s as "poor d e s c r i p t i o n s " . t h r e e hundred  Out o f a p o s s i b l e  r e s p o n s e s , "poor d e s c r i p t i o n " was marked o n l y  s i x t y - t h r e e t i m e s i n t h e f a l l and f i f t y t i m e s i n t h e s p r i n g . However, t h e responses t o t h i s q u e s t i o n c l u s t e r e d  around  three statements: 1.  A p r o f e s s i o n which i s s e c u r e and l u c r a t i v e .  2.  A p r o f e s s i o n i n which r e a l a b i l i t y i s r e c o g n i z e d by one's c o l l e a g u e s .  3.  A p r o f e s s i o n r e q u i r i n g h a r d e r work than o t h e r s .  Most s t u d e n t s ' answers c l u s t e r around the m i d d l e range - a " f a i r description" - i n this question. S t u d e n t s were a l s o asked:  "What t h i n g s do you  t h i n k you w i l l l i k e b e s t about b e i n g a d o c t o r ? " Table X I V i n d i c a t e s t h e sample's r e s p o n s e s .  Table XV  i n d i c a t e s t h e d i f f e r e n t i a l emphasis p l a c e d by t h e commitment groups.  31 S t u d e n t s were asked t o check as many o f t h e above statements as a p p l i e d t o them. No one statement was checked by a l l t h e s t u d e n t s . However, percentages a r e worked out on t h e b a s i s o f t h e e n t i r e c l a s s because t h e y had e q u a l o p p o r t u n i t y t o check each statement.  TABLE XIV:  PERCENTAGE DISTRIBUTION, FALL AND SPRING, o f STUDENTS' CHOICES OF WHAT THEY WILL LIKE BEST ABOUT BEING A DOCTOR.  Statement No.  Fall  Spring  1.  Being able t o help other people  80.0  78.0  2.  The c h a l l e n g i n g and s t i m u l a t i n g n a t u r e o f t h e work  68.0  82.0  3.  Being able t o deal d i r e c t l y w i t h people  68.0  76.0  4.  B e i n g my own boss  34.0  46.0  5.  Having i n t e r e s t i n g and i n t e l l i g e n t people f o r c o l l e a g u e s  32.0  48.0  6.  The f a c t t h a t m e d i c i n e i s a h i g h l y respected profession  32.0  38.0  7.  B e i n g sure o f e a r n i n g a good income  28.0  28.0  a.  Doing work i n v o l v i n g s c i e n t i f i c method and r e s e a r c h  26.0  36.0  TABLE XV:  ORDER OF PREFERENCE OF WHAT STUDENTS THINK THEY WILL LIKE BEST ABOUT BEING A DOCTOR,-BY COMMITMENT GROUP  Commitment Group  Order o f importance by t a b l e - s t a t e m e n t numbers Spring  Fall  U n c o n d i t i o n a l l y Com'd. Q u a l i f i e d Changers (only career) Q u a l i f i e d Committed U n c o n d i t i o n a l Changers (one o f s e v e r a l )  ' 2nd 3 r d  1st  2nd  3rd  4th  1st  4th  1  2  3  6  1  2  3  5  1 3  2 1  3 2  4 4  3 2  4 1  1 3  6 4  3  1  4  2  1  2  3  7  G r o u p i n g those s t u d e n t s who, i n t h e f a l l ,  s a y medi-  c i n e i s t h e " o n l y c a r e e r " f o r them, they p l a c e t h e same emphasis on what t h e y w i l l l i k e b e s t about b e i n g a d o c t o r , r e g a r d l e s s o f t h e i r subsequent change o r non-change o f commitment group. same i s t r u e f o r t h e s t u d e n t s who, i n t h e f a l l , "one  o f s e v e r a l c a r e e r s " t o them.  The  say medicine i s  I n the s p r i n g , the uncondi-  t i o n a l l y committed remain c o n s t a n t i n . r a n k i n g t h e importance o f what they w i l l l i k e b e s t about b e i n g a d o c t o r .  The q u a l i f i e d  committed have k e p t t h e i r t o p t h r e e c h o i c e s b u t have changed the emphasis.  The u n c o n d i t i o n a l changers (one o f s e v e r a l  c a r e e r s ) have now t h e i d e n t i c a l c h o i c e and o r d e r f o r t h e i r f i r s t t h r e e p o s i t i o n s as do t h e u n c o n d i t i o n a l l y . c o m m i t t e d . They have t a k e n on some o f t h e a t t i t u d e s o f t h e peers w i t h whom they now share a s i m i l a r s t a t e d degree o f commitment. The  q u a l i f i e d changers ( o n l y c a r e e r ) have now t a k e n  on some o f t h e l e s s e r c h o i c e s o f t h e i r p e e r s , b u t they have n o t g i v e n t h e same o r d e r o f p r e f e r e n c e .  T h i s group i s t h e most  d i v e r g e n t from t h e p a t t e r n s o f t h e o t h e r groups.  This question,  t h e n , says something about t h e d i s o r g a n i z a t i o n t h a t accompanies change.  This " d i s o r g a n i z a t i o n " i s meaningful  o n l y when i t i s  c o n s i d e r e d i n comparison w i t h the responses o f t h e r e s t o f t h i s sample.  I n comparison w i t h some o t h e r group these  changers might n o t be o u t o f s t e p . classmates  qualified  However, compared t o t h e i r  and compared t o t h e i r o r g i n a l thoughts  on what they  would l i k e b e s t about b e i n g a d o c t o r , t h i s group o f s t u d e n t s i s d e v i a n t - t h e y a r e t h e most u n s e t t l e d o f t h e commitment g r o u p s .  Comparing t h e emphases p l a c e d on what t h e y w i l l  like  b e s t about b e i n g a d o c t o r between the two non-change groups, i t i s found t h a t the u n c o n d i t i o n a l l y committed "being able to help other people".  put the emphasis on  The q u a l i f i e d committed  put  the emphasis on t h e " c h a l l e n g i n g and s t i m u l a t i n g n a t u r e o f the work".  T a k i n g t h e l i s t o f s t a t e m e n t s , i n i t s e n t i r e t y , the un-  c o n d i t i o n a l l y committed  tend t o be more a l t r u i s t i c and more  i n t e r e s t e d i n ' o t h e r s ' - b o t h people t h e y w i l l " h e l p " i n the f u t u r e and t h e i r f u t u r e c o l l e a g u e s .  I n a manner they are more  idealistic.  emphasize i n t e r e s t i n t h e i r  The q u a l i f i e d committed  work, i n t e r e s t i n m e d i c i n e r a t h e r t h a n i n p e o p l e .  They appear  to be more concerned w i t h i n s t r u m e n t a l i t i e s and a r e l e s s i d e a l i s t i c toward t h e i r f u t u r e p r o f e s s i o n a l l i v e s than the unconditionally  committed.  C o n t i n u i n g w i t h q u e s t i o n s t o d i s c o v e r the s t u d e n t s ' c o n c e p t i o n s o f the m e d i c a l p r o f e s s i o n and o f s t a n d a r d s w i t h i n m e d i c i n e , the s t u d e n t s were asked which o f a number o f c h a r a c teristics  t h e y c o n s i d e r e d most i m p o r t a n t i n making a good  physician. The f i g u r e s i n Table XVI are f a i r l y c o n s t a n t f a l l s p r i n g , except f o r the decrease i n those who  and  think "dedication  to m e d i c i n e " i s an i m p o r t a n t c h a r a c t e r i s t i c i n a p h y s i c i a n and and i n c r e a s e i n those who o r g a n i z e d way"  c o n s i d e r the " a b i l i t y t o t h i n k i n an  an i m p o r t a n t c h a r a c t e r i s t i c .  People tend t o  e v a l u a t e c h a r a c t e r i s t i c s i n terms o f themselves: have a c e r t a i n one, o r would l i k e t o have i t .  The  whether t h e y aforementioned  t r e n d i n responses t h e n , a g a i n , denotes a l o s s o f i d e a l i s m and  the s u b s t i t u t i o n o f a m a t t e r - o f - f a c t approach - " l e t ' s g e t d o i n g what we have t o do" - on t h e p a r t o f t h e sample t a k e n as a whole.  TABLE III:  FIRST YEAR MEDICAL STUDENTS' CHOICES OF THE TWO CHARACTERISTICS MOST IMPORTANT IN MAKING A GOOD PHYSICIAN.  Characteristic Good appearance Warm and p l e a s i n g p e r s o n a l i t y  Fall  Spring  —  —  7  10  21  10  High i n t e l l i g e n c e  7  5  S k i l l f u l management o f time  2  Scientific  1  1  Integrity  14  14  A b i l i t y t o t h i n k i n an o r g a n i z e d way  12  19  Research a b i l i t y  —  —  A b i l i t y t o g e t along w i t h people  11  15  5  8  G e t t i n g r e a l enjoyment o u t o f m e d i c i n e  10  14  No answers  10  4  100  100  Dedication t o medicine  curiosity  R e c o g n i t i o n o f own l i m i t a t i o n s  —  .  However, once again, i f t h e changes a r e examined b y commitment group, t h e changes w i t h i n t h e sample a r e n o t u n i f o r m .  The r e l a t i v e p o s i t i o n i n g o f " i m p o r t a n t c h a r a c t e r i s t i c s " f o r a p h y s i c i a n , by commitment group, f o l l o w : Q u a l i f i e d Committed  U n c o n d i t i o n a l l y Committed Fall  Spring  1.  Dedication  2.  Organized thinking  Spring  Fall 1.  Integrity  Integrity  A b i l i t y t o get along w i t h others  2.  Organized thinking  Organized thinking  Enjoyment o f medicine  3.  Research ability  Recognition of l i m i t s  4-.  Dedication  Enjoyment o f medicine  Organized  3.  Enjoyment o f medicine  4.  Get a l o n g Dedication with others  5.  Integrity  thinking  Integrity  F o r the u n c o n d i t i o n a l l y committed between f a l l  and  s p r i n g t h e r e i s a change i n emphasis about what they c o n s i d e r t o be more i m p o r t a n t and l e s s i m p o r t a n t c h a r a c t e r i s t i c s f o r a p h y s i c i a n t o embody.  T h i s change seems t o be, f i r s t l y ,  s e n i n g i d e a l i s m , o r o f " d e d i c a t i o n " toward m e d i c i n e ;  a les-  and,  s e c o n d l y , a g r e a t e r emphasis on what t o do about g e t t i n g t h r o u g h t h i s course.  The u n c o n d i t i o n a l l y committed seem t o be s a y i n g :  " D e d i c a t i o n i s n o t g o i n g t o g e t us through t h i s . b e s t way?"  What i s the  The q u a l i f i e d committed b e g i n , i n the f a l l , w i t h a  " p r o f e s s i o n a l " approach t o what c h a r a c t e r i s t i c s a p h y s i c i a n s h o u l d have.  F u r t h e r , t h e i r f i r s t two c h o i c e s remain c o n s t a n t .  The t h i r d and f o u r t h c h o i c e s , i n the s p r i n g , a r e , l i k e  the  c h o i c e s o f the u n c o n d i t i o n a l l y committed, i n terms o f the p r e sent r a t h e r than the f u t u r e .  I t seems r e a l i t y takes over.  a g a i n , the q u a l i f i e d committed appear t o be more c o n s i s t e n t than the u n c o n d i t i o n a l l y committed.  Once  Q u a l i f i e d Changers (only career) Fall  U n c o n d i t i o n a l Changers (one of s e v e r a l c a r e e r s ) Spring  Fall 1. Warm,pleasing personality  Warm,pleasi n g personality  2.  Dedication  1.  Dedication  Integrity  2.  Integrity  A b i l i t y to get along w i t h others  3. A b i l i t y t o get a l o n g with others  Spring  Warm,pleasing personality  4. Warm,pleasing personality The u n c o n d i t i o n a l changers (one of s e v e r a l c a r e e r s ) a p p a r e n t l y see good p e r s o n a l r e l a t i o n s as the most  important  c h a r a c t e r i s t i c i n the make-up of a good p h y s i c i a n .  By s p r i n g ,  they s t i l l h o l d t h e i r c o n v i c t i o n but have added another component:  dedication.  T h i s group i s the o n l y one t h a t becomes  more " i d e a l i s t i c " r a t h e r than l e s s .  Those who  change t o become  "more" committed t o m e d i c i n e as a c a r e e r have a tendency t o express  s a t i s f a c t i o n w i t h a l l f a c e t s of a m e d i c a l  c a r e e r . They  are l e s s d i s c r i m i n a t i n g i n t h i s r e g a r d than t h e i r p e e r s .  The  q u a l i f i e d changers ( o n l y c a r e e r ) l o s e a component i n the makeup of a good p h y s i c i a n i n the p r o c e s s . " d e d i c a t i o n to medicine" whereas i t was  i s completely  the most i m p o r t a n t  The  importance o f  absent i n the s p r i n g ,  c h a r a c t e r i s t i c i n the  fall.  T h i s group has l o s t i n i d e a l i s m , w h i l e the o t h e r change group has  gained. I n the f o r e g o i n g , the c o n d i t i o n a l student a l i g n s  h i m s e l f w i t h the q u a l i f i e d committed.  The u n c o n d i t i o n a l change  91  student  ( n o t t h e most s a t i s f y i n g c a r e e r I can t h i n k o f ) a l i g n s  w i t h t h e o t h e r u n c o n d i t i o n a l change group. student  The q u a l i f i e d change  ( n o t t h e most s a t i s f y i n g c a r e e r I can t h i n k o f ) a l i g n s  w i t h t h e o t h e r q u a l i f i e d change group. The s t u d e n t s xvere a l s o asked w h i c h o f t h e above mentioned c h a r a c t e r i s t i c s they considered  t o be more i m p o r t a n t  men t h a n t o o t h e r p r o f e s s i o n a l s .  Fewer s t u d e n t s  question i n the s p r i n g than i n the f a l l .  t o medical  answered t h i s  The f o u r  character-  i s t i c s most o f t e n i n d i c a t e d were: Fall  Spring  D e d i c a t i o n t o medicine  4 4 . 0 (22)  4 2 . 0 (21)  R e c o g n i t i o n o f own l i m i t a t i o n s  3^.0 (19)  3 6 . 0 (18")  A b i l i t y t o g e t along w i t h people  3 4 . 0 (17)  28.0 ( 1 4 )  Warm and p l e a s i n g p e r s o n a l i t y  1 4 . 0 ( 7)  12.0 ( 6)  The n e c e s s i t y o f s p e c i a l c h a r a c t e r i s t i c s f o r t h e medical  p r o f e s s i o n decreases s l i g h t l y i n a l l categories  the f i r s t y e a r i n m e d i c a l  school.  more l i k e o t h e r p r o f e s s i o n s .  The s t u d e n t s  during  see m e d i c i n e as  T h i s was r e f e r r e d t o e a r l i e r .  T h i s type o f r e a c t i o n i n l e a r n i n g , i n t h i s case, i s l i k e l y t o come f r o m a c o m b i n a t i o n o f two sources:  1.  devaluation of  something ( m e d i c a l t r a i n i n g ) one i s d i s a p p o i n t e d not meet p r e c o n c e p t i o n s  - and 2.  a l l p r o f e s s i o n s , e n t a i l s hard,  i n - i t does  r e a l i t y t h a t medicine, l i k e  r o u t i n e s l u g g i n g as w e l l as  exciting, stimulating material. A t a b u l a t i o n o f the twelve  c h a r a c t e r i s t i c s most im-  portant i n making a good p h y s i c i a n ( l i s t e d on page BB) was made  a l s o t o determine  which o f t h e s e c h a r a c t e r i s t i c s were c o n s i d e r e d  t o be o f " l i t t l e importance" by t h e s t u d e n t s i n t h e making o f a good p h y s i c i a n .  Throughout t h e q u e s t i o n n a i r e s , no s t u d e n t  takes a c o n s i s t e n t l y  n e g a t i v e approach by marking t h e most  n e g a t i v e s e l e c t i o n i n every q u e s t i o n .  I n f a c t , i t seems more  l i k e l y from t h e q u e s t i o n n a i r e s t h a t , i f t h i s sample was "not sure'' o f how t h e y wanted t o answer a q u e s t i o n , they took the m i d d l e ground. i n approach. noteworthy.  T h i s sample i s much more p o s i t i v e t h a n n e g a t i v e T h e r e f o r e , n e g a t i v e e x p r e s s i o n s o f any s i z e a r e  The f i v e c h a r a c t e r i s t i c s  " l i t t l e importance"  c o n s i d e r e d t o be o f  t o t h i s sample were: Spring  Fall Research Scientific  ability curiosity  S k i l l f u l management o f time Good appearance G e t t i n g r e a l enjoyment out o f m e d i c i n e  48.0  (24)  68.0  (34)  26.0  (13)  12.0  ( 6)  8.0  ( 4)  1 8 . 0 ( 9)  1 0 . 0 ( 5)  1 2 . 0 ( 6)  8.0  ( 4)  6 . 0 ( 3)  I n t h e s p r i n g more than f i f t y p e r cent o f every commitment group c o n s i d e r r e s e a r c h a b i l i t y t o be o f l i t t l e i n t h e make-up o f a good m e d i c a l p r a c t i t i o n e r .  importance  Perhaps t h i s i s  because t h e m a j o r i t y o f s t u d e n t s a s s o c i a t e " r e s e a r c h " w i t h a l a b o r a t o r y and f u l l - t i m e employment.  This i s c e r t a i n l y a  q u e s t i o n t h a t s h o u l d be asked a g a i n d u r i n g t h e t r a i n i n g y e a r s . I t would be i n t e r e s t i n g t o know i f , and when, t h e s t u d e n t s f e e l ''research'' i s p a r t o f t h e m e d i c a l d o c t o r ' s r e g u l a r r o u t i n e . I t would a l s o be i n t e r e s t i n g t o know i f , and when, as p r a c t i t i o n e r s  t h e y drop t h i s " f r i l l " .  The l a c k o f s c i e n t i f i c c u r i o s i t y can  l i k e l y be r e g a r d e d i n the same l i g h t as the c o n s i d e r a t i o n o f "research a b i l i t y " . It  i s t h e u n c o n d i t i o n a l l y committed  who c o n s i d e r  n e i t h e r t h e " s k i l l f u l management o f t i m e " n o r "good to  be i m p o r t a n t .  appearance"  F o r " g e t t i n g r e a l enjoyment o u t o f m e d i c i n e "  t h e r e i s no c o n c e n t r a t i o n by commitment group; each b e i n g from a d i f f e r e n t commitment group.  response  G e n e r a l l y , t h e nega-  t i v e responses a r e i n t e r e s t i n g f o r t h e c l a s s * a t t i t u d e , b u t t h e y are n o t s i g n i f i c a n t by commitment group. Summarizing the sample's c o n c e p t i o n s o f medicine as a c a r e e r , i n g e n e r a l , they c o n s i d e r medicine t o be b e s t d e s c r i b e d as f i r s t , a p r o f e s s i o n o f s e r v i c e t o the community, a p r o f e s s i o n which h e l p s i n d i v i d u a l s d i r e c t l y .  and second,  I"he percentage  d i s t r i b u t i o n o f s t u d e n t s ' responses t o t h i s q u e s t i o n i s c o n s t a n t for  f a l l and s p r i n g .  However, h a l f t h e s t u d e n t s make a d i f f e r e n t  response i n t h e s p r i n g than t h e y do i n t h e f a l l .  Proportionately,  the commitment changers g i v e d i f f e r e n t answers i n t h e s p r i n g than i n t h e f a l l t w i c e as o f t e n as t h e non-changers. The sample c o n s i d e r s t h e l e a s t a p p r o p r i a t e d e s c r i p t i o n of  t h e m e d i c a l p r o f e s s i o n t o be:"A p r o f e s s i o n w h i c h i s s e c u r e  and l u c r a t i v e . "  The a s p e c t s o f a m e d i c a l c a r e e r t h e sample  t h i n k s they w i l l l i k e best are:  being able t o help other people,  the c h a l l e n g i n g and s t i m u l a t i n g n a t u r e o f t h e work, and b e i n g able t o d e a l d i r e c t l y w i t h people.  The importance p l a c e d on  t h e s e t h r e e a s p e c t s d i f f e r s by commitment group;  the  u n c o n d i t i o n a l l y committed emphasizing  a l t r u i s m , while the  q u a l i f i e d committed emphasize t h e work o f a d o c t o r . The c h a r a c t e r i s t i c s c o n s i d e r e d t o be most i m p o r t a n t i n the make-up o f a good p h y s i c i a n v a r y w i t h the f a l l and the spring.  I n the f a l l " d e d i c a t i o n " and " s c i e n t i f i c  are r a t e d as t h e most i m p o r t a n t .  curiosity"  I n the s p r i n g , " a b i l i t y t o  t h i n k i n an o r g a n i z e d way" and " a b i l i t y t o g e t a l o n g w i t h p e o p l e " a r e c o n s i d e r e d t o be most i m p o r t a n t . emphasis v a r i e s by commitment group.  Again, the  "Research  ability" i s  c o n s i d e r e d t o be t h e l e a s t i m p o r t a n t c h a r a c t e r i s t i c o f those listed.  CHAPTER V I I FACTORS IN SOCIALIZATION  From the foregoing chapters i t i s apparent that the f i r s t year medical students' conceptions and d i r e c t i o n of change d i f f e r according to t h e i r expressed degree of commitment. What happened w i t h i n the process of medical s o c i a l i z a t i o n t o f i r s t year medical students to e f f e c t t h i s change? According to the theory of s o c i a l i z a t i o n p r e v i o u s l y o u t l i n e d there are a t l e a s t three major f a c t o r s which i n f l u e n c e the process of s o c i a l ization:  the teachers or r e p r e s e n t a t i v e s of the superordinate  system i n t o which the neophytes are t o be s o c i a l i z e d - i n t h i s case the medical f a c u l t y ;  the members of the subordinate  system who are to be s o c i a l i z e d - the f i r s t year medical students and the i n d i v i d u a l selves who make up the subordinate system. The t h i r d f a c t o r i s important i n r e l a t i o n to the f i r s t two i n socialization.  That i s , i t i s important how each s e l f sees  himself i n r e l a t i o n to h i s superiors - the f a c u l t y - and i n r e l a t i o n to h i s peers - the other members of the f i r s t year medical class of 1959-1960. Faculty Unfortunately, the f i r s t year medical students were asked very few questions w i t h regard to t h e i r teachers; and how they were r e a c t i n g to the a c t u a l l e a r n i n g process.  Of  course, these kinds of questions are d i f f i c u l t t o ask i n a manner which w i l l e l i c i t meaningful answers, because students are very much aware that the persons they are asked to assess  96  are the very same people who give them t h e i r grades.  Students  see l i n e s o f communication between a u t h o r i t i e s everywhere.  They  are not anxious t o "cut t h e i r own t h r o a t s " by t e l l i n g one set of a u t h o r i t i e s f a c t s , which another set of a u t h o r i t i e s could "use against them", i f they had the information.  The question-  n a i r e given to the sample d i d not overcome t h i s d i f f i c u l t y . I n the area of teacher-student mation.  r e l a t i o n s there i s l i t t l e i n f o r -  There was one question, however, where the students  were asked whether or not the f a c u l t y gave them s u f f i c i e n t d i r e c t i o n f o r t h e i r studying. TABLE XVII:  PERCENTAGE DISTRIBUTION OF FIRST YEAR MEDICAL STUDENTS' OPINIONS AS TO WHETHER THE FACULTY GIVES MEDICAL STUDENTS ENOUGH DIRECTION IN WHAT TO EMPHASIZE IN THEIR STUDYING.  Commitment Group  Unconditional Qualified Conditional Q u a l i f i e d Change;' (only c a r e e r !  Right Too l i t t l e More than direction amount enough F a l l s p r i n g r a n spring r a n spring 11.1 ( 3)  37.0 (10)  88.8  —  3.7 (1)  —  (24)  59.2 (16)  —  25.0 ( 2)  75.0 ( 6)  75.0 ( 6)  —  —  —  50.0 ( 4)  75.0 ( 6)  -25.0 ( 2)  100.0 100.0 ( 1) ( 1) 50.0 ( 4)  25.0 ( 2)  Unconditional Change (not most s a t i s f y ing career) (One o f several)  No answer F a l l Spring  25.0 ( 1)  Q u a l i f i e d Change (not most s a t i s - 1 0 0 . C f y i n g career) ( 1)  50.0 ( 2)  -  r  50.0 ( 2)  100.0 ( 1)  100.0 (1)  25.0 ( 1)  25.0 (1)  100.0 ( 1)  —  —  25.0 ( 1)  Twenty students - f o r t y per cent of the sample express d i s s a t i s f a c t i o n w i t h the amount of f a c u l t y d i r e c t i o n they r e c e i v e .  Nineteen students - t h i r t y - e i g h t per cent -  think they should receive more d i r e c t i o n .  Of these nineteen  students, seventeen - t h i r t y - f o u r per cent - make t h i s statement i n the spring (seven students - fourteen per cent - of these seventeen students make the same statement f a l l and s p r i n g ) . The one student who s t a t e s , i n the s p r i n g , that the f a c u l t y gives "too much d i r e c t i o n " i s a woman. Although over one t h i r d of the sample - w i t h representatives from each commitment group - f e e l they receive too l i t t l e d i r e c t i o n from the f a c u l t y , t h i s question does not g i v e any answers to the question:  Can any patterns of change be  traced to the f a c u l t y ? This question does, however, again i n d i c a t e that the u n c o n d i t i o n a l l y committed are the most consistent of a l l groups i n responses.  The s e v e n t y - f i v e per cent of that group  who states that the f a c u l t y gives the " r i g h t amount" of d i r e c t i o n to students i n the f a l l , i s the same s e v e n t y - f i v e per cent who places i t s e l f i n that group i n the s p r i n g , except f o r one student. is  The movement i n the other commitment groups  diverse.  Peers There i s a wide s o c i o l o g i c a l l i t e r a t u r e on the comp o s i t i o n and f u n c t i o n i n g of small groups.33 i t i s assumed i n 33  Hare, P a u l ; Edgar Borgatta and Robert F. Bales, Small  t h i s t h e s i s that the phenomena of group sanction, c o n t r o l , norms, s e l e c t i o n , r e j e c t i o n , support, and s a t i s f a c t i o n e x i s t and operate w i t h i n the " s m a l l " group being studied here - the f i r s t year students of medicine.  They are considered to  be a small group because over the school term they have had sustained face-t'o-rface contact w i t h one another.  They have  worked together - i s o l a t e d from students of other d i s c i p l i n e s who conceivably could d i v e r t the l o y a l t i e s of members of the medical c l a s s .  They play f o o t b a l l together during t h e i r lunch  hours, and together they plan the major y e a r l y s o c i a l outing of a l l medical students - the Med B a l l .  This r e g u l a r , sus-  t a i n e d , and e x c l u s i v e grouping c l a s s i f i e s the medical class as a small group. small.  I n a c t u a l number, a l s o , they are r e l a t i v e l y  The students, presumably, are given i d e n t i c a l s t i m u l i  to l e a r n - they have the same teachers, the same classrooms, the same subject m a t e r i a l .  An e f f o r t was made to discover  why some students change t h e i r mind about how they f e e l about a career i n medicine and some do not.  I f the students are  exposed to the same s i t u a t i o n s a f t e r entering medical•school, but r e a c t d i f f e r e n t l y , they must experience the s i t u a t i o n s d i f f e r e n t l y i n some - or many - respects. Studies of small groups have shown that members of the group exert considerable e f f e c t on t h e i r peers.  I n some  instances they can "make or break" a member of t h e i r group by  Groups, New York, Knopf, 1955, i s a good source book c o n t a i n i n both t h e o r e t i c a l and experimental work.  t h e i r attitude  o r by t h e i r overt or covert actions toward him.  In a l e a r n i n g s i t u a t i o n , p a r t i c u l a r l y i n our s o c i e t y where performance of a high c a l i b e r - winning - i s rewarded and given much approval, candidates often regard each other, not as peers s t r u g g l i n g toward the same g o a l , but as adversaries.  Students  were asked questions t o determine to what extent the sample found "competitiveness" among t h e i r classmates and whether or not t h i s v a r i e d by commitment group.  TABLE X V I I I :  PERCENTAGE DISTRIBUTION OF HOW MUCH COMPETITIVENESS FIRST YEAR MEDICAL STUDENTS FOUND AMONG THEIR CLASSMATES IN MEDICAL-SCHOOL. -  Commitment Group  Great deal o r f a i r amount  L i t t l e o r none  Fall  Spring  Unconditional  AS.2 (13)  73.1 (20)  51.9 (14)  26.9 (7)  Qualified  62.5 (5)  87.5 (9)  37.5 (3)  12.5 (1)  —  100.0 (1)  100.0 (1)  —  Q u a l i f i e d Change (only career)  37.5 (3)  100.0  —  (8)  62.5 (5)  Unconditional Change (one o f s e v e r a l careers)  50.0 (2)  100.0 (4)  50.0 (2)  —  —  100.0 (1)  100.0 (1)  —  —  —  100.0 (1)  100.0 (1)  Conditional  (not most s a t i s f y i n g career) Q u a l i f i e d Change (not most s a t i s f y i n g career)  Fall  Spring  There i s a general increase i n the amount of competition experienced i n the s p r i n g as contrasted to the f a l l , f o r a l l commitment groups.  However, proportinnat  l y , the changers experienced more competition i n the spring although they had experienced l e s s competition i n the f a l l , than the non-changers.  The range of the changers'  movement i s greater than the movement o f the non-changers. Further, i n the spring, there i s only one changer who s t a t e s he has experienced " l i t t l e competition" from his  classmates.  This i s the student who placed f i r s t i n  the f i r s t year medicine c l a s s .  Change or non-change  of commitment makes a d i f f e r e n c e i n the amount of competition experienced by students. Although the students state t h a t they experience a f a i r amount of competition among t h e i r classmates, they a l s o s t a t e that they have found that the students help one another.  TABLE XIX: PERCENTAGE DISTRIBUTION CF THE HELPFULNESS THE FIRST YEAR MEDICAL STUDENTS EXPERIENCED FROM ONE ANOTHER. Commitment Group  Not Much  No Answer  Fall  Spring  F a l l Spring  88.8 (24)  3.7 (1)  11.1 (3)  7.4 (2)  62.5  —  25.0 (2)  —  F a i r Amount  F a l l Spring Unconditional  88.8 (24)  100.0  Qualified  (8)  Conditional  —  (5)  100.0 (1)  100.0 (1)  Q u a l i f i e d Change (only career)  87.5 (7)  75.0 (6)  12.5 (1)  25.0 (2)  Unconditional Change (one of several)  75.0 (3)  50.0 (2)  . 25.0 (1)  50.0 (2)  U n c o n d i t i o n a l Change 100.0 (not most s a t i s (1) f y i n g career)  100.0 (1)  100.0 (1)  100.0 (1)  Q u a l i f i e d Change (not most s a t i s f y i n g career)  —  12.5 (1)  --  —  —  —  The great m a j o r i t y of students consider t h e i r classmates to help one another a f a i r amount - e i g h t y - e i g h t per cent of the sample i n the f a l l (eight per cent r e p l i e d i n the negative, four per cent d i d not answer) and eighty per cent i n the s p r i n g (eighteen per cent r e p l i e d i n the negative, two per cent d i d not answer).  The m a j o r i t y of  each commitment group think students help one another a f a i r amount.  However, each commitment group has two or three  students who r e p l y i n the negative i n the s p r i n g except f o r those three students whose i n i t i a l commitment was that medicine was "not the most s a t i s f y i n g career" they could t h i n k o f . Except f o r t h i s group of three students, the remaining f o u r commitment groups each i n d i c a t e an increase i n the percentage of those students who, by s p r i n g , state that they do not think the f i r s t year medical students help each other much.  The i n d i v i d u a l change i n p o s i t i o n i s f o r  the most p a r t , i n one d i r e c t i o n :  from s t a t i n g students  help each other a " f a i r amount" to s t a t i n g "not much" help i s given by students to one another.  That i s , w i t h i n  the commitment groups the answers remain constant or move i n the one d i r e c t i o n .  There i s not a great deal o f  switching from one category t o the other. Although t h i s p a t t e r n of l e s s endorsement toward one's peers i s evident i n the s p r i n g , the m a j o r i t y of students s t i l l i n d i c a t e that they t h i n k students are h e l p f u l one toward another.  This i s an i n d i c a t i o n that the sample's  esprit-de-corps i s g e n e r a l l y h i g h .  I t i s a l s o evident t h a t i t  i s p r o p o r t i o n a t e l y highest i n the u n c o n d i t i o n a l l y committed group.  The l e s s e n t h u s i a s t i c s p r i n g response might be  c o r r e l a t e d w i t h the pervasive theme that runs through the m a j o r i t y of the s p r i n g responses: the students are l e s s enthused i n almost a l l areas they were questionned  about.  I t seems as though they are somewhat "disenchanted" w i t h "the whole world". What seems to be a c o n t r a d i c t i o n appears upon examination of the responses t o the l a s t two questions:  103  "How  much competitiveness have you found among your classmates?"  and "To what extent do you t h i n k f i r s t year students help each other?"  The students express f e e l i n g s that they have experienced  both a great d e a l of competition and a f a i r amount of help from t h e i r classmates.  These two c o n d i t i o n s are u s u a l l y regarded as  mutually e x c l u s i v e i n American s o c i e t y .  I t i s not expected  that adversaries - competitors - "help" one another. tor  A competi-  i s not expected to give away h i s price-copping secrets and  thereby a i d h i s adversary to "beat" him. I t i s suggested t h a t i n the case.'of the f i r s t year medical students, although they f i n d one another competitive, they do not regard one another i n the f i r s t instance as compet i t o r s . The two above-mentioned questions need to be examined along w i t h a former question, where students ranked the importance of 1.  f e l l o w students' comments, 2 .  information from the  f a c u l t y , and 3 . personal s e l f - e v a l u a t i o n i n determining how w e l l they were doing.  This question i n d i c a t e s that the m a j o r i t y  of students consider themselves as the most s i g n i f i c a n t estimat o r s of how they are performing as medical students. upon t h e i r own judgment;  they assess themselves.  They r e l y  They are  most i n t e r e s t e d i n - and regard i t as most s i g n i f i c a n t - how w e l l they are doing i n t h e i r own e s t i m a t i o n . This would seem to i n d i c a t e that medical students do not d i r e c t t h e i r competit i o n against one another but t u r n i t back upon themselves. That i s , the f i r s t year medical student i s not so  concerned  how he does i n r e l a t i o n to other medical students as he i s concerned how w e l l he does i n comparison to how w e l l he t h i n k s  he should do. Competition becomes more personal.  A smaller  proportion of one's competitive d r i v e i s d i r e c t e d toward keeping up or g e t t i n g ahead of others.  A l a r g e r proportion i s  concentrated on achieving the standard one has set f o r oneself, whether i t be to "make" s i x t y - f i v e per cent or get over eighty per cent i n one's f i n a l examination mark. I n t h i s way students experience a competitive atmosphere i n the medical school - students are t r y i n g hard to beat ( or obtain) a c e r t a i n standard.  They can also regard one another  as " h e l p f u l " when they do not have to "hoard" s p e c i a l knowledge but can share i t .  I n f a c t , the students have a common adver-  sary - a s e l f - s e t t a r g e t .  This, along with the knowledge that  there i s "room" i n t h e i r c l a s s f o r them a l l - no one has to be dropped i n order to keep w i t h i n a quota - (that was done the previous year) t h e i r close a s s o c i a t i o n , and common occupational g o a l produces a high esprit-de-corps among the students during t h e i r medical school years. Competition American s o c i e t y i s assumed to regard  "competitive-  33 ness'' and "success" as major values.  These are often con-  sidered to be " l e v e r s " i n the s o c i a l i z a t i o n process employed to spur s o c i a l i z e e s to t r y harder.  There are greater '^rewards"  given f o r being " f i r s t " or "best" than there are f o r being last".  As the sample i n d i c a t e d that they had experienced  a  competitive l e a r n i n g atmosphere i n t h e i r f i r s t year of medical school, and to t e s t the explanation drawn above, t h e i r a t t i t u d e toward t h i s point was pursued. 33 Robin W i l l i a m s , American Society, New York, Knopf, pp. 388-442.  1957,  TABLE XX: PERCENTAGE DISTRIBUTION OF FIRST YEAR MEDICAL STUDENTS' FEELINGS ABOUT COMPETING WITH OTHER PEOPLE FOR HIGH STAKES, BY COMMITMENT GROUP. Commitment Group  Dislike., i t  Neutral  Enjoy i t  F a l l Spring  F a l l Spring  F a l l Spring  Unconditional  29.6  18.5  11.1  29.6  59.2  51.8  Qualified  62.5  12.5  —  25.0  37.5  62.5  .  —  100.0  Conditional Q u a l i f i e d Change (only career;  100.0  —  —  50.0  25.0  37.5  50.0  12.5  25.0  Unconditional Change 25.0 (one of several)  25.0  50.0  25.0  25.0  50.0  ...  —  —  --  —  —  (not most s a t i s f y i n g career) Q u a l i f i e d Change (not most s a t i s f y i n g career)  100.0 100.0  100.0 100.0 —  TABLE XXI: PERCENTAGE DISTRIBUTION OF CHANGE IN SAMPLE'S FEELINGS ABOUT COMPETITION. Description Dislike  competition  Fall  Spring  38.0 (19)  18.0 ( 9)  Neutral  18.0 ( 9)  34.0 (17)  Enjoy  44.0 (22)  48.0 (24)  100.0 (50)  100.0 (50)  Competition  106  There i s a trend f o r the students to f e e l l e s s negative toward competition i n the s p r i n g than they d i d i n the f a l l . S t i l l , p r o p o r t i o n a t e l y , the non-changers "enjoy" competition more than the changers, both i n the f a l l and i n the s p r i n g . There i s a s i g n i f i c a n t amount of change on the part of i n d i v i d u a l s on the above question between f a l l and s p r i n g . The p a t t e r n of change i s not s i g n i f i c a n t by commitment group. One p a t t e r n of constancy does emerge however.  Those persons  who enjoyed competitive s i t u a t i o n s i n the f a l l - except f o r four students - a l s o enjoyed them i n the s p r i n g .  Regardless  of commitment, i f a student f e l t at home i n a competitive s i t u a t i o n i n the f a l l , he was l i k e l y to f e e l s i m i l a r l y i n the spring.  Those students who f e l t d i s l i k e or n e u t r a l i t y with  regard to competitive s i t u a t i o n s i n the f a l l were l i k e l y t o . give a d i f f e r e n t response i n the s p r i n g , although there i s no apparent p a t t e r n to which of the other categories these students would switch t o . Although commitment group can t e l l us l i t t l e about competition, f o r t h i s sample, those persons who remain constant i n t h e i r commitment, l i k e competition b e t t e r than those who do not remain constant i n t h e i r stated degree of commitment to a medical career. In a f u r t h e r attempt to determine the e f f e c t , i f any, of a'bompetitive" atmosphere on the sample, the students were grouped according to t h e i r f a l l and spring statements pert a i n i n g to competition.  TABLE XXII:  PERCENTAGE DISTRIBUTION OF FIRST YEAR MEDICAL STUDENTS ACCORDING TO THEIR FEELINGS ABOUT COMPETING WITH OTHER PEOPLE FOR HIGH STAKES, FALL AND SPRING.  F a l l Statement  Spring Statement  Like i t  Like i t  36.0  (18)  Don't l i k e i t  Don't l i k e i t  13.0  ( 9)  Neutral  Neutral  10.0  ( 5)  Don't l i k e i t  Neutral  14.0  ( 7)  Don't l i k e i t  Like i t  6.0  ( 3)  Like i t  Neutral  3.0  ( 4)  Neutral  Like i t  6.0  ( 3)  Neutral  Don't l i k e i t  2.0  ( 1)  Per Cent of Sample  100.0  (50)  A l i t t l e over one t h i r d of the c l a s s state they " l i k e " competition i n the f a l l , and, again, i n the s p r i n g .  Of t h i s  t h i r t y - s i x per cent, fourteen per cent come from the lower c l a s s socio-economic group.  This i s f i f t y - f o u r per cent (seven) of  the e n t i r e representation ( t h i r t e e n ) i n the sample from the lower c l a s s e s . The twenty-two per cent of the students who  "like"  competition and come from the upper c l a s s e s , represent per cent of t h e i r e n t i r e group ( t h i r t y - s e v e n students).  29.7 Pro-  p o r t i o n a l l y , t h i s i s h a l f as many as the lower socio-economic group.  Where t h i s "competitive" s p i r i t came from and how i t  has aided the students i n t h e i r career ambitions i s f o r speculation. The only other expression of a t t i t u d e s toward competition of any magnitude was from those students who s t a t e d , f a l l and s p r i n g , t h a t they "don't l i k e " competitive s i t u a t i o n s . Eighteen per cent of the students made t h i s statement. one student i n t h i s group was from the lower class mic group.  Only  socio-econo-  The remaining students represent 21.6 per cent  (eight) of the upper class socio-economic seven students.  group of t h i r t y -  As can be seen from the t a b l e , the other s t u -  dents are d i v e r s i f i e d i n t h e i r combinations of f a l l and s p r i n g feelings. Taking the age of the sample i n the f a l l of 1959, those students who have " n e u t r a l " f e e l i n g s w i t h regard to comp e t i t i o n are the o l d e s t group. six  years.  Their average age i s twenty-  The other groups are a l l under twenty-four years,  ranging up from eighteen years.  The four students who  begin  i n the f a l l with " n e u t r a l " f e e l i n g s about competition and change to another group by the s p r i n g are the youngest.  They  average about nineteen and one h a l f years, while a l l other groups, excluding the o l d e s t group, average twenty-three  years  of age. I t would seem that age of the s o c i a l i z e e and h i s socio-economic  background could  be f a c t o r s i n the a t t i t u d e s  held about competition. However, to r e t u r n to the e f f e c t of these f e e l i n g s upon l e a r n i n g , i n the case of the sample, these f a c t s , although  i n t e r e s t i n g , a r r i v e nowhere as f a r as c o n t r i b u t i n g to the s o l u t i o n of questions surrounding the s o c i a l i z a t i o n process. L i t t l e could be discovered from the a v a i l a b l e data regarding the part played by the recognized agents of s o c i a l i z a t i o n ; i n t h i s case, the medical f a c u l t y .  Seventy-two per cent  i n the f a l l and sixty-two per cent of the sample i n the s p r i n g took the middle road and s t a t e d that they received the " r i g h t " amount of d i r e c t i o n from t h e i r teachers. The students i n d i c a t e d t h a t they had experienced a competitive atmosphere i n f i r s t year medical school, but they regard t h e i r peers as helpmates.  Together w i t h data presented  i n a former s e c t i o n , t h i s would i n d i c a t e that students do not p r i m a r i l y regard one another as competitors. competes w i t h h i m s e l f .  U s u a l l y , a student  This r e s u l t s i n a "competitive* atmosphe  as students are t r y i n g t o b e a t rt  !l  a s e l f - s e t g o a l , w h i l e , at the  same time, a high esprit-de-corps i s developed through sustained contact and support from one  another.  The combined f a l l and spring statements p e r t a i n i n g to a t t i t u d e s toward competition are d i v e r s i f i e d .  I f the above  conclusions are accurate, i t would appear, at t h i s time, t h a t students are not too concerned  about competition i n the u s u a l  sense of p i t t i n g oneself against others.  CHAPTER V I I I DEGREE OF COMMITMENT AND PATTERNS OF CHANGE  Regardless of expressed commitment, f o r t h i s sample there i s a notable change i n f e e l i n g i n some areas between the f a l l and s p r i n g questionnaire. In p a r t i c u l a r , there i s a decrease  i n the expressions of how d i f f e r e n t and unique  medicine i s , compared to other p r o f e s s i o n s . By the s p r i n g of I960, the p r o f e s s i o n i s considered to be more " l i k e ' other 1  professions and l e s s " s p e c i a l " .  There i s an increase i n the  number of negative responses to questions i n the questionnaire, i n d i c a t i n g increased c r i t i c i s m on the part of the students. They f i n d more f a u l t w i t h t h e i r environment.  At the same time,  there i s a change of emphasis of what i s important to the medical student.  The emphasis switches from a focus on  " d e d i c a t i o n " to the p r o f e s s i o n to a focus on the work at hand - g e t t i n g through medical school.  At t h i s point i t seems  that many of the students suspend the ' I d e a l i s t i c " a t t i t u d e s they have h e l d regarding medicine and t u r n to the more press i n g , p r a c t i c a l matters which have to be d e a l t with irnmediately.  Whether or not the " i d e a l i s t i c " focus i s ever  picked up again, or i f i t i s permanently put to one s i d e , or l o s t e n t i r e l y , i s beyond the scope of t h i s t h e s i s .  34 S i g n i f i c a n t l y , as stated p r e v i o u s l y , the q u a l i f i e d change group does lose the component of d e d i c a t i o n i n i t s s t a t e ment of the important c h a r a c t e r i s t i c s of a medical man. 35 The M.A. t h e s i s of Y. Chang, now i n preparation f o r the Department of Anthropology and Sociology, U n i v e r s i t y of  Although there i s a general "change" on the part of the sample, there i s a d i f f e r e n t i a l change by commitment groups. Looking f i r s t at the students w i t h respect to whether or not they changed t h e i r expressed degree of commitment between the f a l l of 1959  and the spring of I 9 6 0 , i t i s apparent from the  foregoing chapters that those students who change i n t h e i r expression of commitment also tend to change more often i n t h e i r responses to other questions than do the non-changers.  The  changers are more i n c o n s i s t e n t i n t h e i r answers than the nonchangers.  They are l e s s c e r t a i n .  They i n d i c a t e that they are  i n a g r e a t e r s t a t e of d i s e q u i l i b r i u m than the  non-changers.  Seventy-two per cent ( t h i r y - s i x students) of the sample do not change t h e i r expression of commitment to a career i n medicine between f a l l and s p r i n g .  This represents 67*5  per cent of the upper c l a s s group and 84.7 per cent of the lower c l a s s group.  Twenty-eight per cent (fourteen students)  do change t h e i r expression of commitment to a career i n medicine between the f a l l and s p r i n g .  They represent 32.5  cent of the upper c l a s s group and 15.3 c l a s s group.  per  per cent of the lower  I n t h i s sample the changers were more apt to  be from the upper c l a s s group than from the lower c l a s s , and younger i n years at the time of entry i n t o the medical school than those i n the commitment group they aligned themselves with i n the f a l l who d i d not change. B r i t i s h Columbia, focuses on t h i s l o s s of i d e a l i s m , which he c a l l s " r e a l i s t i c d i s i l l u s i o n m e n t " . Howard S. Becker and Blanche Geer, "The Fate of I d e a l i s m i n Medical School", American Sociol o g i c a l Review, V o l . 23, No.l, Feb. 1958, pp. 50-56, w r i t e t h a t medical students change t h e i r mind about which matters they define as appropriate to receive t h e i r i d e a l i s m .  The devaluation or d e c l i n e of i d e a l i s m surrounding the  medical career has been r e f e r r e d to above.  However, the  changers are more p e s s i m i s t i c and more negative toward medicine i n the s p r i n g than the non-changers.  The m a j o r i t y of the  changers expect t o have more t r o u b l e " l e a r n i n g what i s expected" of them than the non-changers.  They a l s o experience more  anxiety regarding t h e i r future career, l e a r n i n g t o think f o r themselves and t r y i n g not t o become overly tense. l e s s "decided" about the f u t u r e :  They a r e  the s p e c i a l t y they would  l i k e t o enter, the kind of work environment they would p r e f e r . I n t e r e s t i n g l y , they expect t o earn a higher income than do the  non-changers. With regard t o competition, i n the f a l l , the changers  experienced l e s s than the non-changers. the  However, by spring  changers experienced more than the non-changers, who also  had experienced more than they d i d i n the f a l l .  This means  that the changers' movement was comparatively g r e a t e r .  In  a d d i t i o n , the changers i n d i c a t e d that they enjoyed competition to  a l e s s e r extent than the non-changers.  I n a c t u a l achieve-  ment, the changers d i d not perform as w e l l as the non-changers. However, i t i s noteworthy that the change group that became more committed d i d not have a f a i l u r e , while the change group that became l e s s committed p r o p o r t i o n a t e l y had the greatest number o f f a i l u r e s .  Although both groups were changing more  r a p i d l y than the non-change groups, and presumably experiencing greater d i s o r g a n i z a t i o n and s t r e s s , t h e i r r e s u l t s were quite  different.  P r o p o r t i o n a t e l y , the non-change groups shared  the "better than average" honours. I t i s evident t h a t , i n t h i s sample,those students who change i n t h e i r degree of commitment to a career i n medicine, are also more anxious and l e s s secure i n t h e i r convictions and ideas about a medical career. A l l l e a r n e r s experience s t r e s s but r e l a t i v e l y the changers experience more s t r e s s w i t h i n t h i s s o c i a l i z a t i o n experience than the  non-changers.  Non-change: Degree of Commitment: "Only career that could s a t i s f y me" - The U n c o n d i t i o n a l l y Committed. This group of students, f i f t y - f o u r per cent of the sample, (twenty-seven students) which i s n u m e r i c a l l y the l a r g e s t commitment group, i s characterized by a wholehearted and p o s i t i v e approach to the future when compared to the other commitment groups. The u n c o n d i t i o n a l l y committed made t h e i r " f i n a l d e c i s i o n " to study medicine at an e a r l i e r age than the other groups.  They see medicine as being more d i f f e r e n t and set  apart from other careers than do t h e i r peers. career choices are the most s t a b l e ; they l i k e l e a s t .  Their future  as are the s p e c i a l t i e s  This group would seem to have the strongest  i d e n t i f i c a t i o n with the p r o f e s s i o n of medicine. seem to be the most s e l f - c o n f i d e n t :  They also  the m a j o r i t y of t h i s group  do not expect to have t r o u b l e keeping themselves from becoming o v e r l y tense and they can p i c t u r e themselves as doctors e a r l i e r than can t h e i r classmates.  P r o p o r t i o n a l l y more of the u n c o n d i t i o n a l l y  committed  expect to do " b e t t e r than average" i n t h e i r s t u d i e s than t h e i r peer groups.  I n a c t u a l performance  with the q u a l i f i e d group. group placed below average.  they shared t h i s honour  However, 48.1 per cent of t h i s This they d i d not foresee and  just  how t h i s a f f e c t e d t h e i r stated degree of commitment and what t h e i r commitment response would be at the beginning of t h e i r second year of medical school i s open f o r s p e c u l a t i o n . In estimating how w e l l they are doing, these students turn f i r s t inward f o r self-examination, and then to other students.  They continue to be independent and are the one  group that c l e a r l y i n d i c a t e s t h a t when they graduate they wish to have t h e i r own o f f i c e with a h o s p i t a l  affiliation.  However, they s t a t e that they would l i k e more d i r e c t i o n from the f a c u l t y w i t h regard to t h e i r s t u d i e s .  The  u n c o n d i t i o n a l l y committed also experienced an increase i n student competition from f a l l to s p r i n g .  This may be an ex-  p r e s s i o n of the increased pressure a l l students f e l t .  How-  ever, i n t h i s group the m a j o r i t y enjoy competition r i g h t from the beginning.  A l s o , e i g h t y - e i g h t per cent of t h i s group,  both f a l l and s p r i n g , thought that students were h e l p f u l to one another.  This response i s outstanding both f o r i t s  constancy and i t s degree of i n t e n s i t y . Two t h i r d s of the u n c o n d i t i o n a l l y committed  change  t h e i r ideas about what phrase could best describe the medical profession.  However, they r e f e r r e d medicine back to the  practitioner  r a t h e r than on to :his c l i e n t s or the community  p r o p o r t i o n a t e l y more o f t e n than members of the other groups. There i s a change between the f a l l and spring statements of t h i s group as to what they consider t o be the most important characteristic  i n the making of a good p h y s i c i a n .  In the f a l l  "dedication t o medicine" i s considered t o be most important. By s p r i n g the " a b i l i t y first.  t o think i n an organized way" rates  These seem t o be a f a i r l y p r a c t i c a l group of students  and i f they found that t h e i r f i r s t assumption was not g e t t i n g them where they had to be, they would change.  And they d i d .  In the f a l l t h i s group estimated t h e i r f u t u r e i n come a t a lower l e v e l than a l l other groups but one.  I n the  s p r i n g , however, they made the second highest estimate. I n s t a t i n g what they think they w i l l l i k e best about being a . doctor, the u n c o n d i t i o n a l l y committed are c o n s i s t e n t over the year.  They s t a t e they w i l l l i k e "being able t o help other  people" when they are M.D.'s.  T h e i r statements centre around  the people they w i l l help and work w i t h , r a t h e r than the a c t u a l work of the doctor. The u n c o n d i t i o n a l l y committed have made up t h e i r mind with regard t o the various aspects of the p r o f e s s i o n of medicine.  As t h e i r answers are the most c o n s i s t e n t and the  most constant, compared t o the other commitment groups, they appear to be the most dedicated t o a career i n medicine. Along w i t h t h i s consistency they have fewer fears regarding t h e i r f u t u r e and seem t o be experiencing fewer s t r a i n s i n the l e a r n i n g process i t s e l f .  I t seems as though t h e i r d e f i n i t u d e ,  t h e i r sureness, and assuredness, give them the support they require to see them through the s t r e s s e s of l e a r n i n g .  Non-change: Degree of Commitment: "One of s e v e r a l careers I could f i n d e q u a l l y s a t i s f y i n g " - The Q u a l i f i e d Committed This group of students was the o l d e s t at entry into medical s c h o o l , and the o l d e s t when they made t h e i r f i n a l d e c i s i o n to study medicine.  This i s the only group t h a t has  a m a j o r i t y of lower c l a s s students r a t h e r than upper c l a s s . From the beginning they see medicine as being "more l i k e " other professions r a t h e r than " d i f f e r e n t from" other p r o f e s s i o n s , as t h e i r peers do. As a group, they worry more than the u n c o n d i t i o n a l l y committed  about not becoming overly tense i n t h e i r work, but  l e s s than the changers.  I n assessing how w e l l they are doing,  these students also rate t h e i r own estimate f i r s t but the f a c u l t y ' s second.  In f a c t , during the year these students  f i n d t h e i r contemporaries of l e s s help than they d i d at the beginning.  The q u a l i f i e d committed  experience more competi-  t i o n i n the spring but they a l s o l i k e i t more. In s t a t i n g which d e s c r i p t i o n s best s u i t e d the medical profession,  the q u a l i f i e d committed followed the same p a t t e r n  as the other commitment groups.  However, whereas two t h i r d s  of the other groups changed t h e i r answers, the q u a l i f i e d group were constant f a l l and s p r i n g .  This would i n d i c a t e  that t h e i r pre-medical assessment of themselves and of medicine has not been s e r i o u s l y found wanting, i n t h i s regard, at  least.  When t h i s group rated what they thought they would l i k e best about being a doctor, i n the f a l l they emphasized being able to d e a l d i r e c t l y w i t h people, and i n the s p r i n g they emphasized the challenging and s t i m u l a t i n g nature of the work.  They emphasize the work a doctor does r a t h e r than the  r e s u l t s of that work.  They seem to be more i n t e r e s t e d i n  doctoring than i n being a doctor.  This same emphasis recurs  when t h i s group l i s t s what they consider to be important c h a r a c t e r i s t i c s i n the make-up of a good p h y s i c i a n . F a l l and s p r i n g , the q u a l i f i e d committed l i s t i n t e g r i t y as the most important c h a r a c t e r i s t i c , and organized t h i n k i n g as the second most important. of a l l groups.  They present the most " p r o f e s s i o n a l " approach That i s , t h e i r terms of reference are more  o b j e c t i v e and r a t i o n a l r a t h e r than s u b j e c t i v e . This group was the most accurate i n estimating a c t u a l performance.  In estimating what they expected to earn  at the peak of t h e i r careers, they gave the lowest estimate of the f i v e groups i n the f a l l and the second lowest i n the spring. Of a l l the commitment groups, the q u a l i f i e d committed seem to be more d e l i b e r a t e and mature i n t h e i r answers. They seem to be the most s e l e c t i v e and, as said before, " p r o f e s s i o n a l " i n t h e i r approach to a career i n medicine.  Change: Degree of Commitment: From "Only career that could s a t i s f y me" t o "One of s e v e r a l careers I could f i n d e q u a l l y s a t i s f y i n g " - Q u a l i f i e d Changers This group of students decided on a medical career at a l a t e r age than other students, who i n the f a l l said medicine was the "only career" f o r them, the u n c o n d i t i o n a l l y committed. However, the q u a l i f i e d changers are the youngest of a l l groups at the time of entry i n t o medical s c h o o l . d e c i s i o n i s lowest f o r t h i s group.  The time f a c t o r of  Neither d i d the q u a l i f i e d  changers see medicine as being so d i f f e r e n t from other professions as d i d the u n c o n d i t i o n a l l y committed.  I n a sense, medi-  cine was not so " s p e c i a l " to the q u a l i f i e d changers r i g h t from the beginning of t r a i n i n g . At the same time, t h i s group expected more trouble i n t h e i r l e a r n i n g process than d i d any other group.  They are  the only group that expected t o experience d i f f i c u l t y i n a l l f o u r of the f o l l o w i n g areas:  keeping up w i t h other students;  l e a r n i n g t o t h i n k f o r y o u r s e l f ; l e a r n i n g what i s expected of you; and t r y i n g not to become o v e r l y tense. changers are the most p e s s i m i s t i c group.  The q u a l i f i e d  By s p r i n g none of  them expected to do b e t t e r than average i n h i s s t u d i e s and none of them d i d . A l s o , p r o p o r t i o n a t e l y , t h i s group had the highest number of f a i l u r e s .  I n evaluating how w e l l they  were doing, they r e l i e d f i r s t , upon s e l f - e v a l u a t i o n and second, upon the f a c u l t y .  Other students were not considered as  important f a c t o r s i n e v a l u a t i o n . In s t a t i n g what best describes the medical profess i o n , and what they t h i n k they w i l l l i k e best about being  doctors, the q u a l i f i e d changers change often and i n d i c a t e more d i s o r g a n i z a t i o n i n t h e i r thoughts i n at l e a s t these matters than do the other commitment groups.  In the a c t u a l statements  of what they w i l l l i k e best about being a doctor, t h i s group switches from statements concerning what they w i l l be able to give to others, to statements i n the spring which i n d i c a t e having c o n t r o l of the s i t u a t i o n , f o r example, being my own  boss.  When asked what c h a r a c t e r i s t i c s they considered to be most important i n the make-up of a good p h y s i c i a n , i n the f a l l the q u a l i f i e d changers stated f i r s t , d e d i c a t i o n and second, i n t e g r i t y . In the spring they l i s t e d i n t e g r i t y f i r s t and a b i l i t y to get along with others, second.  They are the only group that  completely l o s t a c h a r a c t e r i s t i c between f a l l and s p r i n g . Looking to t h e i r f u t u r e , the Q u a l i f i e d changers expect to t h i n k of themselves as doctors at a l a t e r time than a l l other groups.  They are a l s o the only group that says they  received the " r i g h t amount" of f a c u l t y d i r e c t i o n , and s t a t e a decrease i n need f o r f a c u l t y d i r e c t i o n .  They a l s o change from  experiencing l i t t l e competition i n the f a l l to one hundred per cent agreement that there was a great d e a l of competitiveness i n the f i r s t year medical c l a s s .  Along with t h i s , , they  experienced a decrease i n students' h e l p f u l n e s s and, as a group, enjoy competition the l e a s t . The q u a l i f i e d changers i n d i c a t e the greatest change and the greatest inconsistency i n responses between f a l l and spring.  They seem to be d i s i l l u s i o n e d and disorganized.  120  Change: Degree of Commitment: From "One of s e v e r a l careers I could f i n d e q u a l l y s a t i s f y i n g " to "Only career t h a t could s a t i s f y me" - U n c o n d i t i o n a l Changers The u n c o n d i t i o n a l changers are younger and decided at an e a r l i e r age to study medicine than the group with which they were a l i g n e d i n the f a l l , the q u a l i f i e d committed.  With  respect to t h e i r outlook on medical school, there was a change from h a l f of the group expecting medical school to be b a s i c a l l y tough and the other h a l f expecting i t to be b a s i c a l l y enjoyable i n the f a l l , to one hundred per cent agreement i n the s p r i n g that medical school was going to be b a s i c a l l y enjoyable. S i m i l a r to the balance of the sample, the uncondit i o n a l changers expected t r o u b l e not becoming overly tense. This was i n l i n e w i t h the sample norm.  In no other area d i d  t h i s group experience undue s t r e s s . The outstanding c h a r a c t e r i s t i c  of t h i s group i s  t h e i r constancy between f a l l and s p r i n g . expectations of performance,  They have i d e n t i c a l  f a l l and s p r i n g .  Although two  expected todo b e t t e r than average, no member of t h i s group d i d do b e t t e r than average, but the u n c o n d i t i o n a l changers were the only group where no one had to w r i t e a supplemental examination, repeat the year, or withdraw.  In t h e i r estimate  of how w e l l they were doing compared to other students, the f a c u l t y was t h e i r primary source and s e l f - e s t i m a t i o n was secondary source.  their  L i k e a l l the other groups, except the  u n c o n d i t i o n a l l y committed, they d i d not consider t h e i r mates' estimates of primary  importance.  class-  The u n c o n d i t i o n a l changers' statements of what best describes the medical p r o f e s s i o n have the l e a s t change between f a l l and spring of any group.  I n s t a t i n g what they consider  to be important c h a r a c t e r i s t i c s of a good p h y s i c i a n , i n the f a l l they think that a p l e a s i n g p e r s o n a l i t y i s most important.  In  the s p r i n g , they have added a c h a r a c t e r i s t i c - they s t a t e both a p l e a s i n g p e r s o n a l i t y and d e d i c a t i o n to medicine as being important.  They are the only group t h a t becomes more i d e a l i s t i c . One question area where t h i s group does change, i s i n  t h e i r statements of what they think they w i l l l i k e best about being a doctor.  They change from statements l i k e the q u a l i -  f i e d committed's to statements l i k e the u n c o n d i t i o n a l l y committed' s.  They t u r n more to the s a t i s f a c t i o n s of being a  doctor. In terms of income expected at the peak of t h e i r careers, the u n c o n d i t i o n a l changers have the highest hopes of any group.  In the f a l l they give the second highest estimate  but i n the spring they give the highest estimate of a l l groups. They expect to think of themselves as doctors sooner than they had estimated they would i n the f a l l .  They found more competi-  t i o n among t h e i r classmates i n the spring than they had i n the f a l l , but they enjoyed competition more than they d i d formerly. The u n c o n d i t i o n a l changers are d i f f e r e n t from the other groups between f a l l and spring i n t h a t they are e i t h e r constant i n t h e i r expectations and conceptions of medicine, or they become more p o s i t i v e i n t h e i r expressions.  This i s  e s p e c i a l l y i n t e r e s t i n g because the other groups move the other  122  way.  I n many respects they take on the a t t i t u d e s of the  u n c o n d i t i o n a l l y committed.  I t seems as though the expecta-  t i o n s of t h i s group have been  met to some s i g n i f i c a n t degree  and t h i s has r e i n f o r c e d t h e i r s t a b i l i t y and t h e i r o r i g i n a l plans to become a doctor.  The three students who  i n the f a l l of 1959 stated  medicine was "not the most s a t i s f y i n g career I can think of" are presented here as p o s s i b l e i n d i c a t o r s of patterns w i t h i n the change groups r a t h e r than i n d i v i d u a l commitment cases. I t seems l i k e l y that the l a b e l s attached to these three can as l o g i c a l l y be hung on other students w i t h i n a r e s p e c t i v e change group.  This i s not to assume that these three comprise  a comprehensive l i s t of kinds of students.  I t does point out,  however, t h a t the same career pattern i s l i k e l y followed by q u i t e d i f f e r e n t "kinds" of students.  Change: Degree of Commitment: From "Not most s a t i s f y i n g career I can t h i n k of" to "The only career that could r e a l l y s a t i s f y ; ! ^ Unconditional Changer Male, 21 years o l d , f a t h e r c l a s s i f i e d i n c l a s s V.  socio-economic  None of h i s immediate r e l a t i v e s i s a p r o f e s s i o n a l .  This student f i r s t thought of medicine as a career before he was ten years old and d e f i n i t e l y decided to study medicine ween eighteen and twenty years of age.  bet-  Many professions were  considered as occupations, i n c l u d i n g engineering, law, business, and the m i n i s t r y . He i s a mobile student: ally.  s o c i a l l y and economic-  In the f a l l he expressed " s l i g h t doubts" about h i s occupational d e c i s i o n , and worry about the f i n a n c i n g of h i s career.  His choice of s p e c i a l t y w i t h i n medicine was  p s y c h i a t r y , and second, pathology.  first,  He enjoyed competitive  situations. By s p r i n g of I960 t h i s student had a more o p t i m i s t i c outlook.  I n the f a l l he stated he "didn't know" how w e l l he  was doing i n comparison to h i s classmates.  I n the s p r i n g he  thought he was doing " b e t t e r than average".  In the f a l l he  was "not sure" how he was performing. " q u i t e sure".  In the s p r i n g he  was  Along w i t h these two statements, i n the spring,  t h i s student had experienced l i t t l e d i f f i c u l t y making f r i e n d s with h i s classmates, considered medical students to be "helpf u l " toward one another, and when asked which of eight aspects of-a  medical career he would l i k e best, checked them a l l .  a l s o changed h i s "choice" of s p e c i a l t i e s .  He  In the spring he  thought he would l i k e to be a p e d i a t r i c i a n or do research. These two choices are higher i n p r e s t i g e w i t h medical students than h i s f a l l s e l e c t i o n s .  He stated he would not l i k e to do  o b s t e t r i c s or Ear, Nose and Throat s p e c i a l t y p r a c t i c e . I t would seem that t h i s young man has been "shopping" among the p r o f e s s i o n s , l o o k i n g f o r the " r i g h t " one f o r him. In the f a l l of 1959 he was ready to take on a "coat" but was not sure i f the coat would f i t . By the s p r i n g of I960, he was f a i r l y sure he and the coat "were made f o r each other".  Change: Degree of Commitment: From "Not most s a t i s f y i n g career I can t h i n k of" to "one of s e v e r a l careers I could f i n d equally s a t i s f y i n g " - Q u a l i f i e d Changer Male, 21 years o l d , f a t h e r c l a s s i f i e d i n socio-economic class I.  A few r e l a t i v e s are p r o f e s s i o n a l s .  This student f i r s t  thought of medicine as a career when he was fourteen or f i f t e e n years o l d .  He d e f i n i t e l y decided to study medicine between  eighteen and twenty years of age.  He s e r i o u s l y considered the  professions of engineering and a r c h i t e c t u r e .  I n the f a l l he  states that he has had "serious doubts" about h i s d e c i s i o n to become a doctor.  He was worried "a f a i r amount" about the  kind of medical career he would have.  This i s a questioning  student. By s p r i n g t h i s student's questionnaire i n d i c a t e s that he has been somewhat reassured i n h i s choice of careers. In the f a l l he stated he expected to do "average" i n comparison to h i s classmates. average".  By s p r i n g he expected to do " b e t t e r than  I n the f a l l he was "not sure" how w e l l he was  i n the s p r i n g he was "sure".  doing;  I t seems h i s reassurance came  from h i s professors and peers, whom he considers more important than himself i n a p p r a i s i n g how he was doing.  This student  i s more confident i n the s p r i n g than he was i n the f a l l , but s t i l l i s not s e l f - c o n f i d e n t .  Few students wrote on t h e i r  questionnaires to e x p l a i n t h e i r answers, but t h i s student when asked which medical s p e c i a l t y he would l i k e to enter checked o f f pathology or research and then wrote: the b r a i n s . "  " I f I had  This young man placed f i r s t i n h i s c l a s s .  Non-change: Degree of Commitment: "Medicine i s not the most s a t i s f y i n g career I can t h i n k of, everything considered" Conditional Male, 24 years o l d , f a t h e r c l a s s i f i e d i n socio-economic c l a s s I , r e l a t i v e s are p r o f e s s i o n a l s .  This student f i r s t  thought of medicine as a career a f t e r he was eighteen years old.  He d e f i n i t e l y decided to study medicine a f t e r he  twenty-one years o l d .  was  His p r e - c o l l e g e education i s European.  He s t a t e s the one other occupation s e r i o u s l y considered was a Ph.D.  i n mathematics.  Since "choosing" a medical career he  has had "serious doubts" regarding the wisdom of the choice. His  questionnaire responses i n d i c a t e l i t t l e i d e a l i s m and com-  pared to many students, a good deal of r e a l i s m . I t would seem, that f o r some reason, t h i s young man chose to become a doctor a f t e r a very d e l i b e r a t e weighing of the pros and cons of medicine and h i s other a l t e r n a t i v e .  For t h i s reason, because  of t h i s apparently r a t i o n a l d e c i s i o n , t h i s student i s a r a t i o n a l student. This student i s s e l f - c o n f i d e n t .  His answers, f a l l  and s p r i n g , are h i g h l y c o n s i s t e n t . At both time periods he stated he expected to do " b e t t e r than average" i n h i s c l a s s . He was "sure" of h i s expectations.  He would l i k e to become  a psychiatrist.  He expresses no doubts or qualms, i n terms  of performance,  regarding h i s a b i l i t y to achieve h i s occupa-  t i o n a l goal.  He d i s l i k e s competitive s i t u a t i o n s , but t h i s a l s o  seems to be a " r a t i o n a l " statement which has no obvious connect i o n or negative e f f e c t on what he expects to do. Although t h i s student does not expect to have i n t e l l e c t u a l d i f f i c u l t i e s i n  becoming a doctor, he expresses anxiety i n two areas: 1.  t h a t he made the best" occupational choice ( f o r him),  and 2.  ,f  he expresses worry w i t h regard to f i n a n c i n g h i s  t r a i n i n g throughout medical school and h i s f i r s t years of practice. Although t h i s student i s very r a t i o n a l i n h i s responses, they also i n d i c a t e that he i s an i s o l a t e .  CHAPTER IX CONCLUSION AND SUGGESTIONS FOR FURTHER STUDY  At the beginning, the o b j e c t i v e of t h i s paper was stated to be to demonstrate  that the s o c i a l mechanism of  degree of commitment i s connected with, f i r s t , the experiences of l e a r n i n g during the process of becoming a member of a s o c i a l system and, second, the " s o c i a l i z e d " r e s u l t a n t when the l e a r n i n g process has been completed.  For t h i s sample,  d i f f e r e n c e s i n a t t i t u d e s and experiences during the f i r s t year i n medical school have been shown to vary with d i f f e r e n t degrees of commitment. The major assumption i n t h i s t h e s i s has been that an i n d i v i d u a l does not change h i s mind unless he decides that his  former d e c i s i o n was "wrong" or "incomplete" and that  -changing one's mind i n a negative d i r e c t i o n , e s p e c i a l l y about a matter of some importance, " l o s i n g a bet" i n Becker's terms, i s i n j u r i o u s to h i s self-imagei  Each m i s c a l c u l a t i o n has some  e f f e c t on t h i s self-image but a concentrated s e r i e s of miscalculations i s disequilibrating. In t h i s sense, then, the u n c o n d i t i o n a l l y  committed  have been shown to be the most s t a b l e of a l l commitment groups. There i s c o n t i n u i t y t o t h e i r answers;  they have the strongest  i d e n t i f i c a t i o n with the profession i n the e a r l y stages of t r a i n i n g , at l e a s t .  The "degree" of t h e i r commitment seems  to have two major bases, and one s u s t a i n i n g p o i n t . F i r s t , they s t a r t e d to t h i n k of medicine as a career at an e a r l y age, they  have had a long time to t h i n k about, read about and t a l k about medicine.  Relatively,  they have considered few other occupations  s e r i o u s l y , so the d i g r e s s i o n s i n t h e i r contemplation of medicine have been minor.  They have a s u b s t a n t i a l 'investment' to carry  out t h e i r d e c i s i o n to become a doctor.  Secondly, although,  l i k e t h e i r classmates, the u n c o n d i t i o n a l l y committed l o s e some of t h e i r " i d e a l i s m " with regard to a medical career, they do not l o s e i t a l l . They have the strongest i d e n t i f i c a t i o n w i t h the p r o f e s s i o n so that not only do they have more to l o s e , but they see medicine as a "good" thing and the t r a i n i n g i s a means to the end.  This group some times seems to be immature, but  they are u s u a l l y e n t h u s i a s t i c .  When d e d i c a t i o n to medicine i s  "a non-functional emphasis i n t h e i r l e a r n i n g , they change to a more p r a c t i c a l one.  This group of students want to become  d'octors, they i d e n t i f y with being a member of the medical profession.  They i d e n t i f y w i t h the end and perhaps t h i s helps  them to be able to "take" the means. I t should be remembered, too, that although these students undergo " r e a l i t y shock" they have the f a c u l t y t h e i r peers f o r support.  and  That brings up a v i s i b l e s u s t a i n i n g  point of t h i s group's commitment.  They are the group that  states they r e l y upon peers f o r support.  A competitive s i t u -  a t i o n i s not u s u a l l y considered as a supportive s i t u a t i o n .  Yet,  although the m a j o r i t y of the sample stated they found a f a i r amount of competition among t h e i r classmates, they also stated that they found t h e i r classmates to be " h e l p f u l " toward  one  129  another.  This would seem to be a c o n t r a d i c t i o n .  I t i s sug-  gested, t h e r e f o r e , that t h i s i s a s p e c i a l case. This i s a s i t u a t i o n where there i s room f o r a l l the s o c i a l i z e e s as long as they reach a minimum standard of e x c e l l e n c e . There i s no c u t - o f f l i n e i n terms of numbers of students who can pass.  Although there i s honour attached to coming " f i r s t " ,  there i s no p a r t i c u l a r " d i s h o n o u r " to j u s t reaching the minimum standard.  Also, the s o c i a l i z e r s , e s p e c i a l l y i n the beginning,  are i m p a r t i a l toward students regardless of t h e i r achieved performance - as long as they reach the set minimum. The s o c i a l i z e e s then may d i r e c t t h e i r competitive e f f o r t s toward t h i s standard, or toward the point where they think they should be above i t , r a t h e r than against t h e i r contemporaries.  The  s o c i a l i z e e s have a common g o a l , which i s a c c e s s i b l e to a l l . They can a f f o r d to help one another and, i n f a c t , can use one another both f o r s p e c i f i c help and l e s s s p e c i f i c support i n the stressful learning situation.  The small group s e t t i n g , the  face-to-face contact over time, and t h i s common o b j e c t i v e t o become a doctor, promote " h e l p f u l n e s s " and e s p r i t - d e - c o r p s . Once the s o c i a l i z e e s graduate they can resume competition against colleagues, e.g., g e t t i n g p a t i e n t s , because there are then other rewards, s a t i s f a c t i o n s , and supports f o r t h e i r work. The same i s true f o r c h i l d r e n ( i d e a l l y ) .  They do not have to  "compete" w i t h one another t o become a d u l t s . as to how many w i l l reach twenty-one. another example.  There i s no quota  Novices i n the church are  Once they are taken i n t o the t r a i n i n g , they  are expected t o do t h e i r " b e s t " .  They a r e not expected t o  compete w i t h one a n o t h e r . The e n t i r e sample e x p e r i e n c e d c o m p e t i t i o n and h e l p f u l n e s s from t h e i r c l a s s m a t e s .  I f t h e above i s a c c e p t e d ,  then  i t seems t h a t t h e s t u d e n t s e x p e r i e n c e d the c o m p e t i t i v e n e s s o f t h e i r c l a s s m a t e s a g a i n s t t h e i r p e r s o n a l o b j e c t i v e and, a t the same t i m e , h e l p f u l n e s s toward one a n o t h e r .  While t h i s  arrange-  ment seems t o have w i t h h e l d some p r e s s u r e from the o t h e r commitment groups, t h e u n c o n d i t i o n a l l y committed seem t o have been a b l e t o use i t t o advantage.  They evidenced the h i g h e s t  e s p r i t - d e - c o r p s and t h e l e a s t change.  The u n c o n d i t i o n a l l y  committed a r e more u n i t e d and, c o n s e q u e n t l y , l e s s a l o n e the members o f the o t h e r groups. approach  than  They had a more u n i f o r m  t o medicine than the members o f the o t h e r  groups,  and seem t o have been a b l e t o both s u p p o r t and r e i n f o r c e one another.  T h e i r "degree" and " k i n d " o f commitment seems t o  have enabled them t o use the e x t e r n a l r e s o u r c e s a t hand t o t h e b e s t advantage. The q u a l i f i e d committed are more independent  and  l e s s bound t o o t h e r s t u d e n t s than t h e u n c o n d i t i o n a l l y committed.  I n the sense o f t h i n k i n g out c h o i c e s , t h i s group i s the  most mature.  They a r e not so u n d i s c r i m i n a t i n g i n t h e i r  enthusiasm about m e d i c i n e .  From the b e g i n n i n g t h e y seem t o  have the more ' p r o f e s s i o n a l " and r a t i o n a l approach  t o medicine -  t h e y l o o k a t i t as a way o f work r e q u i r i n g i n t e g r i t y and organized t h i n k i n g .  Compared t o the o t h e r non-change group,  t h e y a r e l e s s i n t e r e s t e d i n b e i n g a d o c t o r and more i n t e r e s t e d i n d o i n g the work o f a d o c t o r .  The changers are outstanding f o r t h e i r impatience. However, the impatience, change, and subsequent d i s o r g a n i z a t i o n , has had opposite r e s u l t s f o r the change groups.  The uncondi-  t i o n a l changers were unsure of themselves at the.beginning of the year, but since having a s u c c e s s f u l year - with many of t h e i r expectations being met - they are anxious to get on w i t h their training.  They ''changed" t h e i r mind about t h e i r commit-  ment to medicine but i n a d i r e c t i o n s a t i s f a c t o r y  to themselves,  proving they were more " r i g h t " i n t h e i r d e c i s i o n to study medicine than they were a f r a i d to admit i n the beginning. They are now prepared to wager more on t h e i r investment of becoming a doctor. The q u a l i f i e d changers seem to have experienced more d i s i l l u s i o n m e n t as a r e s u l t o f m i s c a l c u l a t e d expectations. I n a comparison w i t h the u n c o n d i t i o n a l l y committed, with whom they began i n the f a l l , the q u a l i f i e d changers appear as isolates.  They d i d not consider medicine to be as d i f f e r e n t  from other occupations, they expected more t r o u b l e i n s t r e s s situations  and r a t h e r than t u r n i n g t o t h e i r peers f o r an e s t i -  mate of how they were doing, t h i s group turned to the f a c u l t y . Of the three students who i n the f a l l stated that medicine was. "not the most s a t i s f y i n g career I could think of", the c o n d i t i o n a l l y  committed one seems to be an i s o l a t e  among h i s classmates.  The u n c o n d i t i o n a l changer appears to be  l i k e the other u n c o n d i t i o n a l changers, while the q u a l i f i e d changer seems to be l i k e the q u a l i f i e d committed i n many respects.  132  Although the d i f f e r e n c e s among the various commitment groups are outstanding questions,  by the responses given to the  various  the d i f f e r e n c e s are more pronounced when the groups  are ordered by the amount of change undergone during the year. In order of change, with the Least change f i r s t , groups rank:  the  the u n c o n d i t i o n a l l y committed, the q u a l i f i e d  committed, the u n c o n d i t i o n a l changers, and the q u a l i f i e d changers. Compared to non-changers, very g e n e r a l l y , the changers can  be  characterized by t h e i r comparative youth, an upper class background, more p e s s i m i s t i c and negative approach to t h e i r undecided f u t u r e , experience more competition,  career,  expect to earn  a higher income, and a f e e l i n g of being on the outside  of  the f i r s t year medical student group. I t i s assumed that l e s s change i s i n d i c a t i v e of l e s s s t r e s s (or the more successful handling of s t r e s s f u l s i t u a t i o n s ) and greater s t a b i l i t y .  Degree of change i s one i n d i c a t o r of  the degree of d i s e q u i l i b r i u m of a group.  I t i s suggested that  the change groups are i n a c o n d i t i o n of greater d i s e q u i l i b r i u m than the other commitment groups and, f u r t h e r , that the q u a l i f i e d changers (only career) are i n the greater state of d i s organization.  To become more committed to a previous d e c i s i o n  i s not l i k e l y to be h i g h l y d i s o r g a n i z i n g .  But i t i s "change"  and therefore concomitant with i t , according  to the previous  assumptions of t h i s paper, a state of d i s e q u i l i b r i u m may expected.  be  I t i s contended here, therefore, that i f the second  year of medical school i s not as " s u c c e s s f u l " f o r the uncondit i o n a l changers as t h e i r f i r s t year, they can be expected to  change t h e i r p o s i t i o n again.  Under the same amount of s t r e s s ,  the non-changers would not be expected to change during the second year.  The d i f f e r e n c e between the two change groups  then, i s t h a t , although both are i n a s t a t e of d i s e q u i l i b r i u m , only the q u a l i f i e d changers  (only career) are p r e s e n t l y i n a  state of d i s o r g a n i z a t i o n . S p e c i f i c a l l y , why d i d some students change while others d i d not when they began f i r s t year medicine w i t h the same stated degree of commitment?  They received a s i m i l a r  exposure to medicine and although a l l students became l e s s e n t h u s i a s t i c about medicine, only a few changed t h e i r commitment.  Comparing the u n c o n d i t i o n a l l y committed with the q u a l i -  f i e d changers  (only c a r e e r ) , the u n c o n d i t i o n a l l y committed  decided at an e a r l i e r age to become doctors, so they had time to become "more" committed.  But perhaps most important,  although the u n c o n d i t i o n a l l y committed were a l s o under s t r e s s , they turned to and r e c e i v e d the support of t h e i r peers. q u a l i f i e d changers  (only career) d i d not.  mitted, compared to the q u a l i f i e d changers  The  The q u a l i f i e d com(only c a r e e r ) , are  older i n years and more d e l i b e r a t e i n t h e i r choices.  They  were expecting, and were b e t t e r prepared to deal w i t h , s t r e s s . The u n c o n d i t i o n a l changers  (one of s e v e r a l c a r e e r s ) , although  they experienced s t r e s s as w e l l , had many of t h e i r expectat i o n s met and they received the support of t h e i r classmates. I t seems, therefore, t h a t the q u a l i f i e d changers had the poorest equipment to meet s t r e s s :  (only career)  the fewest reserves  and the fewest compensations from t h e i r l e a r n i n g experience.  In attempting to determine which students are the "most" committed to t h e i r d e c i s i o n to have a career i n medicine, i t becomes apparent that not only are there of commitment, but there are a l s o "kinds". denced two "kinds".  "degrees"  This sample e v i -  Other samples and/or other l e a r n i n g  s i t u a t i o n s may uncover a d d i t i o n a l "kinds" of commitment to a learning situation. I n assessing the u n c o n d i t i o n a l l y committed and the q u a l i f i e d committed i t i s c l e a r that both groups are to become medical doctors.  determined  The u n c o n d i t i o n a l l y committed have  a determination of long standing and the support of "others" to see t h i s l e a r n i n g process through to completion.  Each  student looks forward to being a member of the medical profession.  The q u a l i f i e d committed decided to study medicine  a f t e r more d e l i b e r a t i o n and comparison of medicine with other occupations.  Their choice i s more d e l i b e r a t e .  Their i n v e s t -  ment l i e s i n t h e i r conscious choice of medicine as a career. They can a l s o be d i s t i n g u i s h e d from the u n c o n d i t i o n a l l y committed f o r t h e i r emphasis not on being a doctor, but on wanting to do the work of the doctor.  Both groups are h i g h l y committed  to t h e i r chosen p r o f e s s i o n . P r o p o r t i o n a t e l y , t h e i r achievement i n f i r s t year medicine was equal.  There i s no basis i n the,  a v a i l a b l e data on which to decide which group i s the "most" committed.  Nor i s there any basis f o r saying which i s the  most adequately equipped to handle s t r e s s s i t u a t i o n s .  They  seem to manage these s i t u a t i o n s i n d i f f e r e n t ways - the uncond i t i o n a l l y committed seem more ready to absorb s i t u a t i o n s as  being part of becoming a doctor while the q u a l i f i e d committed seem to ponder questions longer.  Perhaps the length of time  which passed a f t e r the u n c o n d i t i o n a l l y committed had decided to become doctors, but before they were academically i n a p o s i t i o n to enter medical school, was used to resolve many of the questions the q u a l i f i e d committed now have to r e s o l v e . S t i l l , the two groups' means of i d e n t i f i c a t i o n with the medical p r o f e s s i o n also d i f f e r .  Looking to the future and  the choice of a s p e c i a l t y , one might guess that, as the uncond i t i o n a l l y committed seem to i d e n t i f y with the outward symbols of a M.D.,  e.g., o f f i c e , income, they might be expected to  choose a s p e c i a l t y which w i l l give them these symbols f o r t h e i r own.  On the other hand, the q u a l i f i e d committed seem to iden-  t i f y more with the work, so t h a t they might be expected to choose the s p e c i a l t y that w i l l a l l o w them to do the kind of work they enjoy.  I t i s not intended to  suggest that these  are mutually e x c l u s i v e i d e n t i f i c a t i o n s - merely d i f f e r e n c e s i n emphasis.  B r i e f l y , d i f f e r e n t degrees of commitment, as  s o c i a l mechanisms, e f f e c t d i f f e r e n t  results.  That both groups are "committed" both at the beginning and the end of t h e i r f i r s t year of medical school there can be l i t t l e doubt.  I n terms of s t r e s s and change,  the q u a l i f i e d committed seem to have - and handle - more. This, of course, says nothing about the r e l a t i v e merits of the f i n i s h e d products.  I n view of t h i s , the best measure of  the force of "commitment" as a s o c i a l mechanism may be the r e l a t i v e measures of change or non-change over time.  136  A degree of commitment, f o r t h i s sample, was e s t i mated at two points i n time: of i 9 6 0 .  the f a l l of 1959 and the s p r i n g  At a point i n time a degree of commitment i s com-  p r i s e d of the components that Kadushin o u t l i n e d f o r the making of a d e c i s i o n :  a perception of what w i l l f o l l o w the choice, e.g.,  what medical school i s l i k e ; a self-image; the s i g n i f i c a n t others i n one's l i f e ; and time.  A d e c i s i o n i s a commitment;  terms, an investment i n consistency, a "bet"  i n Becker's  that the d e c i s i o n  can be c a r r i e d out. I t must be c l e a r , however, that a commitment and a d e c i s i o n are not i d e n t i c a l . d e c i s i o n leaves o f f .  A commitment -takes up where a  U n t i l a d e c i s i o n i s made there i s f r e e -  dom to choose a d i r e c t i o n of movement - or non-movement. Commitment, by d e f i n i t i o n , r e s t r i c t s freedom of a c t i o n . r e s t r i c t s and i t governs a c t i o n .  It  At a point i n time, a degree  of commitment may be so low as to a l l o w a subsequent choice or change i n the i n i t i a l d e c i s i o n , but a d e c i s i o n of magnitude, without exception, necessitates a commitment of magnitude, because they are comprised of i d e n t i c a l components. As a s o c i a l mechanism, degree of commitment r e s t r i c t s and governs a c t i o n .  Using the f i r s t year medical students at  the U n i v e r s i t y of B r i t i s h Columbia as a sample, degree of commitment has been shown to make a d i f f e r e n c e i n the l e a r n i n g experience of these students.  That i s , degree of commitment  makes a d i f f e r e n c e i n the s o c i a l i z a t i o n process. S o c i a l i z a t i o n i s a process of change. Degree of commitment i s one of the mechanisms i n the process of  socialization.  As a mechanism, l i k e socializers,,, degree of  commitment makes a d i f f e r e n c e i n the l e a r n i n g experiences of socializees.  I t i s one of the mechanisms which determines  how r e l a t i v e l y complicated or uncomplicated, how more or l e s s p a i n f u l , the process of s o c i a l i z a t i o n w i l l be. committed  The "more"  a s o c i a l i z e e i s to becoming a member of a s o c i a l  •system, the " e a s i e r " the process should be, a l l other things •being equal.  However, i n t h i s regard, i t must be kept i n mind  that the measurement of commitment i s , so f a r , imperfect, and what appears t o be a greater degree may t u r n out to be a l e s ser  degree when a l l the f a c t s are known. The g e n e r a l i z a t i o n s of t h i s t h e s i s a r i s e out of a  s p e c i a l case:  f i r s t year medical students at the U n i v e r s i t y  of B r i t i s h Columbia.  Of course, they need to be tested in-  other l e a r n i n g s i t u a t i o n s .  I t i s submitted f o r study that  degree of commitment i s an i n t e g r a l part of the s o c i a l i z a t i o n process and, t h e r e f o r e , i t i s one of the mechanisms t h a t must be studied i n any a n a l y s i s of s o c i a l i z a t i o n as a s o c i o l o g i c a l concept.  Problems For Further Study Many times i n the body of t h i s t h e s i s i t becomes apparent t h a t there are many i n t e r e s t i n g problems i n t h i s f i e l d t h a t require study.  A few of them are l i s t e d below:  1.  Follow "commitment" through (a) t o the end of the f o u r years of medical school: (b) to the end of s p e c i a l t y t r a i n i n g ; and (c) to ten years a f t e r p r a c t i c e has commenced.  2.  When and how do medical students decide on the s p e c i a l t y of t h e i r choice?  3.  What s o r t s of pressures are of s u f f i c i e n t magnitude to lower a student's commitment and subsequently a l l o w or force him to change h i s career choice?  4.  Compare the ecology of todays' medical students with the medical students • of twenty-five years ago. Do they come from s i m i l a r or d i f f e r e n t backgrounds than formerly?  5.  Compare medicine to other professions as a means of s o c i a l and economic m o b i l i t y .  6.  I n p r o f e s s i o n a l schools, do students' a t t i tudes toward competition vary by t h e i r socio-economic backgrounds?  APPENDIX A  Following i s the questionnaire which was given to f i r s t year medical students at the U n i v e r s i t y of B r i t i s h Columbia i n September 1959, and again i n A p r i l I960. Starred i n red, i n the l e f t - h a n d margin of the questionnaire, are those questions which were used i n t h i s t h e s i s .  INSTRUCTIONS TO MEDICAL STUDENTS This questionnaire i s designed to find out what you, as a medical student, think about various aspects of medical training and practice. The information which you provide w i l l be helpful i n c l a r i f y i n g certain problems of medical education. We recognize that many of the questions deal with complex issues, and that the check-list alternatives do not always express the subtleties of your' opinions. But the purpose of a questionnaire l i k e this one i s to obtain an overall picture of the attitudes held by medical students. There are a few points which you should bear i n mind while f i l l i n g out this questionnaire: (1) The questionnaire i s not a "test" — t h e r e i s no "grade" or other mark. The only "right" answers to the questions are those which best express your feelings, your opinions, and your experiences. ( 2 ) Your individual identity w i l l not be revealed and your personal answers w i l l be kept confidential. The information provided by yocr class w i l l be tabulated and w i l l be made available to the faculty only i n the form of s t a t i s t i c a l summaries. (3) Read every question or statement carefully before answering. answer every question i n accordance with the directions.  Please  Thank you for your cooperation i n this study.  PART A Medical Students' Expectations and Advance Knowledge 1.  (a) At what age did you f i r s t think of becoming a doctor? (Check one) Before the age of 10 Between 10 and 13 years of age At 14 or 15 years of age At 16 or 17 years of age Since the age of 18  *  (b) At what age did you definitely decide to study medicine? Before the age of 14 At 14 or 15 years of age At 16 or 17 years of age Between 18 and 20 years of age Since the age of 21  141 - 2 •M-  2. Before deciding on medicine, did you ever seriously consider any other occupation or profession? Yes No IF YES:  Which occupations or professions did you consider? many as apply)  ......  Elementary or high school teaching College or university teaching (What f i e l d ? Scientific research (What field? Engineering, architecture Lav Ministry Business Other (Which? ;...)  (Check as  ) )  3. Which one of the following statements best describes the way you f e e l about a career i n medicine? (Check one)  .......  It's the only career that could r e a l l y satisfy me It's one of several careers which I could find almost equally satisfying It's not the most satisfying career I can think of, everything considered A career I decided on without considering whether I would find i t the most satisfying  4. (a) How important was each of the following i n your decision to enter the medical profession? (Answer f o r each) „ ., ~ . „ , . * ' Fairly Of minor Not at a l l (1) Mother important important importance important (2) Father (3; Other relatives (4) Friends who are not i n medicine ( 5 ) Physicians you know personally ...... (6) Physicians you have heard or read about (7) Medical students you know (8) Undergraduate teacher (9) Books, movies or plays (Give titles) n  (10) Other (What?. (b) Which two of these were of most importance i n your decision to become a doctor? (List the appropriate numbers) # and #  -  5  142  -  5. Since you made the decision, how much have the following members of your family encouraged you to become a doctor? (Answer for each) Strong  encour* egeffiOfit  Slight encouragement  Expressed no opinion  Slight opposition  Strong opposition  Doesn't apply  Mother Father Wife or Husband Brother or Sister Other relatives 6. Once you made up your mind to become a doctor, did you every have any doubts that this was the right decision f o r you? (Check one) Yes, serious doubts Yes, slight doubts No, no doubts at a l l 7. How important has each of the following been i n helping you to form a picture of what medical school i s like? (Answer f o r each) Very Fairly Of minor Not at a l l important important importance important Medical school bulletins Medical students at (your) school Medical students at other schools Members of your family who are doctors Your family physician Other physicians who are friends Medical school faculty College faculty Books, movies, plays (Give t i t l e s . .  Other (What?  8. A l l things considered, how do you think medical training compares with each of the following kinds of training? Are medical studies more d i f f i c u l t , less d i f f i c u l t , or about the same? (Answer for each) Medical Training Is Much Somewhat more more About Less diffidifficult the d i f f i c u l t Don't Studying to be a — — same_as than Know lawyer Studying to be an engineer ...... Studying to be a dentist Training to be an Army o f f i c e r Studying for a Ph.D i n physics Studying f o r a Ph.D in  n n v n V i n l ncnr  143 - 4 -  *  9. Which of the following statements comes closest to describing the way you feel about medical school? (Check one) ...... Basically, i t ' s going to be a tough, four year grind, but I ' l l manage to enjoy i t somehow Basically, i t ' s going to be an enjoyable experience, even though i t w i l l mean very hard work at times 10. Do you think that, as you move from the f i r s t to the fourth year of medical school, your studies w i l l become more difficult for you, less d i f f i c u l t , or do you think they w i l l remain relatively unchanged i n this respect? (Check one) Will become more difficult Will become less difficult ...... Will remain about the same Don't know 11. In your opinion, how important i s each of the following for a student to get the most out of the f i r s t year of medical school? (Answer for each) Very Fairly Of minor important important importance  Manual dexterity (with instruments, .ools, machines, ett, ) Ability to memorize ..... Ability to cope with theoretical material Previous knowledge of physical science Ability to put aside almost everything for your studies Previous knowledge of social science ..... Getting along with other students Ability to remain relaxed, rather than overly tense and nervous about your work Learning as many medical facts as possible Making up your own mind about what to emphasize in your studying Getting along with the medicaltofaculty Ability carry out research  Haven't Not at a l l thought important about i t  +  .....  /  .... .....  144 - 5 12. What i s your r e a l i s t i c appraisal of how well you w i l l do i n your f i r s t year courses compared with the other members of your class? (Check one) ....... I expect to I expect to I expect to I expect to Don't know  do do be be  considerably better than average somewhat better than average about average below average  13. How d i f f i c u l t do you think each of the following w i l l be f o r you i n your f i r s t year of medical school? (Answer f o r each) Very „ ,. ^ . . difficult Making friends i n your class Keeping up with other students Learning what i s expected of you Adjusting to the sights and smells of the anatomy lab * Learning to think f o r yourself Getting to know f a c u l t y members * Not allowing yourself to become overly tense or nervous about your work  „ * * *  J  Fairly difficult  Not very difficult  Not at a l l difficult  14. (a) How much contact do you expect to have with f a c u l t y members during your f i r s t year of medical school? (Check one) A great deal A f a i r amount Only a l i t t l e Don't know (b) On the whole, do you expect that your contacts with the medical school f a c u l t y during your f i r s t year w i l l be more formal, l e s s formal, or about the same as your contacts with your undergraduate professors? (Check one) Contacts i n medical school w i l l be more formal They w i l l be less formal They w i l l be about the same Don't know * 15. To what extent do you think the f i r s t year medical students help each other? (Check one) They They They They  t r y to t r y to t r y to do not  16. VJhen would you l i k e patients? (Check one") I would l i k e I would l i k e I would l i k e I would l i k e I would l i k e Don't know  help each other a great deal help each other a f a i r amoi.nt help each other only a l i t t l e t r y to help each other at a l l to have your f i r s t substantial amount of contact with to to to to to  have have have have have  my it it it it  f i r s t substantial contact i n my f i r s t year i n my second year i n my t h i r d year i n my fourth year during my interneship  145 - 6 17. In which year of t r a i n i n g do you expect to have your f i r s t amount of contact with patients? (Check one) I expect to I expect to I expect to I expect to I expect to Don't know *  have have have have have  my it it it it  substantial  f i r s t substantial contact i n my f i r s t year i n my second year i n my t h i r d year i n my fourth year during my interneship  18. When do you expect that you w i l l f i r s t come to think of yourself as a doctor? (Check one)  19.  During my f i r s t year i n medical school During my second year During my t h i r d year During my fourth year During my interneship During my residency Haven't given i t any thought What things do you think you w i l l l i k e best about being a doctor? (Check as many as apply) Being able to deal d i r e c t l y with people Being able to help other people The f a c t that medicine i s a highly respected profession Having i n t e r e s t i n g and i n t e l l i g e n t people f o r colleagues Doing work involving s c i e n t i f i c method and research Being my own boss Being sure of earning a good income The challenging and stimulating nature of the work Other (What?  20. (a) In your opinion, how well does each of the following phrases describe the medical profession? (Answer f o r each) Very good description (1) (2) (3) (4) (5)  (6)  y  A profession which has high standing i n the community A profession of service to the community A profession which i s secure and l u c r a t i v e A profession which helps individuals d i r e c t l y A profession i n wh' -h r e a l a b i l i t y i s recognized by one's colleagues A profession r e q u i r i n g harder work than others  Fair description  Poor description  ..... .....  (b) In your opinion, which one of the above phrases best describes the medical profession? ( L i s t the appropriate number) 7777  )  - 7 -  PART B Medical Students' Experiences and Opinions  I.  This Section of the questionnaire deals with your experiences i n medical school and with your f e e l i n g s about the kind of t r a i n i n g a medical student ought to receive.  1. Many medical students seem to f e e l that they do not always have enough time to do a l l the things they want to. How do you f e e l i n t h i s respect - do you f e e l that you have enough time f o r each of the following a c t i v i t i e s ? (Answer f o r each)  Ample time  Just about enough time  Not quite enough time  Not nearly enough time  Learning a l l that you are expected to know i n medical school Following the l a t e s t medical advances i n books and journals Spending time with your family and friends Following up your own i n t e r e s t s i n the f i e l d of medicine Reading the newspaper, and keeping up with current a f f a i r s *  2. Compared to the other students i n your c l a s s , how hard would you say that you have worked i n your studies during the current semester? (Check one) Considerably harder than average Somewhat harder than average About average Somewhat less than average Considerably less than average 3. (a) Which phase of your medical t r a i n i n g do you think w i l l be most important f o r your l a t e r career i n medicine? (Check one)  '  3  F i r s t two years of medical school Last two years of medical school Interneship Residency Don't know (b) Which phase of your medical t r a i n i n g do you expect to f i n d most d i f f i c u l t ? (Check one) F i r s t two years of medical school Last two years of medical school ...... Interneship Residency Don't know  147 - 8 r  4. Everyone knows that medical students are given much more f a c t u a l information than they can possibly assimilate. In general, do you think that the f a c u l t y gives medical students enough d i r e c t i o n i n what to emphasize i n t h e i r studying? (Check one) Faculty gives too l i t t l e d i r e c t i o n Faculty gives about the r i g h t amount of d i r e c t i o n Faculty gives more than enough d i r e c t i o n  *  5. (a) What i s your r e a l i s t i c appraisal of how w e l l you are doing i n your courses compared with the other members of your class? (Check one) Considerably better than average Somewhat better than average About average Below average Don't know  *  (b) How  sure are you about how well you are doing?  (Check one)  Completely sure Quite sure Not sure t  (c) Rank the following according to t h e i r importance to you i n deciding how well you are doing at the present time. (Rank a l l three, placing a 1 before the most important, and so on) Comments of your fellow students Information given you by the f a c u l t y Your own personal self-evaluation  *  6. To what extent are you concerned about how well you are doing i n comparison with the other students i n your class? (Check one) Deeply concerned Quite a b i t concerned L i t t l e concerned Not at a l l concerned  *•  7. How do you f e e l about competing with other people, e s p e c i a l l y when the stakes are so high? My f e e l i n g about competitive situations i s that (Check one) I I I I I  *  d i s l i k e them and prefer to avoid them completely d i s l i k e them somewhat have neutral f e e l i n g s about them enjoy them somewhat get a kick out of them and sometimes seek them out  8. How much competitiveness have you found among your classmates i n medical school? (Check one) A great deal of competitiveness A f a i r amount of competitiveness Only a l i t t l e competitiveness No competitiveness at a l l  148  - 9 9. Are there some kinds of sick people to whom you f e e l e s p e c i a l l y drawn or toward whom you f e e l p a r t i c u l a r l y sympathetic? Yes No IF YES: (a) Toward which of the following types of patients are you most sympathetic? (Check as many as apply) Young people ...... People with terminal i l l n e s s e s People who are "down and out" A r t i c u l a t e people People who are optimistic about t h e i r i l l n e s s People who have clear-cut p h y s i c a l i l l n e s s e s People who have confidence i n the doctor .. Other (Which? ) (b) What do you think you should do when you f i n d yourself p o s i t i v e l y drawn to a patient? (Check one) I'd t r y to control these f e e l i n g s , and regain my sense of objectivity I'd take advantage of these feelings to t r y to draw the patient closer to me I wouldn't t r y to change my feelings at a l l Other (What? ) 10. Are there some kinds of sick people toward whom you f i n d yourself reacting negatively? Yes No IF YES: Toward which of the following types of patients do you react negatively? (Check as many as apply) Old people People who think they know as much about medicine as the doctor Inarticulate people People who have nothing but psychogenic symptoms People who f e e l sorry f o r themselves People who have p h y s i o l o g i c a l l y improbably symptoms People who make no r e a l e f f o r t to get well Other (Which? )  149  -loll.  This section deals with the medical profession i n general and with standards of medical care.  *  11. (a) In your opinion, how important i s each of the following c h a r a c t e r i s t i c s i n making a good physician? (Answer f o r each) Very Fairly Of minor Not at a l l important important importance important (1) Good appearance (2) Warm and pleasing personality (3) Dedication to medicine (4) High i n t e l l i g e n c e (5) S k i l l f u l management of time (6) S c i e n t i f i c c u r i o s i t y (7) Integrity (8) A b i l i t y to thinkin an organized way ..... (9) Research a b i l i t y (10) A b i l i t y to get along with people (11) Recognition of own limitations (12) Getting r e a l enjoyment out of medicine  *  (b) In your opinion, which two of these c h a r a c t e r i s t i c s are most important i n making a good physician? ( L i s t the appropriate numbers) # and # (c) In your opinion, which of these are more important to medicine than to other professions? # and # 12. How important i s each of the following types of s o c i a l behavior to the success of a physician? (Answer f o r each) Very Fairly Not at a l l important important important To maintain a restrained and d i g n i f i e d manner To wear conservative clothing To p a r t i c i p a t e i n community a c t i v i t i e s To be a good conversationalist To have a degree from a top medical school To maintain an a i r of confidence (even when he i s not f e e l i n g confident) .....  150 - 11 13. The various s p e c i a l t i e s within the medical profession present d i f f e r e n t opportunities, and correspond to d i f f e r e n t sorts of interests and talents among doctors. What i s your judgment about the following s p e c i a l t i e s i n the respects l i s t e d below? Please indicate to what extent each of the following i s a good description of the s p e c i a l t i e s l i s t e d . ( I f you think the statement i s very appropriate to the specialty, please put a 1 on the corresponding line"! I f you think i t i s f a i r l y appropriate, please put a 2. I f you think i t i s not very appropriate, please put a 3. I f you think i t i s inappropriate, please put a 4.) (Please put a number f o r each s p e c i a l t y on every statement.) Surgery A f i e l d where one can e s t a b l i s h h i s own hours of work A f i e l d i n which patients are highly appreciative of what i s done f o r them A f i e l d where diagnostic problems are e s p e c i a l l y challenging A f i e l d where r e l a tionships with c o l leagues i n the same s p e c i a l t y are part i c u l a r l y enjoyable A f i e l d which i s very l i k e l y to y i e l d a good income A f i e l d which presents opportunities f o r knowing patients well A f i e l d which has high prestige within the medical profession  Ifedicine  Psychiatry  Paediatrics  Ob.Gyn.  General Practice  .....  .....  ..... *  14. In which one of the following categories would you say that the average y e a r l y income of the s p e c i a l i s t and of the general p r a c t i t i o n e r f a l l ? (Check one i n each group) Specialist Under $5,000 $ 5,000 up to $10,000 up to $15,000 up to $20,000 up to $25,000 up to  $10,000 $15,000 $20,000 $25,000 $35,000  General P r a c t i t i o n e r Under $5,000 % 5,000 up to $10,000 $10,000 up to $15,000 $15,000 up to $20,000 $20,000 up to $25,000 $25,000 up to $35,000  151 - 12 III.  This section deals with your p r o f e s s i o n a l plans and ambitions for the future.  Even though you may not be c e r t a i n of your plans, please answer  the questions on the basis of your present hopes or preferences. 15. How much have you thought about the kind of medical career you would l i k e to have? (Check one) A great deal A f a i r amount Only a l i t t l e Not at a l l 16.  Which of the 1st Which of the 1st  following f i e l d s of medicine would you l e a s t l i k e to enter? choice... ......... 2nd choice following f i e l d s of medicine would'you l i k e to enter? choice 2nd choice  Medicine Surgery Obstetrics and Gynaecology Paediatrics Pathology Psychiatry Orthopaedics Dermatology Ear, nose and throat Public Health General Practice Research Other (What?  )  17. I f you could arrange i t , i n vh i c h one of the following situations would you plan to carry out the professional a c t i v i t y you said you prefer most? (Check one) Own professional o f f i c e with h o s p i t a l a f f i l i a t i o n Own p r o f e s s i o n a l o f f i c e without h o s p i t a l a f f i l i a t i o n Large private c l i n i c or h o s p i t a l Small group c l i n i c Medical school Other (What? ) (a) For the student who does exceptionally well i n medical school, how would you rank the following f i v e career plans i n order of t h e i r d e s i r a b i l i t y ? (Rank a l l f i v e , placing a 1 before the most desirable, and so on) Residency, followed by general practice Advanced t r a i n i n g , followed by a research career Residency, followed by s p e c i a l t y practice No residency, followed by general practice Advanced t r a i n i n g , followed by f u l l - t i m e teaching i n medical school  152 - 13 17. (Cont'd) (b) How do you think the f a c u l t y as a whole would rate these career plans f o r the student who does exceptionally well? (Rank a l l f i v e ) Residency, followed by general practice Advanced t r a i n i n g , followed by a research career Residency, followed by specialty practice No residency, followed by general practice Advanced t r a i n i n g , followed by f u l l - t i m e teaching i n a medical school 18.  What yearly income do you think you might r e a l i s t i c a l l y expect (a)  Ten years after medical school?  (Check one)  Under $5,000 $ 5,000 up to |10,000 $10,000 up to $15,000 $15,000 up to $20,000 $20,000 up to $25,000 $25,000 or over *•  (b) At the peak of your career?  (Check one)  Under $5,000 $ 5,000 up to $10,000 $10,000 up to $15,000 $15,000 up to $20,000 $20,000 up to $25,000 $25,000 or over How s a t i s f i e d w i l l you be with the y e a r l y income you think you might r e a l i s t i c a l l y expect (c)  Ten years after medical school?  (Check one)  Very s a t i s f i e d Fairly satisfied Dissatisfied (d)  At the peak of your career?  (Check one)  Very s a t i s f i e d Fairly satisfied Dissatisfied * 19. what extent have you worried that you may not be able to have the kind of medical career you want? (Check one) A great deal A f a i r amount Only a l i t t l e Not at a l l  153  - 14 -  20. Once you have received a licence to practice medicine, to what extent do you expect to continue your medical education by each of the following routes? (Answer f o r each)  Regularly  Occasionally  Never  Reading medical journals Reading medical textbooks Attending l o c a l medical society meetings Supplementing your practice with research a c t i v i t i e s Teaching f u l l - t i m e i n a medical school Teaching part-time i n a medical school Serving i n an out-patient c l i n i c Taking post-graduate and summer s p e c i a l t y courses Examination of publications of pharmaceutical houses By contacts with consultants on your cases  Unsure  .....  21. Below are some considerations that might enter into your selection of a s p e c i a l t y or of general practice i n medicine. Which two are most important to you as you think about your career? Which two are l e a s t important? (Check two i n each column) Most important  Least important  Having the opportunity to know your patients well Being able to establish your own hours of work Meeting diagnostic problems that are p a r t i c u l a r l y challenging Having enjoyable r e l a t i o n s h i p s with colleagues Making a good income Having patients who w i l l appreciate your e f f o r t s Having prestige within the medical profession IV  This f i n a l section deals with your background and your i n t e r e s t s .  The  information you provide here w i l l permit a comparison of the opinions, plans, and experiences of students with d i f f e r e n t kinds of backgrounds. *  22. Exact Date of B i r t h :  *  23. Sex:  *  24.  Male,  Month  Day  Female  M a r i t a l status: Single Married Engaged Divorced, separated, widowed If engaged: When do you plan to marry?  Year  25.  I f married:  (a) How long have you been married?  Years  (b) How many children do you have? 26.  How much have you worried that you might not be happy i n a medical career?' (Check one) A great deal Somewhat Only a l i t t l e Not at a l l  27.  How d i f f i c u l t i s i t f o r you to finance your medical (Check one)  education?  Very d i f f i c u l t Fairly difficult Not very d i f f i c u l t Not at a l l d i f f i c u l t 28.  (For students who depend on parents f o r some or a l l of t h e i r support) How do your parents f e e l about having you depend on them f o r f i n a n c i a l aid while you are i n medical school? (Check one) They are not happy about i t They are w i l l i n g , although i t i s d i f f i c u l t f o r them They are w i l l i n g to do i t They are very glad to do i t Other (What?  )  29. How much have you worried about the problems of supporting yourself (and your family): (Check one) (a)  While you are i n medical school? A great deal Quite a b i t Not very much Not at a l l  (b)  During your interneship?  (Check one)  A great deal Quite a b i t Not very much Not at a l l (c)  During your residency? (Check one) A great deal Quite a b i t Not very much Not at a l l Do not plan to take residency  (d)  During your early years i n practice? A great deal Quite a b i t Not very much Not at a l l  (Check one)  155 - 16 30.  Have you had a job f o r pay during the current semester? IF YES:  Yes....  No.  On the average, how many hours a week have you worked? (Check one) 10 or less 11-20 21-30 31 or more  31.  During the coming summer, do you plan to work (Check one) full-time part-time not at a l l  32.  If "FULL-TIME" or "PART-TIME": Is t h i s work related to medicine?  Yes  No.  W i l l you get paid f o r t h i s work?  Yes  No  What are your f a v o r i t e l e i s u r e time a c t i v i t i e s ? Going to the movies Reading serious books and magazines Listening to music Attending sports events as a spectator P a r t i c i p a t i n g i n sports events Going out on dates Talking with friends Working at s p e c i a l hobbies (What?. Other (What?  (Check 2 or 3 f a v o r i t e s )  ) )  *  33.  What i s your father's occupation? ( I f r e t i r e d or deceased, l i s t previous occupation)  *  34.  Name the c i t y , province or state and country i n which you l i v e d longest before going to college.  *  35.  What undergraduate college d i d you attend?  36.  (a)  In what f i e l d did you major as an undergraduate?  (b) I f jyou had i t to do over again i n what would you major i n undergraduate college?  156  - 17 #37.  Do you have any r e l a t i v e s who are i n any of the following professions?  Mo M.D.'s? Lawyers? Dentists? Clergymen? Teachers? Nurses? Engineers? Other professionals? (What?  Parents  Siblings  !!!!!!  !!!!!! !!!!!!  .... )  \[  ......  Name; First  Other relatives  Surname  3-57  BIBLIOGRAPHY  A s s o c i a t i o n of American Medical Colleges, The Ecology of the Medical Student, Report of the F i f t h Teaching I n s t i t u t e , Evanston, I l l i n o i s , 1958. Becker, Howard S., "Notes on the Concept of Commitment", American Journal of Sociology, V o l . LXVI, No. 1, J u l y I960, pp. 32-40. Becker, Howard S., and Carper, James V/., "The Development of I d e n t i f i c a t i o n with an Occupation", American Journal of Sociology. V o l . 61, No. 4, January 1956, pp. 289298. Becker, Howard S. and Carper, James W., "The Elements of I d e n t i f i c a t i o n w i t h an Occupation", American Sociol o g i c a l Review, V o l . 21, No. 3, June 1956, pp. 341-348. Becker, Howard S. and Geer, Blanche, "The Fate of Idealism i n Medical School", American S o c i o l o g i c a l Review, V o l . 23, No. 1, February 1958, pp. 50-56. Becker, Howard S. and Geer, Blanche, "Student Culture i n Medical School", Harvard Educational Review, V o l . 28, No. 1, Winter 1958, pp. 70-80. B l i s h e n , Bernard R., "The C o n s t r u c t i o n and Use of an Occupational Class Scale", Canadian Journal of Economics and P o l i t i c a l Science. V o l . XXIV, No. 4, November 1958, PP. 519-531. Bloom, Samuel W., "The Role of the S o c i o l o g i s t i n Medical Educat i o n " , Journal of Medical Education, V o l . 34, No. 7, J u l y 1959, PP. 667-673. Cahalan, D., C o l l e t t e , P., and Hilmar, N.A., "Career I n t e r e s t s and Expectations of U.S. Medical Students", Journal of Medical Education, V o l . 32, No. 8, August 1957, PP. 557-563. Cartwright, Ann, "The Career Ambitions and Expectations of Medical Students", Journal of Medical Education, V o l . 35, No. 3, March I960, pp. 251-257. Fox, Renee C , A S o c i o l o g i c a l Calendar of the F i r s t Year of Medical School, Columbia U n i v e r s i t y , Bureau of Applied S o c i a l Research, 1958.  Freeman, Howard E., and Reeder, Leo G., "Medical Sociology: A Review of the L i t e r a t u r e " , American S o c i o l o g i c a l Review, V o l . 22, No. 1, February 1957, pp. 73-81. Gee, Helen Hofer and Cowles, John T., Eds., The A p p r a i s a l of Applicants to Medical Schools, Journal of Medical Education, V o l . 32, No. 10, Part 2, October 1957. H a l l , Oswald, "The Stages of a Medical Career", American Journal of Sociology, V o l . 53, No. 5, March 1948, PP. 327-337. Hare, P a u l , Borgatta, Edgar F., and Bales Robert F., Small Groups, New York, Knopf, 1955. Jaco, E. G a r t l y , Ed., P a t i e n t s , Physicians and I l l n e s s , Glencoe, I l l i n o i s , Free Press, 1958. Kadushin, Charles, I n d i v i d u a l Decisions to Undertake Psychotherapy, Bureau of Applied S o c i a l Research, Columbia U n i v e r s i t y , Reprint 268, 1958. McCandless, F.D. and Weinstein, M o r r i s , "The R e l a t i o n of Student Anxiety to Concepts of Role i n M e c i a l Care", Journal of Medical Education, V o l . 33, No. 2, February 1958. Merton, Robert K., S o c i a l Theory and S o c i a l S t r u c t u r e, Revised, Glencoe, I l l i n o i s , Free Press, 1957. Merton, Robert K., Reader, George, and K e n d a l l , P a t r i c i a L., Eds., The Student P h y s i c i a n , Cambridge, Harvard U n i v e r s i t y Press, 1957. N a s a t i r , E. David, Occupational Inheritance W i t h i n the Medical P r o f e s s i o n , Paper read at the F i f t v - s e c o n d Annual Meeting of the American S o c i o l o g i c a l Society, Washington, D.C., August 29, 1957. Parsons, T a l c o t t , The S o c i a l System, Glencoe, I l l i n o i s , Free Press, 1951. Rosenberg, M o r r i s , Occupations and Values, Glencoe, I l l i n o i s , Fre e'Pre ss, 1957Taxation D i v i s i o n , Taxation S t a t i s t i c s , 1959. Ottawa, Queen's P r i n t e r , 1959. W i l l i a m s , Robin M.,  J r . , American Society. New York, Knopf,  

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