1.� Aristeiguieta, C. A.� (1998).� Substance abuse, mental illness, and medical students: The role of the Americans with Disabilities Act.� The Journal of the American Medical Association, 279(1), 80.

TYPE OF ARTICLE:� Review.
PURPOSE:� To review the Americans with Disabilities Act and how it impacts medical education for persons with substance abuse and mental illness disabilities.
FINDINGS:� The author states that although there is a slight increased number of substance abuse and mental illness cases in the medical profession than in others, physicians with such disabilities are no more of a risk to the themselves or the public than other physicians.� As a result, persons with such disabilities should not be dissuaded from pursuing a medical degree on the basis of their disability.� It is illegal.� The legal admissions process is then outlined by: how disability is defined, who qualifies, and what schools must do to comply.

Key words:� substance abuse, mental illness, disability, medical education, ADA.

2.   Arkar, H. & Eker, D. (1997). Influence of a 3-week psychiatric training programme (sic) on attitudes toward mental illness in medical students. Journal of Social Psychiatry Epidemology, 32, 171-176.

ABSTRACT: This study was carried out to assess the influence of psychiatric training, including direct patient contact, on attitudes toward mental illness. An experimental group consisting of medical students going through their 3-week training in psychiatry was compared with a control group going through training in ophthalmology. The psychiatric training involved direct patient contact and course work. Attitudes toward three different vignettes were assessed before and after training. Analyses showed there were no significant changes in the attitudes of the psychiatry group when compared to the ophthalmology group. Inconsistent findings in the literature were pointed out and a more analytical approach, focusing on the specific features of exposure was suggested.

Key words: attitudes toward mental illness, psychiatric training.

3. Arnold, L., Calkins, V.E. & Willoughby, T.L. (1994). Medical Student’s Perceptions of Stress: Gender and Ethnic Considerations. Academic Medicine, 69,10, S22-S24.

ABSTRACT: Stress has always been associated with medical school. Since 1968, studies have been conducted regarding stress, and recommendations were being made on how to best develop positive coping skills for handling stress. Based on knowledge from a number of studies reporting on the level of stress that medical students experience, The University of Missouri-Kansas City (UMKC) developed a unique six-year combined degree program with the intent of alleviating some stressors medical students may endure. A study from 1984 showed that stress at UMKC was, indeed, less than that in traditional schools. However, since the study in 1984, several changes have been made that could increase the stress at UMKC. At the same time; however, stronger support systems for the student body were implemented. The objective of the current study was to learn whether students’ perception of stress in their environment had changed and whether these perceptions were significantly different with regard to the gender or ethnicity of the students. Also, the amount of time students had been in the program and other demographic variables were looked at.

The study participants were all students in years two, four and six of the combined degree program at UMKC. The students completed a questionnaire on stress anonymously. Stress was operationalized by students’ self-reports of situations in their learning environment that they deemed problematic and was measured by the Medical School Environmental Stress Inventory using a Likert scale from 1-7.

Recognizing the changes in the school’s program, the authors had hypothesized a greater increase in students’ stress levels. However, this was not the case. One can deduce that the student support services implemented by the University resulted in more positive coping skills and effective stress management. When looking at comparisons between gender, ethnicity, and time in program, no significant findings existed. However, when looking at the stepwise regression analysis, students who were self-reported minority status (mostly Asian) and had a physician as a parent were apparent. This would suggest that although there was no significant finding in t-tests there is a difference between this population and the other medical students.

Key words: stress, medical school.

4. Ashton, C.H. & Kamali, F. (1995). Personality, lifestyles, alcohol and drug consumption in a sample of British medical students. Medical Education , 29, 187-192.

ABSTRACT: Personality characteristics and lifestyle variables were assessed in two cohorts of second year medical students at the University of Newcastle, Tyne, UK in 1993-94 and then compared, where possible, with a similar survey previously conducted in Newcastle upon Tyne medical students in 1983-84. For the current research, measures included the Eysenck Personality Questionnaire, the Hospital Anxiety Depression Scale and the questionnaire concerning consumption of alcohol, tobacco, cannabis and other illicit drugs, and physical exercise. When comparing alcohol consumption, overall the 93-94 students showed an increase in consumption. Reported use of cannabis and other illicit drugs more than doubled. Anxiety levels were not measured in the 83-84 study, but for the current participants, anxiety levels measured within the clinically significant range. These findings suggest a need for a larger study across different universities and faculties so that appropriate arrangements for student education and health care can be made.

Key words: lifestyle comparisons, medical students, anxiety levels.

5.� Association of Academic Physiatrists.� (1993).� Recommended guidelines for admission of candidates with disabilities to medical school.� American Journal of Physical Medicine Rehabilitation, 72(1), 45-47.

TYPE OF ARTICLE:� White paper.
PURPOSE:� To suggest ratifications, point-by-point, to the Association of American Medical College�s (AAMC) 1991-1992 document on medical school admissions requirements.� These suggestions eliminate the discriminatory message conveyed to schools about applicants with disabilities.
FINDINGS:� The Association of Academic Physiatrists (AAP) was concerned about the ability-focused essential functions outlined by the college accrediting body, the AAMC.� In addition, the AAP began to receive complaints from applicants with disabilities to medical schools that were being denied admission on the basis of their disability and/or its impact.

The guidelines outlined in this white paper are based on the principles that: (1) having a disability does not impact the quality of care a physician may provide in the appropriate setting; (2) no one physician is clinically appropriate in every setting; and (3) each school should have explicit guidelines outlining the admission process for all applicants.� From these principles, the AAP has made specific recommendations that are meant to minimize discrimination against persons with disabilities.� These include: admitting qualified individuals regardless of presence of a disability; all students are held to the same academic standard; reasonable accommodations are provided, the costs of which are assigned to the school; and applicants who are denied admission have the right to appeal.� Lastly, the AAP outlines the 5 necessary abilities and skills in detail that are required for admission: observation; communication; motor; intellectual-conceptual, integrative, and quantitative abilities; and behavioral and social attributes.

The overriding message of the AAP�s recommendations is to instruct medical schools that they do not need to admit every student with a disability.� Rather, they need to provide an equal opportunity for admission to all their applicants.

Key words:� medical schools, disability, essential functions, admissions.

6. Bramness, J.G., Fixdal, T.C. & Vaglum, P. (1991). Effect of medical school stress on the mental health of medical students in early and late clinical curriculum. Acta Psychiatrica Scandinavica, 84, 340-345.

ABSTRACT: Earlier research has shown that medical students in the United Kingdom and the United States report a higher level of nervous symptoms than the general population. To better understand how medical students in Norway compare with these findings, 299 male and female students in the clinical curriculum at the University of Oslo were asked to complete a questionnaire about themselves and their mental health. Medical students in Norway do not differ from the general population in mental health. However, the students report a lower level of general self-esteem than the general population. The male students had more nervous symptoms and less general self-esteem than the female students when compared to the general population. This research also shows that medical school stress is a good predictor of nervous symptoms even when psychosocial variables such as marital or cohabitation status, confident other and general self-esteem are taken into consideration.

Key words: nervousness, medical students.

7.� Brown, M.� (1998).� A medical degree and nowhere to go.� The Journal of the American Medical Association, 279(1), 82.

TYPE OF ARTICLE:� Commentary.
PURPOSE:� To describe the author�s personal experience as a physician with a disability who is collecting unemployment checks because of her inability to secure proper specialty training with accommodations for her disability.
FINDINGS:� The author highlights the attitudinal challenges she faced from professors and students alike during medical school as the foreground for why she believes she was unable to attain specialty training.�

Key words:� medical student with physical disability, physician, physical disability, specialty training, strategy development, attitudes, personal commentary.

8 . Brown, Peggy Ann. (2000, December). Substantial Frustrations. The New Physician, 11-15.

ABSTRACT: This commentary outlines the struggle for those with Learning Disabilities (LDs) to disclose their conditions and receive the proper accommodations on certain tests required before being accepted into medical school. Whether or not to disclose that one experiences an LD can be a hard decision to make because students often worry about the stigma attached when one is identified as having a learning disability. Furthermore, although medical schools are expanding efforts to assist students with LDs achieve their potential, the National Board of Medical Examiners (NBME) still applies strict criterion for determining who may qualify for testing accommodations under the Americans with Disabilities Act (ADA). The NBME requires documented proof of a person’s LD, and the student must satisfy the ADA’s definition of being “substantially limited” in a major life activity before one can receive testing accommodations for the United States Medical Licensing Exam (USMLE). The latter may be especially difficult to prove as most who experience an LD have what some call “gifts of greatness,” helping them compensate for their disabilities. Gifts of greatness range from an above average IQ to strong verbal skills. Hence, something that may substantially limit a medical student would not necessarily substantially limit an average person whose abilities fall below those of most medical students. In other words, the ADA defines the term “substantially limits” against the general public rather than relatively. This article articulates that while some institutions are working to make more comprehensive and improved services available to those with LDs, some students are still reluctant to reveal LDs. These students worry that it may hinder their chances in medical school in other ways. There needs to be a more broad based effort by medical schools and institutions to recognize and reasonably accommodate medical students with learning disabilities.

Key words: learning disabilities, medical school, National Board of Medical Examiners, United States Medical Licensing Exam.

9.� Camp, D. L., Hollingsworth, M. A., Zaccaro, D. J., Cariaga-lo, L. D., and Richards, B. F.� (1994).� Emotional impact of medical school and residency: Does a problem-based learning curriculum affect depression in medical students?� Academic Medicine, 69(10), S25-S27.

TYPE OF ARTICLE:� Research.
PURPOSE:� To investigate and compare changes in self-reported depression among medical students enrolled in either a lecture-based learning (LBL) or problem-based learning (PBL) curriculum at the same medical school.
FINDINGS:� The researchers found that there was not a correlation between depression and the two different types of curriculum.� However, they did find that medical students have a greater tendency to report symptoms of depression than the general population; the reason for this phenomenon is unknown.� In addition, women were more likely to report depression than their male counterparts.� This is different from prior research wherein no difference had been found.

Key words: medical students, depression, medical school, medical education, curriculum.

10.� Clark, D. C. & Zeldow, P. B.� (1988).� Vicissitudes of depressed mood during four years of medical school.� The Journal of the American Medical Association, 260(17), 2521-2528.

TYPE OF ARTICLE:� Research.
PURPOSE:� To quantifiably describe the vicissitudes of depressed mood for one medical school class that was assessed repeatedly over time from the first day of medical school until several months short o graduation.
FINDINGS:� This study found that 12% of the class experienced depressive symptoms during their first three years; the largest fraction of this percentage (25%) were symptomatic near the end of their second year.� Also, it appears that students remained symptomatic throughout their program.� There were no significant differences between men and women.

The depressed mood was found to have no association between substance abuse and depression severity; a positive association between psychotherapy and depression severity, and a negative relationship between academic performance and depression severity.� However, there were no clear distinctions made on if/when students became disabled as a result of their depressed mood, nor was there a discussion on disability related to mental illness.

Of note, the authors postulate that although the prevalence of clinical depression in this study ranged between 3 and 8 percent during the first three years of medical school, it is not medical school or the professional stressors that cause the depression.� Rather, the authors believe that there are premorbid personality factors that influence the student�s vulnerability to depression and these factors may actually be solicited at some level during medical school admission.

Key words:� medical students with depression, medical students, substance abuse, academic performance.

11. Cole, Theodore, Meier, Robert, & Strax, Thomas (1993). Recommended Guidelines for Admission of Candidates with Disabilities to Medical School. The American Journal of Physical Medicine & Rehabilitation, 22,1.

ABSTRACT: Dr. Robert Meier told the Association of Academic Physiatrists that American medical schools were denying applicants simply because they have physical disabilities. A council was appointed to draft a white paper discussing this issue and provide recommendations. The Board strongly recommends that this paper be accepted not only by the Association of American Medical Colleges, but also by all American medical schools.
In 1991-92, the Association of American Medical Colleges published a document on medical school admission requirements for the United States and Canada. It states that candidates for the MD degree must have somatic sensation, the use of all senses, equilibrium, and motor function. The panel for the Association of American Medical Colleges, who seem to be the root of this document, suggest that candidates for the MD degree should have the abilities and skills in these areas: communication, motor, conceptual, integrative, and quantitative, as well as behavior and social. It recognized that technological compensation could be made for handicaps in certain areas. Because there are many practicing MDs who experience disabilities, it has been proven that individuals with physical disabilities are able to successfully practice medicine. This proclamation is what has driven the Association of Academic Physiatrists to create a more inclusive document outlining recommendations for the acceptance of those with disabilities into medical programs.

Key words: medical school admission, persons with disabilities, inclusion.

12.� Conill, A.� (1998).� Living with disability: A proposal for medical education.� The Journal of the American Medical Association, 279(1), 83.

TYPE OF ARTICLE:� Commentary.
PURPOSE:� To describe the process and outcome of a 48-hour pilot �sensitivity training� program for 14 medical students about living with a disability.� The goal was to provide additional insight to physicians providing care to people with disabilities.
FINDINGS:� The author worked with the University of Pennsylvania to provide a sensitivity training program on living with disabilities.� Fourteen students were assigned into pairs wherein one student was a person with a specific disability (with equipment) and the other, the caregiver.� Students had to maintain their roles for a period of 48hours.� At the conclusion of the exercise, students in both roles were equally tired, sad, angry, and frustrated.� As a result, the students realized that physicians working with patients with disabilities need to not only understand the disease process of their patient, but also their experience of illness.� This acknowledgement, the author claims, will lead to more collaborative and integrated care for the patient, especially around issues of communication and skills.

Key words:� medical students, physical disability, sensitivity training, attitude, communication.

13.� Corbett, B.� (1991).� Physicians with disabilities.� Western Journal of Medicine, 154, 514-521.

TYPE OF ARTICLE:� Commentary.
PURPOSE:� To document 18 physicians with disabilities about their experiences with adaptations, discrimination (childhood to current professional life), compensation (i.e. what additional expenses they incur due to their disability), patient acceptance, and about advice they would give to medical schools and other medical students with disabilities.
FINDINGS:� While this article details the 18 physicians� interviewed experience in each of the aforementioned areas, the overriding message is that persons with disabilities can be quality physicians.� The interviews also document the continued existence of discrimination and poor attitudes toward people with disabilities in general.� However, in most of the interviewees� situations, once patients and colleagues became better acquainted with the physician with a disability, they were able to gain their respect; they were not automatically given respect like many of their colleagues without disabilities.

Key words:� physicians with disabilities, medical students with disabilities, attitudes, adaptations, accommodations, patient acceptance, advice, admissions, essential functions, medical schools.

14. Corbett, B. (1991). Rehabilitation Medicine, Adding Life to Years: Physicians with Disabilities. The Western Journal of Medicine, 154, 5, 514-521.

Abstract: There are no reliable data indicating the prevalence of physicians with disabilities. An informal 1987 study found that only 2.6% of all physicians, and only .25% of currently enrolled medical students report having disabilities, as opposed to 14.6% for the general population. There are many reasons for this, some of which include adaptations and discrimination from medical schools, patients and the general population. For all people with disabilities, discrimination is slowly subsiding in the light of awareness generated by their greater visibility in society. Physicians with disabilities are no exception. Their mere presence enables others with or without disabilities to become more aware of the possibilities for people with disabilities. Today’s physicians with disabilities are like pioneers. Medical schools can now build on their successful experience with students who have disabilities.

Key words: physicians with disabilities, discrimination, medical school, disabilities.

15. Deary, I.J., (1994). Need medical education be stressful? Medical Education, 28, 55-57.

Abstract: There would appear to be some agreement to the effect that medical education and, perhaps, medical careers, are too stressful. The cause is usually traced to an overloaded curriculum and/or an uncaring educational environment. Rather, little has been said about the range of individual responses to medical education: those who thrive in the atmosphere of challenge, and those who find they will only work in response to a deadline or an impending examination, are not mentioned. Not much has been said; either, about the inevitability, or otherwise, of stress in professional training that attempts to adequately to prepare young people to make complex life-or-death decisions at speed in the face of uncertain evidence.

Key words: stress, medical school, medical careers.

16. EL-Mallakh, R.S. (October, 1985). Survey of Handicapped Physicians in Practice. Connecticut Medicine, 49, 10, 643-644.

ABSTRACT: A preliminary survey of practicing physicians in neurology, pathology, and psychiatry was conducted. It was found that 1.12% of all physicians in this sample experienced a physical disability. The severity of these disabilities ranged from blindness to impaired hearing. In this preliminary survey, residents with disabilities appeared predominantly in programs with faculty members who had disabilities, indicating that role models may play an important role for the young doctor with a disability.

17. Essex – Sorlie, D. (1994) The Americans with Disabilities Act: I. Implications and Suggestions for Compliance for Medical Schools. Academic Medicine, 69, 7, 525-535.

ABSTRACT: This report presents a brief history and summary of the Americans with Disabilities Act (ADA) including an extensive section of definitions and explanations of key components outlining their relevance to medical schools. While these definitions are numerous and somewhat technical, an understanding of them is essential for medical school faculty, staff, and administrators to assess the ADA’s impact on, and implications, for their institutions to assure adequate and appropriate compliance. A companion article, published in the same issue of Academic Medicine, focuses on the implications of the ADA for colleges of medicine and offers suggestions for compliance.

Key words: Americans with Disabilities Act (ADA), medical school, medical students with disabilities, implications of ADA and medical schools.

18. Essex – Sorlie, D. (1994) The Americans with Disabilities Act: II. Implications and Suggestions for Compliance for Medical Schools. Academic Medicine, 69, 7, 525-535.

Abstract: There is a need for more information about the Americans with Disabilities Act (ADA) that is tailored to colleges of medicine so that faculty, staff, and administrators can understand and carry out their responsibilities under the Act. This report (part II) as well as part I (in the same issue of Academic Medicine) address this need. The present report focuses on the educational relationship between medical schools, applicants, and students in the context of the ADA. A comprehensive array of implications for the ADA is discussed in question and answer format. The report concludes with fifteen recommended steps that colleges should take to comply with the ADA. Medical educators must continue to adjust their understanding and knowledge of the ADA’s implications for medical schools, given that the interpretation of the ADA will evolve as the courts amplify and implement it.

Key words: Americans with Disabilities (ADA), medical school, medical students with disabilities.

19. Faigel, H. (May, 1992). Services for Students with Learning Disabilities in U.S. and Canadian Medical Schools. Academic Medicine, 67, 5, 338-339.

ABSTRACT: Between September 1, 1990, and March 31, 1992, 103 of the 142 schools in the United States and Canada responded to a questionnaire regarding their services and programs for medical students with learning disabilities. Ninety-three schools accepted such students (and ten did not), but only two thirds had support programs, and half lacked the capacity to diagnose learning disabilities. Twenty-five did not know they could administer licensing examinations in a nonstandard manner, and 19 had no senior administrator or faculty member coordinating learning disability services. The author concludes that these results suggest that medical schools are poorly informed about, and unprepared to help, students with learning disabilities.

Key words: medical school accommodations, medical school services, medical students with learning disabilities.

20. Faigel, H. (December, 1998). Changes in Services for Students with Learning Disabilities in U.S. and Canadian Medical Schools 1991-1997. Academic Medicine, 71, 12, 1290-1291.

Abstract: The purpose of this article was to determine the changes between 1991 and 1997 in the admission policies of, and services offered, by U.S. and Canadian medical schools to students with disabilities. Between June 1 and August 31, 1997, the author surveyed 144 medical schools in the United States and Canada regarding their services and programs for medical students with learning disabilities. The questionnaire was the same one as used in a 1991 study. The results showed that of the medical schools contacted, 106 responded (one Canadian school sent a letter but did not complete the questionnaire). Ninety-four of 96 U.S. schools, and seven of the remaining nine Canadian schools said that they accept students with learning disabilities. All of the respondents that accept such students claimed to make some academic accommodations and indicated that they would administer non-standard (un-timed) licensing examinations, and many reports state their affiliated post-graduate medical training program would also make appropriate accommodations for students with learning disabilities. The author concludes that when compared with the results from the 1991 survey, the new data suggest that medical schools have improved their services for students with learning disabilities in response to the Americans with Disabilities Act.

Key words: medical school accommodations, medical students with learning disabilities, medical school acceptance of students with learning disabilities.

21. Flaherty, J. & Richman, J. (March, 1993). Substance use and Addiction Among Medical Students, Residents and Physicians. Psychiatric Clinics of North America, 16, 1, 189-196.

ABSTRACT: This literature review examines the existing data on alcoholism, drug addiction, and substance usage among physicians in the service of answering the salient questions on this topic. First, what is the true prevalence of substance abuse and alcohol problems among medical students, physicians in training, and practicing physicians? Do these prevalence rates change over the course of medical school, residency, and entry into practice? Are these rates greater or less than those for the general population or specific control populations such as nurses or lawyers? Second, what are the risk factors that determine which physicians become substance abusers or alcoholics? What is the relative role of family history compared with other psychosocial factors such as personality, coping style, and environmental stress? Do medical students bring in to medical school a risk for alcoholism and substance abuse based on their past socialization, genetic endowment, and personality, and/or do they acquire an at-risk status as a result of the incumbent demands of their training? Are there gender differences in substance abuse and alcohol problems among medical students and physicians, and if so, are these different from their age cohorts in the general population? Finally, what is the prognosis for problems related to substance abuse and alcohol in young physicians over the course of time, and what are the effects of treatment on maintaining abstinence rates?

Key words: alcohol abuse, drug abuse, substance abuse, physicians, residents, medical students.

22.� George, S. C.� (****).� Ready and able: With federal legislation ensuring a place for them in medical school, many aspiring physicians are eager to prove that their disabilities aren�t inabilities.� **The New Physician?****, ***, *****.

TYPE OF ARTICLE:� Review.
PURPOSE: To review the implications of the ADA for medical schools by giving specific, actual student scenarios.
FINDINGS:� The ADA provides a legal �open-door� to students with disabilities, unlike any prior legislation, without compromising academic integrity.� However, there are some organizations, such as the Association of American Medical Colleges, which is responsible for school accreditations, that remain in arguably discriminatory waters.� As a result, some groups, such as the Association of American Physiatrists and the American Medical Students Association, are studying the implications of disability on medical education and profession, and making recommendations.� This discussion is substantiated by the inclusion of interviews with medical students with disabilities ranging from cerebral palsy to blindness in terms of their admissions process and progress through their programs.

Key words: medical students with physical disabilities, medical education, ADA, disclosure, admissions, accommodations, student scenarios.

23. Gordon, L. (Spring, 1996). Mental health of medical students: the culture of objectivity in medicine. The Pharos, 2-10.

ABSTRACT: The mental health of medical students is often over looked. Studies of depression, suicide, and substance abuse demonstrate that medical students constitute a population at risk. An estimated 12% of medical students suffer from major depression during the first two years of medical school. The literature review in this article provides a comprehensive analysis of medical students and their likelihood to become substance abusers, depressed, suicidal, etc. There are debates on the influence medical school has on these dispositions and the effect of one’s own personality traits going into medical school. The author concludes that depression, suicide, and substance abuse have been demonstrated to be significant problems in the medical student population and may be under recognized and under treated.

Key words: mental health of medical students, depression, substance abuse, suicide.

24. Graham, J. & Ramirez, A.J. (1997). Mental Health of Hospital Consultants. Journal of Psychosomatic Research, 43, 3, 227-231.

ABSTRACT: This editorial articulates the risk of those in the medical field to depression, burnout/emotional exhaustion, and suicide. One statistic shows that psychiatric morbidity among hospital consultants is 28% while that reported among the general population is only 18%. The editorial outlines a stress model of four stages: 1) environmental demand, such as excess workload and lack of professional support; 2) perceptions of demand and the inability to cope; 3) maladaptive coping responses such as working longer hours and drinking alcohol; and 4) poor mental health. The author concludes that the continued exposure of hospital consultants to a high risk of burnout and psychiatric morbidity will not only involve the ongoing personal suffering of doctors and their families, but may also constitute a threat to the quality of patient care they deliver. It may also increase the trend for early retirement and the burden on colleagues remaining behind.

Key words: psychiatric morbidity, stress, mental health, medical field.

25. Guthrie, E., Black, D., Bagalkote, H., Shaw, C., Campbell, M. & Creed, F. (1998). Psychological stress and burnout in medical students: a five-year prospective longitudinal study. Journal of the Royal Society of Medicine, 91, 237-243.

ABSTRACT: The aim of this study was to assess psychological morbidity and symptoms of burnout in medical students during their undergraduate training, and to identify baseline factors that predict psychological morbidity in students in the final year of the course. It was a 5-year prospective longitudinal cohort study. Students were assessed in years 1, 4 and 5 of their medical undergraduate training by means of the GHQ-12 and the Maslach Burnout Inventory. One hundred seventy two, 157, and 155 students out of an original group of 204 completed assessments in years 1, 4 and 5, respectively. Eighteen students were above threshold on the General Health Questionnaire (GHQ-12) on all three occasions, 25 on two occasions and 43 on one occasion; 69 students were never a “case.” Students who were cases on two or more occasions were more likely to find the medical course stressful during the first year, but not subsequent years. There was no significant difference between the percentages of men and women who scored as cases on the GHQ-12 in any of the years. The best predictor of psychological morbidity in the final year of the course was the GHQ-12 score in year 1. This study suggests that a small group of students repeatedly experience psychological distress during their medical training.

Key words: burnout, medical students, psychological morbidity, assessment, GHQ-12

26. Guthrie, E., Black, D., Shaw, C., Hamilton, J., Creed, F. & Tomenson, B. (1995). Embarking upon a medical career: psychological morbidity in first year medical students. Medical Education, 29, 337-341.

Abstract: This study was undertaken to measure the prevalence of psychological morbidity, and the nature and source of stress, in first year medical students. Two hundred and four first year medical students at a university in north England were sent a postal, self-report questionnaire. They were asked to complete the General Health Questionnaire (GHQ), the Stress Incident Report and to give details of their alcohol consumption. A total of 172 students replied. Thirty-six percent of the students scored above the threshold of the GHQ, indicating probable psychological disturbance. There was no difference between men and women. Approximately half of the students described a stressful incident, the majority of which were related to medical training rather than to personal problems. Male students reported drinking significantly more than female students, but there was no relationship between levels of alcohol consumption and either psychological disturbance or reporting of stress.
The findings suggest that even at the preliminary stages of medical training, many students find aspects of the medical course very stressful. The psychological well being of medical students needs to be more carefully addressed, and closer attention needs to be paid to the styles of medical teaching that may provoke avoidable distress.

Key words: stress, medical school, medical students.

27.� Haas, R.� (1998).� Experiences with d/deaf culture.� The Journal of the American Medical Association, 279(1), 82.

TYPE OF ARTICLE:� Commentary.
PURPOSE:� To describe the author�s personal experience as a medical student with a hearing impairment learning about the Deaf community and culture.
FINDINGS:� The author describes the distinction between being deaf and being part of the Deaf community.� For example, many members of the Deaf community do not consider their inability to hear to be pathological, which is contrary to what some deaf people believe.� This insight would be helpful for physicians working with deaf individuals.� Therefore, the author encourages other physicians and medical students to learn more about being deaf and the Deaf community.

Key words:� medical students with hearing impairment, deaf, Deaf community, personal commentary.

28.� Hartman, D. W. & Hartman, C. W.� (1981, February).� Disabled students and medical school admissions.� Archives in Physical Medicine Rehabilitation, 62, 90-91.

TYPE OF ARTICLE:� Commentary.
PURPOSE: To discuss three questions asked by medical school admissions committees regarding the acceptance of disabled persons who enter into medical schools: (1) Can a student with a disability be admitted to an undifferentiated graduate program when they will not be able to practice in any field of medicine after graduation? (2) Are the costs of educating a person with a handicap prohibitive? And (3) Will the admission of students with disabilities result in the lowering of medical school standards?
FINDINGS:� The authors discuss each of the questions individually and substantiate them with examples from one of the author�s personal experiences as a medical student with a visual impairment.� First, it is their contention that (a) no physician is competent in all fields of medicine due to personality traits, etc. and (b) due to the multiple specialty electives offered during medical school, schools are actually graduating students who have a breadth of knowledge about medicine, but have particular fields of strength.� Therefore, the belief that the �undifferentiated graduate� is a goal of current programs is not only a fallacy; it is not even done today.

Second, the authors believe that with creative, inexpensive alternative methods of learning for students with disabilities, no burdensome costs will be parlayed to the school.� The student should purchase expensive adaptive equipment that may be needed by the student clinically, as they will probably use it throughout their career.� As a result, the school is not burdened, and the student will have the tools they need to succeed upon graduation.

Third, the authors use examples of alternative methods of communication (i.e. Braille) and teaching (i.e. describing orally histology rather than providing microscopic examples) to demonstrate that both are equally effective in teaching the subject matter.� As a result, the material is the same, and the quality of the program is not compromised.

The discussion is concluded by drawing on some advantages that students with disabilities bring to the profession, because of their disability.� For example, students with disabilities have a better understanding of chronic problems and illness, which may help them relate better to patients with chronic problems.�

Key words:� medical students with disabilities, medical schools, undifferentiated graduate, cost, program quality, admissions.

29. Helms, L. & Helms, C. (July, 1994). Medical Education and Disability Discrimination: The Law and the Future Implications. Academic Medicine, 69, 7, 535-543.

ABSTRACT: Students with disabilities who are preparing for careers in health care have been in the forefront of those bringing suit under Section 504 of the Rehabilitation Act of 1973. Passage of the Americans with Disabilities Act in 1990 broadened discrimination statutes and renewed attention to students with disabilities in medical education. Based on an analysis of the medical statutes and case law, the courts in conjunction with medical educators may be expected to refine policies to identify 1) when physicians with disabilities are otherwise qualified; 2) what the essential tasks performed by physicians are; 3) what accommodations to disabled students are reasonable; and 4) how communications about disabilities among program administrators, faculty, and students should be carried out. To ensure that physicians with disabilities are welcome and productive members of the profession, policy must expand from legal foundation to proactive planning and evaluation to minimize the risks of litigation and to enhance the environment of medical education.

Key words: physicians with disabilities, accommodations, medical profession, Americans with Disabilities Act, Rehabilitation Act.

30. Hendrie, H., Clair, D., Briattain, H. & Fadul, P. (1990). A Study of Anxiety/Depressive Symptoms of Medical Students, House Staff, and Their Spouses/Partners. The Journal of Nervous and Mental Disease, 178, 3, 204-207.

ABSTRACT: Symptoms of anxiety/depression and suicidal ideation were studied in medical students, house staff, and their spouses/partners in a large Midwestern school by means of an anonymous questionnaire. A total of 634 medical students and 227 house staff completed the questionnaire.

A significantly higher proportion of female trainees than male trainees reported symptoms of anxiety/depression (41% compared with 27%). This difference between men and women was most marked during residency training. The proportion of men reporting anxiety/depressive symptoms declined between medical school (33%) and residency (10%). No such decline occurred with women (medical students 42%, residents 37%).

Key words: anxiety, depression, stress, medical school, suicide medical students.

31. Henning, K., Ey, S. & Shaw, D. (1998). Perfectionism, the impostor phenomenon and psychological adjustment in medical, dental, nursing, and pharmacy students. Medical Education, 32, 456-464.

ABSTRACT: Extensive attention has been paid over the past three decades to the stressors involved in training in the health professions. Although empirical studies have identified demographic subgroups of students most likely to become distressed during training less research has been carried out to evaluate the impact of students’ personality characteristics on their adjustment. Sever perfectionism is one such personality trait that has been shown to increase the risk for anxiety and depressive disorders in other populations. Another set of personality traits linked to increased psychological problems has been labeled the “imposter phenomenon,” which occurs when high achieving individuals chronically question their abilities, and fear that others will discover them to be intellectual frauds. Both perfectionism and the imposter phenomenon would seem to be pertinent factors in the adjustment of health professional students; however, these character traits have not been empirically examined in this population. In the present study, psychological distress, perfectionism, and impostor feelings were assessed in 477 medical, dental, nursing, and pharmacy students. Consistent with previous reports, the results showed that a higher than expected percentage of students (27.5%) were currently experiencing psychiatric levels of distress. Strong associations were found between current psychological distress, perfectionism, and imposter feelings within each program, and these character traits were stronger predictors of psychological adjustment than most of the demographic variables associated previously with distress in health professional students. Implications for future research, limitations of this study, and clinical recommendations are discussed.

Key words: psychological distress, stress, nursing, dental, and medical students.

32. Hinkley, R. (Janurary, 1998). Changes in Profiles of Students Admitted to Florida Allopathic Medical Schools (1990-1996). J. Florida M.A., 84, 9.

ABSTRACT: The demographic and academic profiles of first-year classes entering the three allopathic medical schools in Florida between 1990 and 1996 have been summarized. In general, the high academic standards for admission (high GPAs and MCAT scores) have been maintained, and in some cases, increased. The percentages of women admitted to the first-year classes at UM and UF have increased in recent years, and the number of women enrolled in MD programs in Florida has increased by 26% since 1990. At the University of Miami, the student body has reached gender parity. There also has been a marked shift in the ethnicity of medical students in the state of Florida. Non-Hispanic white students have decreased by 9% to 64.4% of the total population. Black students and Hispanic students have made modest gains, and now constitute 7.4% and 11.5% of the population, respectively. Asian students have made the largest gain (6.4%), now making up 15.8% of all Florida medical students. In contrast, there has been no sustained increase in the overall number of underrepresented minority students admitted to first-year classes despite national programs and institutional commitments to do so. These changes have not just occurred in Florida medical schools. They parallel far broader national trends resulting from a dramatic increase in the number of medical school applicants, and demographic changes in the applicant pool.

Key words: medical school student demographics, gender, ethnicity.

33. Holt, G. & Bouras, N. (1988). Attitudes of Medical Students to Mental Handicap. Medical Teacher, 10, 3 / 4, 305-307.

ABSTRACT: The attitudes of medical students toward people with cognitive disabilities were examined in two medical schools in London. Medical students appear to be favorably disposed to people with a cognitive disability, in spite of their little contact with them. They are interested to learn more, not only of clinical aspects, but also on the wider issues of social origin.

Key words: social attitudes, people with disabilities, handicap, medical student attitudes.

34. Hood, N. (March, 2000). Time Has Come Today. The New Physician, 34-40.

ABSTRACT: This article identifies three areas of medical education that Hood believes are forgotten about and/or not paid attention to. Hood identifies humanism, diversity and activism as themes that should be specifically integrated into medical education. One confound with the integration of these themes is the lack of comprehensive knowledge of what competencies should be taught and/or sought in medical students. On another note, the United States is regarded as having one of the best medical education systems, and some of the best doctors, in the world. This creates hesitancy about changing the current methodology. However, Hood concludes that “medical educators, students and the public need to appreciate aspects of the status quo but must never tire of seizing opportunities to initiate improvements.”

Key words: humanism, activism, diversity, medical school, medical students.

35. Horrigan, B. (May, 1995). Christine Northrup, MD: Medical Practices as a Spiritual Journey. Alternative Therapies, 1, 2, 64-71.

ABSTRACT: This interview by Bonnie Horrigan with Christine Northrup expounds upon Northrup’s journey as a medical practitioner focusing on the way medicine deals with people in general, and women in particular. Dr. Northrup helped found Women to Women, an innovative healthcare center for women in Yarmouth, Maine that blends allopathic and alternative treatments. With the same goal in mind, she wrote “Women’s Bodies, Women’s Wisdom: Creating Emotional and Physical Health and Healing.” She also edits Health Wisdom for Women, a newsletter about women’s health. Dr. Northrup, who now lectures across the nation, is widely acknowledged as a visionary in women’s health. This interview took place at her office in Yarmouth, Maine.

Key words: healthcare, medicine, women in medicine, women’s health.

36. Jaschik, S. (January, 1995). Ruling Ordering Medical School to Admit Blind Student is Reversed. The Chronicle of Higher Education, 41, 18, A26-27.

ABSTRACT: This article expounds on a case in which a woman was refused admission to Case Western Reserve University medical school because she is blind. A district court in Ohio found that the university had violated an Ohio anti-bias law by rejecting Cheryl Ann Fisher because she was blind. The court of appeals reversed this decision. The Jr. Vice President of the Association of American Medical Colleges agrees with the appeals court decision stating that medical school should be distinguished from other institutions regarding accommodation of those with disabilities because medical school leads to a professional degree that involves the health and safety of others, and is not purely to the personal benefit of the person being educated. The appeals court felt similarly asserting that Case Western’s decision was legitimate because there was not way for Fisher to meet the basic medical school requirements that require vision. Fisher said she felt as though her rights as a U.S. citizen had been taken away from her, that she had lost her citizenship, and the rights she was born with because she is blind.

Key words: blind medical student, medical school accommodations, legal.

37. Josephson, F. (December, 1997). Accommodating Medical Students with Learning Disabilities. Academic Medicine, 72, 12, 1032-1033.

ABSTRACT: The author states that his desire with this commentary is to heighten awareness and to adjust the attitudes of premedical advisors and medical school faculty regarding the potential of students with learning disabilities for successful medical careers. One thing the author offers as help with understanding learning disabilities, is the Americans with Disabilities Act (ADA). Josephson believes that the rights and protections that the ADA provides can increase awareness of those with learning disabilities and the ways they can be accommodated in many institutions, including medical schools. The author believes that one hindrance is that many people in the general population are unaware of the potential that one who experiences a learning disability has to contribute. Josephson offers a personal experience to exemplify this.

Key words: learning disabilities, medical students, Americans with Disabilities Act, medical school accommodations for learning disabilities.

38.� Kenney, A.� (1986, October 3).� MD specialists bring unique insights into rehabilitation needs of disabled.� American Medical News, 33.

TYPE OF ARTICLE:� Commentary.
PURPOSE:� To describe how the specialty of rehabilitation assists people with disabilities.
FINDINGS:� The author interviews two rehabilitation physicians, both of whom have physical disabilities themselves, about their entry to medicine and contributions to patients.� Both physicians emphasize that rehabilitation medicine focuses on helping people with disabilities (defined as a �physical deficiency�) to not be handicapped (dependent, etc.).

Key words:� physicians with disabilities, rehabilitation medicine, rehabilitation, medical education, disability, handicap.

39. Kent, G. (June, 1991). Reactions of Medical Students Affected by a Major Disaster. Academic Medicine, 66, 6, 368-370.

ABSTRACT: This report describes the concerns and reactions of medical students who were affected by a major disaster at a football game in Sheffield in 1989. Some reactions were related to their stage of training, especially their feelings of guilt, doubts about their competence, and concern that they would not be able to cope with the stresses of doctoring. Relationships with fellow students were also problematic. Four months after the disaster, two students were still experiencing considerable distress. Staff can ameliorate such effects by providing formal teaching about posttraumatic stress disorder and by being prepared to offer support.

Key words: posttraumatic stress disorder, coping, stress, medical school, medical student.

40. Kent, G. & Kunkler, A. (1992). Medical student involvement in a major disaster. Medical Education, 26, 87-91.

ABSTRACT: Five to six months after the deaths of 95 football spectators at Hillsborough football ground, senior clinical students at Sheffield Medical School were surveyed in order to assess their degree of involvement with the disaster. Approximately one student in eight could be said to have had a high level of involvement. Students with high involvement showed higher levels of distress on both the General Health Questionnaire and the Impact of Events Scale. Only a small minority of students attended psychological debriefing groups or counseling sessions, perhaps due to the stigma attached to professional help seeking. The results have implications for medical training and provision of support within medical schools.

Key words: distress, stress, coping, debriefing, medical students, medical school.

41. Kincaid, J. Aristeiguieta. (2000). Recent Legal Decisions. Association on Higher Education and Disability, 29-48. Retrieved January, 1st, 2000 from http://www.ahead.org.

ABSTRACT: This document summarizes several different legal decisions regarding cases involving persons with disabilities. These summaries specifically reference cases that involve medical students and the Americans with Disabilities Act (ADA). For example, the first summary outlines a student who was dismissed after failing a clerkship. The student had requested an accommodation, which had been previously granted for other clerkships, but was denied. Thus, he failed the clerkship and was dismissed. A lower court ruled in favor of the medical school, but the decision was remanded for trial by a district court. These summaries expound on the influence sections of the ADA have on these cases, and how it was implemented for certain judgments.

Key words: Americans with Disabilities Act (ADA), legal decisions, medical students, accommodations, medical school.

42. Kondo, D. & Judd, V. (September, 2000). Demographic Characteristics of US Medical School Admission Committees. Journal of American Medical Association, 284, 9, 1111-1113.

ABSTRACT: This was the first study in 28 years to report a comprehensive survey of the composition of admission committees in U.S. medical schools. One focus of this study was the underrepresented minority (URM) membership in medical school admission committees. It was found that on average, 16% of committee members have URM status and that 87% of schools have at least 1 member with URM status on their committee. This shows an increase in URM membership. Another trend outlined in this study was the increase in the number of women represented on committees. In 1982, women comprised 23% of committees and 31% of medical student freshman. Today, those percentages have grown to 37% and 44%, respectively. Presently, a reversal of historical gains in URM medical school matriculation is taking place, and the barriers to the promotion of diversity in medical education continue to grow. Investigators have concluded that the composition of a medical school class reflects the composition of the admission committee, particularly in terms of selecting students with an interest in primary care. Thus, one can deduce that the recruitment of people with URM status to sit on admission committees is a potential method of promoting diversity in the physician workforce.

Key words: diversity, underrepresented minorities (URM), physician workforce, doctors, medical school admission committees.

43. Lin, J. (November, 1995). Assisting Troubled Medical Students. Journal of American Medical Association, 274, 17, 1394-1397.

ABSTRACT: This article articulates that counseling can facilitate exploration of personal issues that have been exposed during medical training, and it offers medical students an opportunity to learn new coping skills and enhance their understanding of themselves and their training environment. On-site psychological services also provide faculty and staff with a referral resource when they encounter students who present with specific psychological challenges and concerns. These services will assist in the development of a training atmosphere, in which students can learn that medical education involves their whole person.

Key words: counseling services, coping skills, medical students, holistic training, medical school.

44. Longmore, P (1995). Medical Decision Making and People with Disabilities: A Clash of Cultures. Journal of Law, Medicine & Ethics, 23, 82-87.

ABSTRACT: This paper addresses, in historical perspective, the ways in which the status of persons with disabilities, as a stigmatized minority group, affects medical decision-making. It also examines the efforts of disability rights activists to prevent discrimination against persons with disabilities in the current medical culture. Finally, it raises questions about how the rights of people with disabilities will fare as new care standards are developed and implemented.

Key words: stigma, people with disabilities, medical community.

45. Marcus, D. (2000). Issues of Trainees with Disabilities in Medicine: Combating Stigma and Ignorance. A Perspective for the New Millennium. Rochester, NY: Department of Neurology.

ABSTRACT: The main theme of this book is how medical students are impacted by medical education, what types of doctors medical students will become, and the way that medical school affects physician’s relationships with their communities, cultures, and identities. Marcus highlights his personal experience with other medical students who had disabilities. He noticed that all of the students with disabilities in one of his courses slowly disappeared. He started to realize “that there was an inherent pressure to conform to the faculty’s notion of what a physician in training should become.” It is Marcus’ belief that medical education robs individuals of their unique qualities, trying to create a cookie cutter image of all physicians.

46. Marsland, E.A. (April, 1981). Reflections of a Disabled Professional. Physiotherapy, 67, 4, 97-100.

ABSTRACT: This autobiographical story outlines the experience of a dentist who acquired poliomyelitis in the 1940’s. He describes his range of memories from waking up in a Welsh hospital hearing of vague diagnosis and that with 6 months of rehabilitation he would be able to walk again, to finding out that he, in fact, had acquired poliomyelitis and would never be able to walk again. The author also describes his emotional challenges with deciding to use crutches or a wheelchair, and how each influenced the amount of independence he felt. His experience may be familiar to other doctors who were suddenly unable to practice their expertise due to the onset of a disability.

Key words: disability onset, doctors with disabilities, paralysis and physicians.

47.� Martini, C. J. M.� (1987).� Physical disabilities and the study and practice of medicine.� The Journal of the American Medical Association, 257(21), 2956-2957.

TYPE OF ARTICLE:� Review.
PURPOSE:� To discuss the impact of a disability on the study and practice of medicine.
FINDINGS:� The author makes a clear distinction between the study and practice of medicine in order to see how disability impacts each individually.� First, the medical education�s goal is to graduate an undifferentiated graduate.� This demands that students are able to �(1) acquire knowledge and understanding, (2) develop appropriate attitudes, and of equal importance, (3) develop professional skills necessary for the general practice of medicine� (p. 2956).� In order to attain these goals, certain physical skills are necessary.� The authors believe that while students with disabilities should be admitted to medical programs, students should first self-select if a career in medicine is an appropriate choice due to their disability and ability to meet the aforementioned demands.� The authors advocate that schools, in accordance with the law, develop explicit guidelines for admissions based on the technical standards of the program to convey this message.

The author states that disabilities that are incurred post-medical school are �of course, an entirely different matter� (p. 2957).� Physicians with physical disabilities may offer unique insights to their colleagues and patients about their particular disability.�

In both instances, the author finds that people with disabilities enrich the medical profession, but that there are certain problems that arise when admitting these individuals into current medical programs, which aim to create undifferentiated graduates.

Key words:� medical students with physical disabilities, physicians with physical disabilities, medical schools, admissions, technical standards, undifferentiated graduate, attitudes.

48. May, D. (1991). Teaching mental handicap to medical students. Medical Teacher, 13, 3, 233-243.

ABSTRACT: An innovative approach to the teaching on mental handicap to pre-clinical medical students as part of their Behavioral Sciences course is first described. The teaching is organized around a number of extended placements, which allow students to interact with people with a cognitive disability on a basis of equality and reciprocity. Students respond positively to the seminar, regarding it as enjoyable, interesting and relevant to their future work as doctors. Questionnaires administered to students participating in the seminar suggest that they have a generally positive image of people with cognitive disabilities and hold vaguely liberal views as to how they should be treated by society. Few; however, wish to work with people with cognitive disabilities. There is no evidence that the experience of the seminar leads to any significant change in these attitudes.

Key words: physician’s attitudes, mental illness, medical student perspectives, teaching, medical course.

49. Michie, S. & Sandhu, S. (1994). Stress management for clinical medical students. Medical Education, 28, 528-233.

ABSTRACT: This study evaluates a new stress management course for medical students offered through the Occupational Health Unit, Royal Free Hospital, London. It was offered to students in their first clinical year, which has been shown to be a highly stressful time. The course took place over three weeks, with one 2-hour session each week. Students completed questionnaires about mood, attitudes, and causes of stress at the beginning of the year and again one year later. The uptake of this optional course was 17%. Attendees, compared with non-attendees, were more anxious, less satisfied with themselves and their life, and perceived both work and outside functioning to be poorer. Over this first clinical year, non-attendees became significantly more dissatisfied at work and increasingly perceived their functioning at work and outside to be poorer whilst attendees showed no such deterioration over the year. Attendees completed the questionnaires before and after the course, and at two time points prior to starting the course when on the waiting list. Improvements in reported work functioning were found after the course. This change was significant compared with the waiting list controls. These results are consistent with the attendees’ own reports that they found the course helpful. These results show that stress management provides long-term protective effects as well as short-term benefits.

Key words: stress, stress management, medical school, medical students, medical course.

50. Miles, S. (September, 1998). A Challenge to Licensing Boards: The Stigma of Mental Illness. Journal of American Medical Association, 280, 10, 865.

ABSTRACT: This article outlines the experience of a doctor diagnosed with Type II bipolar disorder. On a routine re-licensing questionnaire, he felt obligated to disclose his diagnosis, as well as the name of his psychiatrist providing treatment. The Board of Medical Practice subsequently asked for all of the notes and records from his psychiatrist. Neither Miles, nor his psychiatrist, felt that this was legitimate or necessary. The commotion cause by this case has inhibited other physicians to disclose similar diagnoses. Miles states that a more open environment where physicians are able to disclose such circumstances can benefit all.

Key words: mental health disorders, depression, medical doctors, physicians.

51. Moore-West, M. & Heath, D. (1982). The Physically Handicapped Student In Medical School: A Preliminary Study. Journal of Medical Educators, 57, 918-921.

ABSTRACT: The research reported here was undertaken as a preliminary study of the students with physical disabilities in undergraduate medical education because of the lack of information about students with physical disabilities in schools of medicine, or in medicine itself. A questionnaire was mailed to all medical schools in the United States. Results show very few problems with either the students’ academic performance or the institutions’ adaptation. Furthermore, when a school accepts one student with a physical disability, there appears to be a tendency for the school to accept more.

Key words: medical students, physical disabilities, handicapped students, medical education.

52. Mygdal, W., Marcone, M., Hitchcock, M., Featherston, W. & Conard, S. (May-June, 1991). Outcomes of the First Family Practice Chief Resident Leadership Conference. Family Medicine, 23, 308-310.

ABSTRACT: In June of 1989, the first Family Practice Chief Resident Leadership Conference was presented to 27 Texas second-year residents who had been selected to serve as chief residents during their third year. The objectives of the conference were to assist these emerging leaders to develop better stress management and leadership skills and to strengthen their ties with the Texas Academy of Family Physicians. The conference featured two major workshops on stress management and leadership skills, and included plenary speeches and large and small group discussions. This article reports the outcomes of the conference as measured by the evaluation instrument completed by participants. Analysis of the results indicated that the conference had a positive effect on the residents.

Key words: stress management, Family Practice Chief Resident Leadership Conference, leadership skills.

53. Noles, P. (2000). Blind medical student faces skeptics, critics. Some question whether a doctor can function without site. LA Times, *****, ****.

ABSTRACT: This LA Times article outlines the experience of a medical student who is blind at Western University of Health Sciences College of Osteopathic Medicine. Although Jeff Lawler is an outstanding student with a grade point average of 3.8, there is debate about his ability to complete medical school and become an Osteopathic physician. Critics have many concerns including questioning his ability to evaluate a skin rash, read an EKG, or diagnose a patient if he’s not able to see the patient’s facial expression. University officials have responded by educating the public of Lawler’s attendance and referencing other examples of physicians who are blind. Comments from Lawler and his wife are included.

Key words: blind, medical student, physician, medical school.

54. Novak, D., Epstein, R. & Paulson, R. (May, 1999). Toward Creating Physician-Healers: Fostering Medical Students’ Self-awareness, Personal Growth, and Well-being. Academic Medicine, 74, 5, 516-520.

ABSTRACT: To restore the “humanism” in medical care, medical education needs to espouse the goal of creating physician-healers. Critical, and often neglected, factors in healing are the personal development and well being of the healer. Unexamined attitudes, biases, and personal stress can interfere with patient care. Personal awareness and well being can contribute to physicians’ using their emotional reactions to patients for their patient’s benefit. The authors suggest goals and objectives for medical education that can promote trainees’ self-awareness, personal growth, and well being, and comment on how medical educators might achieve and evaluate these goals.

Key words: humanism, medical care, physician personal stress, patient care, medical education.

55. Nsiah-Kumi, P. (2002). Maximizing your Success in Medical Education Tips for Premedical Students with Chronic Illnesses and Disabilities. American Medical Student Association. Retrieved September 4th, 2003 at http://www.amsa.org/adv/cod/disabpre.cfm.

ABSTRACT: Individuals in medicine who have chronic illness or disabilities face a number of challenges. Among them are the frequent inflexibility of the system; inaccessibility/unavailability of necessary resources, support services and personnel; ignorance on the part of peers, faculty and administrators; confidentiality issues; a lack of role models/mentors; and prejudice and discrimination. All of these are in addition to the actual challenges posed by the chronic condition the student experiences and the challenges posed by medical school. The purpose of this chapter is to discuss possible challenges that a student with chronic illness or disability may face in medical school and how to overcome them.

Key words: chronic illness, medical students, coping strategies, stress, challenges.

56. Parkerson, G., Broadhead, W. and Kit, C., (1990). The Health Status and Life Satisfaction of First-Year Medical Students. Academic Medicine, 65, 586-588.

ABSTRACT: The self-reported health status and life satisfaction of 286 first-year Duke University medical students, in four consecutive classes, were measured at the beginning and end of the school year and compared statistically with relevant sociodemographic and behavioral factors. Health status, quantitated in terms of Duke Health Profile score, was generally lower for women than for men. Although there was a definite trend of worsening along all parameters of health and satisfaction during the year for both men and women, the most marked change was the increase in depressive symptoms. The students who were very satisfied with life had fewer symptoms of depression and anxiety; higher self-esteem, better physical, mental, and social health; stronger social ties; more physical activity; more sleep; and fewer stressful life events. Strong social ties was the factor most positively related to better health and life satisfaction.

Key words: stress, depression, medical school, medical students.

57. Powers, J. & Healy, A. (1982). Inservice Training for Physicians Serving Handicapped Children. Exceptional Children, 48, 4, 332-336.

ABSTRACT:: A nationwide project to provide continuing medical education to primary care physicians who provide office-based health care to children with disabilities is described. Included are issues involving the physician’s role in relation to the child’s family, school, and community. Interim evaluation results point to participant’s acknowledgement of a need for and willingness to provide a broader range of medical and traditionally nonmedical services.

Key words: handicapped children, continuing education, physician education, physicians’ roles.

58. Rathbun, J. (1995). Helping Medical Students Develop Lifelong Strategies to Cope with Stress. Academic Medicine, 70, 11, 955-956.

ABSTRACT: The ways in which medical students choose to cope with the stressors of their training act as blueprints for how they will deal with future professional and personal stresses. Medical students are not being provided the services they need to develop highly resistant coping strategies that they can carry on into their professional lives. In this essay the author reviews the problem and outlines some suggestions of primary and secondary prevention. His primary prevention service includes ideas such as psycho-educational lectures or workshops that would be part of the first-year curriculum. Secondary services might include assessments, crisis intervention, and short-term counseling. Finally, consultative services designed to help the institution find ways to reduce the incidence of stress and related problems. Stress is a central component of a physician’s job, and patterns of coping take hold during medical training. These are significant reasons for providing medical students a comprehensive mental health program that includes a spectrum of services incorporating primary and secondary prevention.

59. Reichgott, M. (1996). “Without Handicap”: Issues of Medical Schools and Physically Disabled Students. Academic Medicine, 71, 724-729.

ABSTRACT: The Americans with Disabilities Act (ADA), of 1990, requires that access to education not be denied simply on the basis of disability. The law requires definition of “basic qualifications” required of all applicants, “essential elements” of the curriculum, and whether accommodation would alter the “fundamental nature” of the learning experience or impose “undue burden.” Medical schools have a very low proportion of students with physical disabilities, which the author argues is largely a result of schools’ conception of the “undifferentiated graduate” as being capable of performing the history, physical examination, and any medical procedure without an intermediary. But the author maintains that medical students need not be unblemished physically; medical educators’ obligation is the educate those students who are qualified to become physicians by virtue of intelligence, professional attitude, and ability to effectively interact and communicate. With respect to clinical training, it is important to consider whether persona and hands-on experience is required for adequate learning to occur. The requirement for hands-on capability becomes less compelling because most physicians limit the scopes of their practices and do not perform all procedures, those physicians who develop physical disabilities are not precluded from continuing in some forms of medical practice, and because technologic advances allow for the substitution of imaging and diagnostic testing for the more conventional approach to the physical examination, the requirement for hands-on capability becomes less compelling. Yet not every applicant with a physical disability should be admitted to medical school, and those admitted require coaching, guidance, and career advice in order to succeed with their physical limitations. The author suggests that one of the seminal concepts of medical education, “without handicap,” should be seen not as referring to the pre-existing physical status of students but instead as the obligation of educators to provide all their students with the broadest possible learning experiences, so that they will be without the handicap of inadequate education when they proceed to their chosen fields.

Key words: medical students, physical disabilities, reasonable accommodation, medical school, students with disabilities, Americans with Disabilities Act.

60.� Reichgott, M. J.� (1998).� The disabled student as undifferentiated graduate: A medical school challenge.� The Journal of the American Medical Association, 279(1), 79.

TYPE OF ARTICLE:� Commentary.
PURPOSE:� To challenge the current Association of American Medical Colleges� (AAMC) essential functions for medical education in lieu of professional assistants and technological advances, and to reframe and restate them to eliminate discrimination of persons with disabilities.
FINDINGS:� The author challenges the AAMC�s views on essential functions and the use of assistance and assistive devices.� First, he describes what the AAMC�s views as essential functions for medical students and how they are used to create an undifferentiated graduate (one that can enter into any one of the fields of medical practice without handicap).� Ironically, no one physician is truly undifferentiated-- proficient and appropriate in all fields of medicine.� Therefore, the author states that it is unrealistic for medical students, including those with disabilities, to meet this goal.

Second, the author criticizes the AAMC�s denouncement of assistance and assistive devices used by medical students and physicians with disabilities.� These technological advancements assist medical students with disabilities to work as competently as those without disabilities.� They do not compromise their care, but enhance abilities.

The result of these two points is the author�s recommendation that essential functions not be ability based, but be focused on knowledge, communication skills, interpretation of data, and critical thinking.� Such restated functions would be inclusive of persons with all abilities.

Key words: medical students, medical education, essential functions, undifferentiated graduate, assistance, assistive devices, ADA.

61. Reidar, T., Vaglum, P., Aasland, O., Gronvold, N. and Ekeberg, O. (1998). Use of alcohol to cope with tension, and its relation to gender, years in medical school and hazardous drinking: a study of two nation-wide Norwegian samples of medical students. Addiction, 93, 9, 1341-1349.

ABSTRACT: The aim of this study was to look at the association between the use of alcohol to cope with tension and hazardous drinking, and the prevalence and the predictors of such drinking behaviors. Findings showed that the use of alcohol to cope was reported by 10.5% of the students with no significant gender difference. Hazardous drinking (binge drinking at least 2-3 times per month) was reported by 14% of all the students, 24% men and 6% women. There was a strong association between the use of alcohol to cope with tension and hazardous drinking, when controlling for other possible predictors. Use of alcohol to cope was also associated with increasing age, mental distress and lack of religious activity. Then senior students used alcohol as a way of coping less often, but not hazardous drinking. Male gender, religious inactivity, high self-esteem and having no children were predictors of hazardous drinking. This suggests that the use of alcohol to cope with tension is an independent risk factor connected with hazardous drinking among medical students, with no difference in prevalence between the genders.

Key words: stress, medical school, alcohol use, coping, gender.

62. Richman, J. & Flaherty, J. (1990). Alcohol-Related Problems of Future Physicians Prior to Medical Training. Journal of Studies on Alcohol, 51, 4, 296-300.

ABSTRACT: Time 1 data are presented from an ongoing longitudinal study of drinking patterns and problems of future physicians from medical school entrance through 2.5 years of training. The data in this report address the prevalence and psychosocial correlates of alcohol-related problems experienced prior to medical school training. A group of 167 students (91% of the cohort) was surveyed. Self-report questionnaires included: alcohol-related problems (the MAST), earlier parent-child relationships, personality characteristics (external locus of control, self-esteem, dependency, masculinity-femininity), life events, social supports, motivations for drinking, and symptomatic distress. The male students manifested a higher mean level of alcohol problems, and the sexes differed at the trend level when the MAST was scored to distinguish “problem” from “non-problem” drinkers (with 18.4% of the students reporting five or more problem points and 7.4% reporting four problem points). The significant correlates of alcohol problems included: perceived lack of earlier maternal affectivity (for men) and perceived lack of earlier paternal affectivity (for women), and lack of emotional support (for men). Moreover, escape motives for men were the motives most highly correlated with alcohol problems. Symptomatic distress (anxiety and hostility) was significantly correlated with alcohol-related problems in men but not women. Future reports will depict the psychosocial experiences and alcohol-related problems manifested by this cohort during medical training.

Key words: drinking, alcohol abuse, medical students, men and women.

63.� Rodolfa, E., Chavoor, S., & Velasquez, J.� (1995).� Counseling services at the University of California, Davis:� Helping medical students cope.� The Journal of the American Medical Association, 274(17), 1396-1397.

TYPE OF ARTICLE:� Commentary.
PURPOSE:� To describe the authors� experiences counseling medical students attending the University of California, Davis.
FINDINGS:� The authors� describe their strategies to aid medical students cope by academic year.� These strategies include the teaching that much of what they are evolving through is a developmental phase mixed with a very stressful, new environment.� Included in this environment are challenges to medical students of ethnic minorities and those that have organizational issues; each of which is discussed in detail.

Of particular note, the authors have extrapolated some of the implicit rules of the medical school world from their discussions with students, which add additional stress to students of minority groups.� �These rules include the belief that: (a) medicine should be the highest priority of one�s life, (b) emotional detachment equals objectivity and facilitates the provision of quality medical care, while emotional involvement inhibits clinical judgment, (c) competition produces excellence, while cooperation indulges intellectual mediocrity, and (d) tradition establishes the standards of excellence� (p. 1397).

Key words:� medical students, coping, counseling, minority challenges, rules.


64.� Sacks, O.� (1992).� A neurologist�s notebook: A surgeon�s life.� The New Yorker, *(**), 85-94.

TYPE OF ARTICLE: Commentary.
PURPOSE:� To describe the author�s observations and interview with a surgeon who has Tourette�s syndrome about his personal and professional life experiences (including education).
FINDINGS:� The author provides a historical reference of the syndrome from �moral� to today�s concept of biopsychosocial disease.� Using this later concept as the foundation for his interview and observations, the author documents the surgeon�s life in biological, psychological, and social arenas.� In terms of education, the surgeon stated that his most difficult challenge was reading, because of his obsessive need to repeat words and phrases.� There is no mention of how he created a coping strategy.� However, the surgeon does describe the attitudinal challenges he endured by professional colleagues and communities. It was through time that these issues dissuaded and the surgeon was able to build a successful practice.

The author, also, provides vivid descriptions of a couple patient-surgeon interactions, including a couple surgical procedures.� In each, the surgeon�s coping skills are illuminated (i.e. establishing a set pattern of rhythmic steps in each procedure).

Key words:� physician, surgery, Tourette�s syndrome, attitude.

65. Samkoff, J. (July, 1993). Understanding the Impaired Medical Student. Pennsylvania Medicine, 34-37.

ABSTRACT: Medical students encounter some of the stressors of their chosen profession even before receiving their medical degree, and unfortunately they sometimes turn to alcohol and drugs as an escape. This article outlines the stressors of medical school and their impact on students, and offers resources to avoid becoming a victim of impairment.

Key words: medical students, stress, medical school, coping with stressors, alcohol and drugs.

66. Seyden, N. (1999). Enhancing Medical Students’ Knowledge About Those who Live with Disabilities. Rehabinfo Network, Retrieved December, 07, 2000 from http://www.rehabinfo.net/default.asp.

ABSTRACT: Both the research literature and our surveys among individuals with disabilities point to two key gaps in the medical care of individuals with severe disabilities. The first gap centers on physicians who withhold medical and rehabilitative services because of personal biases or misinformation. The second gap arises from health care providers who lack awareness of underlying causes that have persistent influence on the health and well being of individuals with severe disabilities. In both cases, the end result is that people with disabilities, particularly those with severe disabilities, often do not receive adequate care or important information to make informed decisions to guide their care and live independently. Physician and rehabilitation counselors often work from their own biases about people’s lives when living with disabilities. It is the author’s opinion that physicians and rehabilitation counselors need to be trained to listen to their patients more, as studies have shown that many of those who live with a disability are content and report a high satisfaction with their lives.

Key words: rehabilitation counseling, physicians, people with disabilities, independence, informed decisions.

67. Silver, L., Nadelson, C., Joseph, E., Covi, L., Jones, D., & Ruff, G. (1979). Mental Health of Medical School Applicants: The Role of the Admissions Committee. Journal of Medical Education, 54, 534-538.

ABSTRACT: This study examined the role of admissions committees as it relates to the mental health of applicants. Two-part questionnaires were sent to 115 medical schools. The first part explored to composition of the committee. In most schools, the dean selected the members attempting to obtain equal representation from clinical and basic science departments. Most of the schools had one or more psychiatrists on the committee. The second part focused on the policy for applicants with former mental health problems. Over one-third of the committees asked about previous or present mental illness or therapy. Ninety percent of the schools had no policy or guidelines for using such information; instead, most relied on psychiatric interview or outside reports in making admissions decisions. The impact of federal legislation regarding people with disabilities on the admissions procedures is discussed. Since more students with previous or current psychiatric problems may be admitted, schools much be prepared to respond to their needs as fully as they now respond to other medical problems.

Key words: mental health, representation, admissions, medical school.

68. Smith, H. (1998). Disability Leaders Student to Medical School. Center for Disability Issues and the Health Professions, Retreieved December, 7, 2000 from http://www.westernu.edu/xp/edu/cdihp/links_educating_professionals.xml.

ABSTRACT: This article describes the experiences of a medical student who is blind. Jeff Lawler lost his site due to a degenerative disease. He started college and entered medical school having received A’s in most of his undergraduate work and competitive scores on the Medical College Aptitude Test (MCAT). However, despite his well documented aptitude, Lawler has faced opposition towards his medical student standing because of his disability. This article outlines opinions of those who support Lawler as well as those who question his ability to become a physician.

Key words: blindness, medical student, Americans with Disabilities Act.

69. Steinberg, A., Iezzoni, L., Conill, A. & Stineman, M. (December, 2002). Reasonable Accommodations for Medical Faculty with Disabilities. Journal of American Medical Association, 288, 24, 3147-3154.

ABSTRACT: An unknown number of medical school faculty have disabilities, and their experiences have generally escaped notice and scrutiny. Although most medical schools offer long-term insurance and extended leaves of absence for disability, relatively few have policies explicitly addressing accommodations for faculty with disabilities as they perform teaching, research, and clinical duties. Accommodating active medical school faculty with disabilities, drawing on the University of Pennsylvania School of Medicine initiatives exploring the concerns of faculty with sensory and physical disabilities, are discussed. Anecdotal reports suggest that many faculty, fearing reprisals, resist seeking job accommodations such as those mandated in the 1990 Americans with Disabilities Act (ADA). Although some faculty with disabilities have found supportive academic mentors, others report that lax institutional enforcement of ADA requirements, including physical access problems, demonstrates a tepid commitment to staff with disabilities. Potentially useful job accommodations include adjusting timelines for promotion decisions; reassessing promotions requirements that inherently require extensive travel; improving physical access to teaching, research, and clinical sites; and modifying clinical and teaching schedules. Faculty with disabilities bring identical intellectual and collegial benefits to medical schools as their nondisabled counterparts. In addition, they may offer special insights into how chronic illness and impairments affect daily life.

Key words: medical school faculty, disabilities, accommodations, Americans with Disabilities Act.

70. Stewart, S., Betson, C., Marshall, I., Wong, C., Lee, P. & Lam, T. (1995). Stress and vulnerability in medical students. Medical Education, 29, 119-127.

ABSTRACT: One hundred and forty Hong Kong Chinese students were surveyed early in the second year of their medical education (year 2), and compared with 138 students surveyed prior to beginning their first year of medical school and with 74 non-medical university students in their second year. In year 2 students, distress as reflected in their scores on anxiety and depression self-report scales was high, and these students reported greater utilization of health professional services as compared with the other two groups. In year 2, students’ concerns related to the medical school environment and curriculum, and whether one has the endurance and ability to be successful, were significant correlates with depression and anxiety. Loss of opportunity to maintain social and recreational sources of gratification correlated with anxiety. There was no difference between the sexes with regard to the development of anxiety and depression symptoms. Academically less successful students reported somewhat higher levels of depressive ideation and symptomatology. Trait anxiety correlated with the development of distress, while optimism protected against the development of distress. Active coping styles and positive reinterpretation as a coping strategy correlated negatively with distress, while wishful thinking correlated positively with distress. These findings emphasize the need for greater attention to the psychological well being of doctors-in-training, in Hong Kong as in the Western world. These findings should be further explored in longitudinal studies, and may be helpful in designing intervention and support programs for vulnerable students.

Key words: stress, depression, anxiety, coping, medical students, Hong Kong.

71.� Takakuwa, K. M.� (1998).� Coping with a learning disability in medical school.� The Journal of the American Medical Association, 279(1), 81.

TYPE OF ARTICLE:� Commentary.
PURPOSE:� To describe the author�s personal experience of having a learning disability and pursuing medical school.
FINDINGS:� The author describes his experience with a learning disability from the point at which he was diagnosed (post-baccalaureate) to his current practice.� The emphasis of the article is on the frustration a person with a learning disability experiences when they are clinically competent, but academically compromised due to their disability.

Key words:� medical student with learning disability, physician, learning disability, educational testing, personal commentary.

72. Thomas, C. (1976). What Becomes of Medical Students: The Dark Side. The Johns Hopkins Medical Journal, 138, 5, 185-195.

ABSTRACT: In the cohort of 1337 former Johns Hopkins medical students from the classes of 1948 through 1964, there were 1248 graduates and 89 nongraduates. In follow-up studies of this cohort, 49 subjects, 3.1% of the graduates and 11.2% of the nongraduates, have been found to have died prematurely. Incipient mental illness and emotional disturbance appear to have contributed substantially to academic failure, poor performance during and after medical school, and premature death. These findings underscore the need for learning to identify and help medical students who are especially vulnerable to stress. Such insights would contribute to the prevention of premature disease and death, not only from mental illness but also from other disorders.

Key words: mental health, stress, coping, identification of stress, medical students, premature death.

73. Towes, J., Lockyer, J., Dobson, D. & Brownell, K. (October, 1993). Stress among Residents, Medical Students, and Graduate Science (MSc/PhD) Students. Academic Medicine, 68, 10, 546-548.

ABSTRACT: The last two decades have seen an increase in literature about stress during medical training. Academic stressors, due to the volume of material to be learned, academic performance anxiety, and evaluation through examinations and preceptor ratings, have been cited in the literature. Stressors arising from clinical work, difficult clinical placements (such as intensive care units and emergency rooms), and difficult patients are unique to health care education. This paper reports the results of a study of stressors and stress responses among residents, medical students, and graduate science students at the University of Calgary Faculty of Medicine. This study was undertaken to demonstrate levels of stress among the various groups of trainees to identify the need for a specific trainee stress program. The purposes of this study were to 1) assess the levels of stress among medical students, residents, and graduate science students in the Faculty, 2) determine the types of stressors that the trainees were experiencing, and 3) compare stress levels and stressors (a) among medical students, MS/PhD students, and residents, (b) between men and women trainees, and (c) between trainees at different levels of training.

Key words: medical students, stress levels, medical school, academic stress.

74. Uva, J. (February, 1996). Assisting Medical Students with Undiagnosed ADHD. Journal of American Medical Association, 275, 5, 417.

ABSTRACT: This letter to the editor outlines the author�s appreciation on the November 1st, 1995 issue highlighting the counseling services available to medical students who experience mental health difficulties during their medical training. The author also articulates that studies of intervention strategies for adequate treatment of medical students with Attention Deficit Hyperactivity Disorder (ADHD) are essential. Furthermore, she expounds on the idea that research is also needed on how to train professionals and clinicians to work effectively with such students.

Key words: Attention Deficit Hyperactivity Disorder (ADHD), medical students, mental health, medical staff.

75. Verville, R. (1990). The Americans with Disabilities Act: An Analysis. Archives of Physical Medicine and Rehabilitation, 71, 1010-1013.

ABSTRACT: This piece outlines the Americans with Disabilities Act (ADA), summarizes the main articles of the ADA with definitions, and includes a brief history of the origination of the ADA. The author concludes that the ADA vastly enlarges the rights of people with disabilities to be free from discrimination in employment and in the use of nearly every facility and services common to life in the U.S. These rights will create many new opportunities for people with disabilities to be productive and to achieve independence. In this respect, the ADA has dramatically enhanced the effectiveness of the rehabilitation process by creating real opportunities for social and economic independence for individuals whose physical capacities have been restored through medical rehabilitation. However, states Verville, the extent to which new opportunities will be developed will depend on the advocacy efforts of people with disabilities and of the professionals who work with them to educate the public and private sectors to the new responsibilities they have under the ADA.

Key words: Americans with Disabilities Act (ADA), discrimination, reasonable accommodations.

76. Vitaliano, P., Maiuro, R., Russo, J. & Mitchell, E. Medical Student Distress. A Longitudinal Study. The Journal of Nervous and Mental Disease, 177, 2, 70-76.

ABSTRACT: This longitudinal study investigated the relative importance of correlates of psychological distress in first year medical students (N=312) in September and May. Anxiety levels were one Standard Deviation above the mean when compared with non-patient levels in both September and May, and the percentage of students reporting depression doubled over the study period. Problem-focused coping decreased, emotion-focused coping increased, and satisfaction with social supports decreased over the year. In contrast, type A behavior and anger expression were more stable. Students distressed in September were at higher risk for distress in May, and were characterized by higher scores for suppressed anger and type A behavior in May, even after controlling for distress in September.

Key words: psychological distress, medical students, coping.

77. Wainapel, S. (1987). Physical disability among physicians: an analysis of 259 cases. International Disabilities Studies, 9, 138-140.

ABSTRACT: This article presents data on 259 physicians and medical students with a wide range of physical disabilities and specialty training. Three out of four were in active medical practice, most often in the specialties of internal medicine, family practice, or psychiatry. Neurological disorders accounted for over half the sample, with spinal cord injury, multiple sclerosis, stroke, and post-polio weakness being the most commonly encountered diagnoses. These data indicate that physicians with physical disabilities are more numerous than the previous literature would suggest, and they are capable of practicing in many professional specialties.

Key words: disability, impairment, handicap, physician.

78. Wainapel, S. (1987). The Physically Disabled Physician. Journal of American Medical Association, 257, 21, 2935-2938.

ABSTRACT: This article reviews the available literature on physicians with physical disabilities and discusses the attitudinal, environmental, and political barriers they may encounter. Information on 215 physicians and 92 medical students with a wide range of disabilities was analyzed. Currently available personal and technological resources are outlined and special issues pertaining to medical education are highlighted. Greater awareness and acceptance by medical peers are essential for professional success.

Key words: disability, handicap, impairment, physician.

79. Webster, G. (1980). Blind Internist Passes Board Exam. The New England Journal of Medicine, 302, 1152.

ABSTRACT: This brief letter to the editor comments on the first blind internist to attempt, and pass, the American Board of Medical Examiners certification. The author discusses the physician and his experience, hoping to encourage others who may experience a similar disability.

Key words: blind, American Board of Medical Examiners, physician.

80. West, M., Kregel, J., Getzel, E., Zhu, M. & Maritn, E. Beyond Section 504: Satisfaction and Empowerment of Students with Disabilities in Higher Education. Exceptional Children, 59, 5, 456-467.

ABSTRACT: College and university students with disabilities were surveyed to determine their levels of satisfaction with accessibility, special services, and accommodations at their schools. In addition, students were requested to identify barriers to postsecondary education, improvements in services, and other concerns. Respondents generally expressed satisfaction with the services that they had received. However, the majority indicated that they had encountered barriers to their education, including a lack of understanding and cooperation from administrators, faculty, staff, and other students; lack of adaptive aids and other resources; and inaccessibility of buildings and grounds. Recommendations were made for improving the delivery of services and self-advocacy of students with disabilities.

Key words: students, disability, impairment, handicap, accessibility, accommodation.

81. Western University (1998). A Brief History of Blind Physicians. Center for Disability Issues and the health references. Retrieved December, 7, 2000, from http://www.westernu.edu.

ABSTRACT: The story of healers overcoming visual impairments to render care to others is an old one. In fact, physicians who are blind have distinguished themselves in the practice of medicine for more than a thousand years. This document is a collection of brief biographies, based upon the research of Virginia T. Keeney, MD, of Louisville, KY. They outline the accomplishments of notable figures who, despite their disabilities, contributed significantly to their patients or their profession.

Key words: disability, physician, blind, professional.

82. Winkler, T. (1985). Handicapped in medical school: A personal account. *******, 137, 8, 26-29.

ABSTRACT: This narrative conveys the physical and emotional impact that Terry Winkler experienced from a bullet wound to his spinal cord, leaving him with paraplegia. He speaks of his emotional state, his societal experiences, and his work to function with some normalcy after such an accident. Winkler links his experiences with societal views of people with disabilities to their views of physicians, and the dissonance created when a physician has a disability.

Key words: disability, spinal cord injury, physician.

83. Wolf, T., (1994). Stress, coping and health: enhancing well-being during medical school. Medical Education, 28, 8-17.

ABSTRACT: Medical education can be a health hazard for many students, and far-reaching reforms are needed to improve it. This article reviews the literature on stress, coping, and health during undergraduate medical education. The conclusions drawn from this review are used as a basis for advancing recommendations to improve medical education. It is essential to incorporate the principles of health promotion and disease prevention throughout medical education in order to minimize and prevent later burnout and impairment. Healthy medical students are likely to become healthy doctors who can then model and promote healthy lifestyles with their patients. This preventive approach to health care can lead to an improvement in our health care delivery system.

Key words: stress, coping, medical school.

84. Wu, S. Tsang, P., & Wainapel, S. (1996). Physical Disability Among American Medical Students. American Journal of Physical Medicine & Rehabilitation, 75, 3, 183-187.

ABSTRACT: This survey aimed to assess the prevalence and nature of physical disabilities among medical school graduates, and to investigate the academic performance of these new physicians with disabilities. A questionnaire was sent to the deans of student affairs of each of the then existing 128 United States and Puerto Rican medical schools, addressing the profiles of students with physical disabilities in the 1987 through 1990 graduating classes. Seventy-seven (60%) United States and Puerto Rican medical schools responded to the questionnaire, of which 67 were able to complete it. A total of 67 students with physical disabilities (40 males and 27 females) were reported. Three of the 67 students were excluded from the study because their conditions did not match the definition of physical disability. The remaining 64 students (38 males and 26 females), ranging from 0-10 per school, comprised 0.19% of the 138 students who graduated from the 67 medical schools during these 4 academic years. The disabilities represented by the 64 students encompassed a wide spectrum of etiologies, including neurologic (39%), musculoskeletal (20%), medical-surgical (13%), visual (13%), and auditory (9%). The majority of students with disabilities might be higher than reported because of the underreporting of the less noticeable types of disabilities.

Key words: disability, impairment, medical student, physician.

85.� Yom, S. S.� (1998).� Disabilities: Looking back and looking ahead.� The Journal of the American Medical Association, 279(1), 78.

TYPE OF ARTICLE:� Commentary.
PURPOSE:� To describe the spectrum of discussion on disability in this issue of JAMA.
FINDINGS:� In this editor�s note, the editor states that medical education and the profession alike are being impacted by the ADA.� More people with disabilities are becoming medical professionals.� As a result, the question is being raised whether competence can be evaluated by the presence of specific abilities rather than the absence of all disabilities.� Each of these aspects is described in greater detail in specific articles.

Key words:� medicine, medical school, disabilities, abilities, competencies.

86. Young, M. (1987). Disabled is Not Impaired. Journal of the American Medical Association, 258, 9, 1173-1174.

ABSTRACT: This brief letter to the editor appreciates a report that appeared in an earlier issue of JAMA, about physicians with disabilities. However, the author explains his disappointment on the location of the article relative to reports of impaired physicians, and expounds on the differences between physicians with disabilities and impaired physicians with specific distinctions.

Key words: disabled, impaired, physician.

87. Zirkel, P. (2000). Sorting Out Which Students Have Learning Disabilities. The Chronicle of Higher Education, 12, 8.

ABSTRACT: This narrative delineates the experiences and thoughts of a college professor regarding learning disabilities, and how they are diagnosed. Zirkel acknowledges that in recent years, college attendance of those with learning disabilities has increased. However, these students are all predominantly from affluent backgrounds and are Caucasians. Zirkel ponders this and offers some of his ideas as to why this may be the case. Some of his ideas include the vagueness of the Americans with Disabilities Act definition of learning impaired or learning disabled; other ambiguities in the law about learning disabilities, as well as the difficulty in diagnosing one without support from lawyers, psychologists or other doctors, all of which require financial stability.

Key words: learning disability, diagnosis, accommodations, laws.

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