Abstract This cross-sectional study analyzes the differences between the students at different stages of medical education by examining their general study orientation, their views on characteristics of a good physician and their ways of perceiving patient work. The research cohort (N= 424) was collected from the first-, third- and sixth-year medical students of the Faculties of Medicine in the Universities of Oulu and Turku in autumn 2005. The study consisted of three parts; 1) The Inventory of General Study Orientations, which was used to investigate the students’ general study orientation, 2) the students were asked to name five characteristics of a good physician and 3) they were asked to resolve a short written patient case. General study orientations were analyzed by confirmatory factor analysis. Characteristics of a good physician and the patient case assignment were analyzed by inductive content analysis. This study is part of longitudinal follow-up study on medical education Learning Medical Expertise (LeMex). The obtained findings showed differences in students’ general study orientation, in their dedication to studies as well as in their practical orientation between the different student groups. Dedication to studies decreased and the practical orientation increased as the students proceeded in their studies. Students at different stages of their studies differed on how they estimated the most important characteristics of a good physician, particularly those on patient care, medical know-how and professional ethics. The further the studies had advanced, characteristics on patient care issues became more and more important. As for complying with professional ethics, the result was the opposite. Complying with professional ethics was emphasized as the most important characteristic of a good physician in the beginning of the medical education but its importance decreased in the course of the studies. Medical know-how, as the most important characteristic, was stressed among the third year students. The results showed differences between the student groups in ways they perceived patient work, especially in how they imagined the functions and thoughts of a doctor during on-call appointments. As the studies advanced and the clinical know-how improved and was emphasized, the medical students' holistic view of a human being became narrower. At the same time, non-professional attitude towards the patient increased. Students’ deep-orientation to studying together with desire to develop and specialize predicts development to expertise. The results of this study can be utilized in developing the quality of medical education and teaching. / Tiivistelmä Tässä poikkileikkaustutkimuksessa tutkin sitä, miten eri vuosikurssien lääketieteen opiskelijat eroavat toisistaan. Tarkastelen opiskelijoiden opiskelun yleisorientaatioita, käsityksiä hyvän lääkärin ominaisuuksista ja sitä, miten he hahmottavat potilastyötä. Tutkimusaineisto (n = 424) kerättiin Oulun ja Turun yliopiston lääketieteellisen tiedekunnan ensimmäisen, kolmannen ja kuudennen vuosikurssin opiskelijoilta syksyllä 2005. Tutkimus koostui kolmesta osa-alueesta: 1) IGSO-mittarista (The Inventory of General Study Orientations), jolla tutkittiin opiskelun yleisorientaatiota, 2) hyvän lääkärin ominaisuuksien nimeämisestä ja 3) lyhyen kirjallisen potilastapauksen ratkaisemisesta. Opiskelun yleisorientaatiot analysoitiin konfirmatorisella faktorianalyysillä, hyvän lääkärin ominaisuudet ja potilastapaus analysoitiin induktiivisella sisällönanalyysillä. Tutkimus on osa lääketieteen koulutuksen pitkän aikavälin seurantatutkimusta LeMEx (Learning Medical Expertise). Tutkimustulokset osoittivat, että tutkittujen vuosikurssien välillä on eroja opiskeluun omistautuneisuudessa ja käytännön orientaatiossa. Omistautuneisuus opintoihin vähenee ja käytäntöön orientoituminen lisääntyy mitä pidemmällä opiskelijat ovat opinnoissaan. Lääkärin tärkeimpinä pidetyissä ominaisuuksissa vuosikurssien välillä eroja on potilaan hoitamisessa, työn perustana olevassa tiedonhallinnassa ja ammattietiikan noudattamisessa. Potilaan hoitamiseen liittyviä ominaisuuksia pidettiin sitä tärkeämpänä, mitä pidemmälle opinnot etenevät. Ammattietiikan noudattamisen osalta tulos on päinvastainen. Se korostuu hyvän lääkärin tärkeimpänä pidettynä ominaisuutena koulutuksen alussa, mutta vähenee opintojen edetessä. Hyvän lääkärin tärkeimpänä ominaisuutena työn perustana oleva tiedonhallinta korostuu kolmannella vuosikurssilla. Potilastyön hahmottumisessa vuosikurssien välillä eroja ilmenee lääkärin toiminnassa ja ajatuksissa päivystysvastaanotolla. Opintojen edetessä ja kliinisen osaamisen kehittyessä ja korostuessa kokonaisvaltainen ihmiskuva kaventuu ja potilaaseen kohdistuva epäammatillinen suhtautuminen lisääntyy. Opiskelijoiden syväorientoituminen opiskeluun, halu kehittyä ja erikoistua enteilee asiantuntijuuteen kehittymistä. Tutkimustietoa voidaan hyödyntää lääketieteen koulutuksen laadun ja opetuksen kehittämiseen.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Chronic diseases of lifestyle (CDL) are on a raising trend in the world regardless of age, economic class or geographical location of a population. The mortality rate associated with CDL is alarmingly among the highest globally. Tanzania is not exempted from this development. Literature indicates that physical activity is a health practice that can prevent CDL. It is recommended that medical practitioners should hold the responsibility of counselling patients on physical activity. Some studies outside Africa found an association between doctors’ physical activity patterns and their counselling practices on the same. This study therefore sought to establish whether physical inactivity among medical doctors in Tanzania significantly influenced their counselling practices on physical activity. A cross sectional quantitative survey at the Muhimbili National Hospital and Muhimbili Orthopedic Institute was conducted to derive the required information. A self administered structured questionnaire was voluntarily answered by 144 medical doctors. The Statistical Package for Social Sciences (SPSS) version 17 was used for data capturing and analysis. Descriptive statistics were employed to summarize data and was expressed as means, standard deviation, frequencies and percentages. The students’t-test was used to compare mean physical activity between different groups. Furthermore students’t-test and analysis of variance tests were used to examine association between different variables. Chisquare tests were used to test for associations between categorical variables. Alpha level was set at p< 0.05. Most of the participants in this study were sedentary in their leisure time and only active at work. When their quality of physical activity counselling was assessed, the majority of them were found to be poor physical activity counsellors. A significant association was found between physical activity and age, as well as physical activity and counselling practice (p<0.05). Participants mostly informed their patients about the intensity and duration of exercising more than any other idea of physical activity such as types of exercises, issuing of a written prescription and planning for a follow up. Lack of knowledge and experience about details of physical activity were reasons offered for failure to counsel. Participants also reported the inconvenience of physical activity facility’s schedules, fatigue and tiredness to be their barriers to physical activity participation. Doctors in Tanzania lacked personal initiative to participate in physical activity and consequently lacked the motivation to counsel. Measures around enhancing this health practice should be enhanced by all stakeholders including medical doctors, physiotherapists and patients. The need for short term and long term training in matters related to physical activity are therefore necessary among the practicing doctors and those undergoing training in medical schools. Physiotherapists who are trained in movement science can offer valuable advice/information to medical doctors to ensure that medical doctors acquire physical activity prescription and counselling knowledge. Collaboration between stakeholders in campaigning against sedentary lifestyles should be enhanced. Further reasons for failure to counsel, hindrances to physical activity participation and modern approaches to counselling should be explored. / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / Chronic diseases of lifestyle (CDL) are on a raising trend in the world regardless of age,economic class or geographical location of a population. The mortality rate associated with CDL is alarmingly among the highest globally. Tanzania is not exempted from this development.Literature indicates that physical activity is a health practice that can prevent CDL. It is recommended that medical practitioners should hold the responsibility of counselling patients on physical activity. Some studies outside Africa found an association between doctors’ physical activity patterns and their counselling practices on the same. This study therefore sought to establish whether physical inactivity among medical doctors in Tanzania significantly influenced their counselling practices on physical activity. A cross sectional quantitative survey at the Muhimbili National Hospital and Muhimbili Orthopedic Institute was conducted to derive the required information. A self administered structured questionnaire was voluntarily answered by 144 medical doctors. The Statistical Package for Social Sciences (SPSS) version 17 was used for data capturing and analysis. Descriptive statistics were employed to summarize data and was expressed as means, standard deviation, frequencies and percentages. The students’t-test was used to compare mean physical activity between different groups. Furthermore students’t-test and analysis of variance tests were used to examine association between different variables. Chisquare tests were used to test for associations between categorical variables. Alpha level was set at p< 0.05. Most of the participants in this study were sedentary in their leisure time and only active at work. When their quality of physical activity counselling was assessed, the majority of them were found to be poor physical activity counsellors. A significant association was found between physical activity and age, as well as physical activity and counselling practice (p<0.05).Participants mostly informed their patients about the intensity and duration of exercising more than any other idea of physical activity such as types of exercises, issuing of a written prescription and planning for a follow up. Lack of knowledge and experience about details of physical activity were reasons offered for failure to counsel. Participants also reported the inconvenience of physical activity facility’s schedules, fatigue and tiredness to be their barriers to physical activity participation. Doctors in Tanzania lacked personal initiative to participate in physical activity and consequently lacked the motivation to counsel. Measures around enhancing this health practice should be enhanced by all stakeholders including medical doctors,physiotherapists and patients. The need for short term and long term training in matters related to physical activity are therefore necessary among the practicing doctors and those undergoing training in medical schools. Physiotherapists who are trained in movement science can offer valuable advice/information to medical doctors to ensure that medical doctors acquire physical activity prescription and counselling knowledge. Collaboration between stakeholders in campaigning against sedentary lifestyles should be enhanced. Further reasons for failure to counsel, hindrances to physical activity participation and modern approaches to counselling should be explored.

The incidence of autism has increased tremendously over the past 20 years; however, the tools used for diagnosis and educational identification have largely remained the same. Diagnostic and educational decisions are based on observations and interactions to identify hallmark skill deficits associated with autism. Research demonstrates behaviors are affected by the environment, and real-time data collection is more accurate than reflective methods. The problem is current autism diagnostic and educational identification tools lack essential features. The Autism Diagnostic Observation Schedule (ADOS), considered the gold standard, relies on contrived settings, and lacks an observational comparison to same aged peers. Autism behavior rating scales, rely on reflective data collection, and are not context specific. The purpose of this study was to gain feedback from stakeholders (clinicians, educators, parents) about the perceived efficacy and feasibility of a context-specific autism behavior rating tool with real time data collection methods for diagnosis and educational planning. Results showed stakeholders confirmed the perceived efficacy of the context-specific tool for improved accuracy for diagnosis, more specific information for educational planning, and increased understanding for parents to support their child's learning needs. Even though the tool was useful, stakeholder feedback also indicated the tool lacked feasibility for teacher use and may be better suited for administration by school psychologists or other trained professionals. The increased specificity and accuracy provided by a context-specific autism behavior rating tool has the potential to affect the future of autism evaluations and educational planning; thereby influencing the future life function of individuals with autism.

The aim of this research is to investigate the factors identified as significant in increasing the retention of medical doctors employed in Port Elizabeth hospital complex (PEHC) in the Eastern Cape, South Africa. Medical practitioners of PEHC are providing the needed critical clinical services and are believed to be the strength of tertiary health services in the Eastern Cape, providing world class treatment to the public. Recruitment and retention of talented medical practitioners, then, is in the best interests of the Department of Health. Demotivated staffs are more likely to leave their jobs for better opportunities, and therefore efforts must be geared towards retaining them. This research investigates the independent factors identified. They include the management style, risk exposure, the working environment, the work overload, and the benefits associated with retaining of medical practitioners in PEHC. The results of this study revealed that the following factors influence the talent management and retention of doctors in the hospital complex: a management style that appreciates and recognises staff, a risk-free work environment, a flexible and balanced life, a reasonable work load, and the attitude of immediate supervisors. The results of this study will add to the guidelines and retention strategies already in place by the Department of Health, Eastern Cape. The senior management and policy makers could use the recommendations revealed in this study for an efficient human resources policy. However, future research still needs to be done in the area of providing employment for spouses of members of staff especially on the reward system and the recognition of employees in the organization.

South Africa is experiencing a brain drain of doctors. It is estimated that about 5000 doctors have left South Africa since 2003. Lack of job satisfaction has been identified as one of its causes. The purpose of this study was: To provide an overview of relevant literature concerning job satisfaction. To determine, by means of an empirical survey, whether doctors in the public sector experienced any factors, which were affecting their job satisfaction levels. To make recommendations as to how the job satisfaction levels of doctors in public sector hospitals could be increased. For the empirical study a survey, with a questionnaire as data collecting tool, was conducted among 59 permanently employed doctors at the Dora Nginza Hospital in Port Elizabeth. The questionnaire focused on biographical information, personality-job fit, job content factors and job context factors. For Section B, C and D of the questionnaire, the response options were structured according to a Likert-type scale. Respondents had to indicate the extent to which they agreed with each statement in the questionnaire. The responses obtained from the survey were presented and analysed. The researcher observed in this study that doctors were just satisfied with their jobs. Apart from the personality job fit factor of job satisfaction where excellent scores were recorded, there seemed to be problems with job content and job context factors. Management of Port Elizabeth Hospitals Complex has a challenge in improving job satisfaction of their doctors in these areas. The researcher recommends that management of Port Elizabeth Hospitals Complex should look into the satisfaction level of doctors in their employment. Doctors’ satisfaction level should be improved from being just satisfactory to being excellent.

Self-regulation capacity allows individuals to manage their thoughts, feelings, and actions to attain personal goals (e.g., well-being and performance), as well as adjust to their changing social and physical environment (Zimmerman, 2000). Self-regulation as a positive adaptive skill and process has not been examined in relation to well-being in the context of medicine. The purpose of the current study was to examine self-regulation with 37 medical students and 25 supervising physicians to determine whether or not it may enhance well-being and performance, and reduce stress and burnout. A mixed-methods design was used to collect and analyze the data, and findings from the quantitative and qualitative phases were presented in two separate articles. Self-regulation capacity appears to be an important skill that may help both physicians and medical students to meet the demands of the medical profession and maintain an adequate level of well-being and performance in their work and daily life.

Anton Chekhov pursued two careers simultaneously throughout his life—that of a doctor as well as a writer of prose and drama. It is not surprising, therefore, to discover many physicians amongst his characters but it is puzzling that the portrayal of doctors is frequently unflattering despite his admitted indebtedness to the profession. The thesis herein proposed is that the poor image Chekhov presents points to the necessity of self-determination in matters of emotional and spiritual health; if the doctors are incapable of healing themselves and those in their care, the patients might well take the biblical directive, "Arise! Take up thy bed and walk." In his stated desire to show people how bad and dreary their lives are, thereby assisting them in fashioning better lives, Chekhov's prescription is one of self-help. The short stories—Late-Blooming Flowers, Anyuta, Ward No. 6, The Head Gardener's Tale and The Doctor's Visit—and the plays— Platonov, Ivanov, The Seagull, The Wood-Demon, Uncle Vanya and Three Sisters—have been examined; beneath the incompetence and villainy of the doctors an affirming statement is discovered in the otherwise melancholy canon of Chekhov. / Arts, Faculty of / Theatre and Film, Department of / Graduate

The study was designed to explore the proposition that conduct of and participation in research by general practitioners in British Columbia would be both desirable and feasible. Desirability was defined in terms of benefits for knowledge, for the medical practice, and for society at large. Feasibility was defined in terms of being acceptable for the general practitioner, for the patient, for the practice, and for the requirements of research. To answer specific questions related to desirability and feasibility of research by general practitioners, information was obtained from the literature, from a questionnaire survey of the total general practitioner population of British Columbia, and from a random sample of patients in practices selected at random from respondents to the questionnaire to general practitioners. In the survey of general practitioners, 2,344 questionnaires were mailed. Of the 563 (24%) which were returned, 508 were available for analysis. Five were returned by the post-office undelivered, seven were too late for analysis, and forty-three were returned with information indicating that the respondent was not in general practice. Forty- eight respondents were anonymous, and the remainder identified themselves. The response of general practitioners represented a variety of geographic locations, ages, types of practice, and medical schools. Members of the College of Family Physicians of Canada had a response rate of 39%. In the survey of patients, 15 out of 20 general practitioners who were contacted agreed to submit questionnaires to their patients. Of the patients surveyed, approximately 90% completed the questionnaires. Most were regular patients of the doctors, and represented a full range of ages, and both sexes. General practitioners and their patients agreed that research by general practitioners was desirable, and suggested many areas suitable for research. The benefits of research to the general practitioners, patients, and society were considered to be incentives, encouraging research activity. Important among the benefits were the discovery of new knowledge and the contribution to the academic base of general practice. The feasibility of research was explored in terms of the conditions required for its conduct. Attitudes were receptive to the concept of research, as many of the general practitioners had previously been involved in projects. Major deterrents were heavy workload and lack of time, for the general practitioners, and in their practices the high overhead and pressure of work on the staff were problems. Training for research was variable, with some general practitioners having none and a few having much training. Inadequacy of the usual office records was recognized, so that research would usually require special methods. General practitioners had little awareness of resources available for help, advice or financing, but most were aware of the need for such resources. Patients were willing to cooperate in studies. They suggested that the cost of research should be borne primarily by governments, and to a lesser extent by foundations and the public. Recommendations were made for the support of research, to help overcome the problems which decrease its feasibility. There should be encouragement of training in research methods, at both undergraduate and postgraduate levels. This would include presentation of research findings to scientific meetings of medical societies, and visits to and from eminent research workers in general practice. Some assistance should be given to the general practitioners, such as help in developing office records for research or payment for time spent on research. Resources for help in planning studies and processing results should be readily available, including both consultant advice and the provision of grants. Conclusions from the study were that research by general practitioners in British Columbia is desirable, and that it is feasible but has several major deterrent factors which can inhibit research activity. Because of these factors, the great potential for research in British Columbia is still far from being realized. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Moderne Technikgeschichte deutet den menschlichen Körper als etwas Gemachtes, als „Biofakt“: Der Radsportler erscheint als eine Art Hybridwesen. Nicht nur das Sportgerät, sondern auch der Athlet wurde auf den Prüfstand gestellt und in Funktionseinheiten zerlegt. Das Spektrum des medizinischen Interesses am Sportlerkörper verschob sich im 20. Jahrhundert von physiologischen Studien über die spezielle Traumatologie und Therapie im Sport hin zum Design des Sportlerkörpers. Medizinisches Wissen wurde dabei zu einem konstituierenden Element des Hochleistungssports schlechthin. / Contemporary history of technology interprets the human body as a man-made “biofact”: The racing cyclist, especially, seems to be a hybrid. Not only the sports equipment, but also athletes have been examined and stripped down into functional units. In the 20th century, the interest of sports physicians shifted from physiological studies, via special treatments and therapies for athletes, to the design of their bodies. Medical knowledge became an important element of top-class sports.