Photographic memory, money, and liposuction: survey of medical students' wish lists

British Medical Journal, Dec 18, 1999 by Keith J. Petrie, Graham R. White, Linda D. Cameron, John P. Collins

Abstract

Objectives To examine whether medical students made fewer altruistic wishes and more money oriented wishes in later years of the medical course than students in earlier years.

Design Anonymous questionnaire survey.

Setting Auckland University School of Medicine.

Participants 520 medical students from 6 years of the course responded to the questionnaire item "If you had three wishes what would you wish for?"

Main outcome measures Proportion of wishes in various categories.

Results The three most popular categories of wishes were happiness (34% of students), money (32%), and altruistic wishes (31%). Rates of altruistic wishes (odds ratio = 1.05, 95% confidence interval 0.94 to 1.18; P = 0.36) and wishes for money (odds ratio = 0.96, 0.86 to 1.08; P = 0.52) did not vary over the years of the course. Female medical students were more likely than males to make altruistic wishes (36% v 26%; [chi square] = 5.68, P = 0.02), intimacy wishes (25% v 18%; [chi square] = 3.74, P = 0.05), and happiness wishes (42% v 26%; [chi square] = 18.82, P = 0.0001). Men were more likely than women to make sexual wishes (5% v 0.8%; [chi square] = 7.34, P = 0.01).

Conclusions We found no evidence that students were less altruistic and more money oriented in the later years of the medical course.

Introduction

Medical education is often criticised for having a detrimental influence on the values of students. Medical courses have been accused of taking in idealistic and caring students and producing cynical and less than altruistic graduates. Some studies have found that medical students report they become more uncaring, cynical, and concerned about making money over the course of their training.[1, 2]

Assessment of such changes, if they exist, is problematical. Retrospective, subjective ratings of changes in attitude over the medical course are difficult to interpret because it is hard to know how such ratings may be influenced by expectations and reporting bias. Another approach is to examine whether personal goals and wishes differ over the medical course. Wishes can be defined as goals that are unconstrained by the limitations of the real world and can be used to reveal values such as helping others and the desire to make lots of money[3] By asking students what they would wish for if they were given three wishes, we examined how the proportions of different types of wishes vary across the course and between male and female medical students.

Participants and methods

Five hundred and twenty Auckland University medical students from the six years of the undergraduate medical course participated in the research, representing 81% of the school's medical students. The sample comprised 258 men (49.6%) and 262 women; the number of students in years 1-6 were 79, 87, 90, 93, 99 and 74, respectively. Most students were from a European ethnic background (333, 64%), with the remainder comprising Asian (104, 20%), Maori (26, 5%), Pacific Islanders (15, 3%), and other races (42, 8%). During medical school lectures students were asked to complete an anonymous questionnaire which included the following question: "If you had three wishes, what would you wish for?" Wishes were coded by two judges using an established coding scheme.[4] Interrater reliability was calculated by using the wishes from a subset of 90 students (17% of the sample), and agreement between the two judges was high (Cohen's [Kappa] = 0.89).

Results

The table shows the numbers of students with wishes in the various categories. Some wishes were coded into more than one category--for example, "a great deal of wealth so I can use it to help and enrich the lives of people I love." The three most popular categories were happiness (34%), money (32%), and altruistic wishes (31%). Logistic regression analysis revealed that, contrary to predictions, the rates of altruistic wishes did not vary over the years in the course (B = 0.05 (SE 0.06); Wald's [chi square] = 0.84, P = 0.36; odds ratio = 1.05, 95% confidence interval 0.94 to 1.18). There was also no evidence that the frequencies of wishes for money increased over the years of the course (-0.04 (0.06); [chi square] = 0.42, P = 0.52; odds ratio = 0.96, 0.86 to 1.08). Wishes that related to improving self esteem were more common in the earlier years (-0.17 (0.07); [chi square] = 5.30, P = 0.02; odds ratio = 0.84, 0.72 to 0.97); the numbers of students expressing esteem wishes were 16 (22%), 16 (18%), 20 (22%), 9 (10%), 5 (5%), and 13 (18%) for years 1 to 6 respectively. Similarly, affiliation wishes were more prevalent among students in the earlier years of the course (-0.24 (0.12); [chi square] = 3.98, P = 0.04; odds ratio = 0.79, 0.63 to 0.99); the numbers of students with affiliation wishes were 5 (6%), 9 (10%), 7 (8%), 5 (5%), 0, and 3 (4%) for years 1 to 6 respectively. There was also a trend for wishes for greater knowledge to be reported more commonly by students in the earlier years of the course (-0.21 (0.11); [chi square] = 3.48, P = 0.06; odds ratio = 0.81, 0.65 to 1.00).