Footnotes

1.Keniston, Kenneth. The Medical Student; this paper was an expansion of a speech given at Yale University. It was privately published and distributed. I received a copy form Bill Dickman, MSII. It is included here as Appendix A. p. 13-14.

2. Ibid. p. 1.

3. Ibid. p. 4-6

4. Ibid. footnote p.2

5. Ibid. p. 7-11

6. A. Gullatee, M.D., transcript except Appendix B.

7.UUMC Student Course Evaluation Form. Include as Appendix C.

8. Refer to p. , "Subservience and Black self-image".

9. Fanon, Frantz "A Dying Colonialism", Grove Press, 1965. See also Sessions, Rose MSIII. "Colonialism: Its Effects on The Delivery of Health Care to the Minorities"; The Black Bag, Vol. 3, No. Feb. 1974. p 14, Also Brown and Selznick. Sociology; Harper & Row, 4th Ed. p 94-98.

10."The Study of Recruitment and Progress of Minority Medical Students, SNMA; A Report by Vernon C. Smith, Jr. M.D., Project Director presented at the 84th AAMC Annual Meeting. November 6, 1973.

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11. op. cit - Keniston p.3

12. op. cit. SNMA Recruitment and Progress p. 6

13. ibid. p. 7

14. Personal observation which has been reinforced repeatedly by introspection and numerous interviews with matriculating Black medical students and pre-medical students.

15. op. cit. SNMA Recruitment and Progress. p.55

16. ibid. p. 18

17. ibid p. 9

18. ibid p. 21-24

19.See Appendix D. "Who put energy into Nigeria to get energy out for America?

20. op.cit. SNMA Recruitment and Progress p. 10

21. ibid. p. 9. The total number of medical students nationally was in 1970 - 40,000 and in 1971 - 43,399.

22. ibid p. 32

23. ibid p.37

24. ibid. p.37

25. Refer to Footnote 9

26.See Dixongram. Appendix E.

27.Consensus of opinion at the symposium on student mental hygiene and mental heath at

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the SNMA convention in Atlanta, Georgia April 11-14, 1974. The number of Black medical students in the country is small enough and the size of the lecture hall was large enough that at least 11% of all Black medical students in the country were present.

28. See appendix B, Excerpted transcript of taped recorded lecture given by Dr. A. Gullattee at SNMA Mental Hygiene symposium.

29.Jones, Reginald L. "Labels and Stigma in Special Education",Exceptional Children, March 1972. p 553-564. Garcia, Phd. Augustine. "A Study of the Relationship Between Teacher Perceptions and Bicultural
Bilingual Affectiver Interaction in the Classroom"; University of New Mexico Press, 1972. "Special Status" and "Faculty Unpreparedness"; Dynamics of Communication; SNMA monograph. See 37.

30. Comments by many married, with children Black medical students. See Appendix B. p. , Gullattee.

31.A frequently heard euphemism used at the UUMC by students, house officers and faculty.

32.Jordan, Wilbur C. - Study on Intern Matching Progress.

33.Gullattee, op. cit. p. Appendix B

34.op. cit. Jordan

35.Broom, L. and Selznick, P.Sociology; Harper
& Row, 4th edition, 1968.p. 177


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36.See "Dixongram" Appendix E for illustrative explanation.

37.Solutions for Communication and Retention of the Minority Medical Student; "The Dynamics of Communications"; A Report and Evaluation. Monograph SNMA. SNMA Dynamics of Communication Conference, April 17-18, 1973; Philadelphia, Pennsylvania. p. 1.

38. Ibid, p.15

39.Clemmons, J.B. Editorial Comment on Admissions and Retention. The Black Bag, Vol. 3, No. 1; Feb. 1974. p.2

40. op. cit. "Dynamics of Communication" SNMA monograph - p. 11.

41.Racism is defined, here, along lines consistent with the SNMA Dynamics of Communications Conference. That is, in addition to mere overt or covert pejorative racial prejudice, racism, includes lack of self-awareness on the part of faculties, administrators, white and non-white students and health agency representatives about their own racial feelings. This also includes not understanding the cultural conditioning which can unconsciously influence them not to accept others from different social, racial, cultural and economic backgrounds. Ibid, p.17.

42. Ibid. p. 21-22

43.op. cit. SNMA "Recruitment and Progress"
p.44


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44.ibid. p. 51

45.Part of the Earth Catalog; access to travel Published by Western Airlines; 1974. p. 4. "A few words about Salt Lake City". reproduced as Appendix M.

46.Dixon, John A., M.D. "Letter to Concerned Medical Students" Jan. 9, 1974. reproduced here as Appendix F.

47.The "Third World" is a term coined early in the 1950's, used to my knowledge in 1954 by Frantz Fanon, M.D., psychiatrist, to denote persons who are of, or descendants of, those countries not designated the Old World (Europe, including Russia) or the New World (the USA, including Canada). It is used, and used here, as opposition to "minority" because in a global view of the world's problems and races, those termed "minority" are actually the majority.

48.Reproduced here as Appendix G. Letter to Pre-Meds U of Md.

49.Reproduced here as Appendix H. Letter of Apology from C.C. Whitehead to myself after I complained about two particular incidents involving the same officer.l These two incidents are not the only one that occurred to me, or that I know of; certainly George Woods, and Wilbur Jordan, et al. could supply numerous others.

50.Reproduced here as Appendix I is a biography
entitled "About Myself" submitted to the
Admissions Committee.

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51.Appendix J. Articles of incorporation and logo of the Third World Medical Association.

52.Wolback, Robert A, M.D., Assistant to the Dean for Minority Student Affairs. Letter to The Black Pre-Medical Society of the University of Maryland at College Park; ibid 48 Appendix G.

53.ibid

54.Robinson, Tony, M.S. III "A Report Concerning the National Black Science Students Organization Convention, New York City, October 19-23, 1972. Available in office of Assistant to the Dean, Minority Student Affairs.

55.Eichwald, Ernst J., M.D. Letter dated April 19, 1972. Reproduced here as Appendix K.

56.Allen, Cordell, Income Supervisor. Letter dated Sept. 10, 1973. cc: forwarded to College of Medicine.

57."Student Information Handbook", U.U.M.C. January, 1974 page 11, paragraph 2.

58. op.cit

59.MCAT record available in Assistant to the Dean, Student Affairs Administration office. In addition consider the horrendous results on National Boards by Black students nationally. Is this evidence of cross-
purposed cross-cultural obstacles in effectively teaching non-white,, non-middle class students. Also refer to SNMA 10th Annual Conference/Convention resolutions
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#002,005, reproduced here as Appendix L.

60.See Becker et al (1961) and Merton et al (1957) for the two major sociological studies of medical schools. For an excellent critical commentary on these studies, and a review of the central theoretical problems in the study of medical socialization, see Levinson (1965). A useful general discussion of problems and issues in the sociology of medical education is Merton (1957). Gee and Glaser (1958) offer preliminary findings about medical schools, and Bloom (1965) reviews more recent studies. Studies of the psychology of medical education are rare. See, however, Bloom (1963) White (1952)and notes below.

61.I am especially indebted to the first-year Yale Medical School students who, over the past four years, have met with me to discuss (among other things) the impact of medical school upon them. Many of my comments here are a distillation of their observations.

62.A family tradition of medicine in modern America has much the same weight on a son as a legacy of the ministry in Victorian England. In both cases, the son must make a decision, pro or con; whereas other paternal occupations seem easier for sons simply to ignore.

63. See, for example, "Dr. X" (1965), Harris (1966), Gross (1966) or typical examples.

64. Put differently, "affective neutrality" increasingly characterizes all professional roles in modern society. In actual practice,
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physicians are probably more emotionally involved with their clients than are lawyers, engineers, business men, etc. But there are strong public objections to the professionalization of doctor-patient relationships, as witnessed, for example, by discomfort over the monetary side of this relationship. On medical roles in modern society, see Parsons (1951).

65. Stated more technically, the medical student's adaptive style tends to be counter-phobic, alloplastic, and obsessive- compulsive, placing special reliance on techniques like isolation and intellectualization. Several studies agree in finding distinctive use of obsessive- compulsive defenses among medical students; see, for example, Schlageter and Rosenthal (1962), Molish et al (1950), and Eron (1954). For most medical students, these techniques remain adaptive; but any account of the psycho-pathology of medical students would involve students in whom these adaptations become excessively rigid or collapse altogether. On the psychiatric problems of medical students, see Bojar (1961) Pitts et al (1961), Saslow (1956).

66.For example, at some publically-supported medical schools, there are probably more students for whom medicine constitutes, among other things, an important way of achieving social mobility. And institutions with a reputation for a research orientation obviously draw more students with vague plans
to enter medical research. Variation amongst the student bodies of medical schools has not been systematically studied.


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67.See Levinson (1965) for a general theoretical discussion of these issues. Medical education does not differ, in principle, from other professional training; in all cases the future professional learns not only the techniques of his profession, but the defenses and adaptations necessary to survive the vocational stresses of that profession.

68.Parsons (1951 discusses in sociological perspective some of the major "strains" in the medical role. Schofield (1953) finds that medical students become more alike as they progress through medical school.

69.See Lief and Fox (1963) for a discussion of related issues. Livingston (1963) and Eron (1955,1958) place a special stress on learning to cope with anxieties about death.

70.Fox (1957) discusses this issue, focussing more on the uncertainty of medical practice than on the responsibilities of the physician.

71.In the later years of medical school, a growing awareness of the variety of careers, styles and specializations possible for the physician tends to shift the student's focus from his fear of losing some valued part of himself to more practical explorations of how to include this part of himself into some medical specialization and style. Furthermore, actual contact with patients during the clinical years helps reassure some
students that is possible to be medically competent and yet to deal humanly with patients.


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73.Several studies have dealt with authoritarianism and its fate amongst medical students. See Livingston (1963), Schneider and Sharaf (1960), Parker (1958) and Libo (1957). These studies suggest that medical students are a rather non-authoritarian group, despite conservative political beliefs, that medical school does not affect levels of authoritarianism, and that low authoritarianism is associated with choice of psychiatry as a specialty. Rational attitudes toward authority have not been studied.

73. Eron (1955,1958) reports an increase in cynicism amongst medical students; Coker et al (1965) report increases in "machievellianism". Miller and Erwin (1959) find no such changes in their population. Becker et al (1961, chapter 21) and Becker and Geer (1958) argue that apparent cynicism is really "realism".

74. Schlageter and Rosenthal (1962) for example, report a general lack of intellectual curiosity among their sample. Some medical school faculty members report that medical students show less intellectual curiosity in their fourth year than in their first year. Here as elsewhere, future studies will have to disentangle the predispositions of the student from the effects of medical school.

75.Several studies have examined differences between medical students with different speciality choices. See, for example,
Schneider and Sharaf (1966) Becker et al (1961, chapter 20),Kendall and Selvin (1957), and Livingston (1963).

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76.On the general question of institutional impact on student development, see, e.g., Pace (1965), Stern (1965). See also Christie and Merton (1958).

77.For an optimistic view of the future of medical practice, see Parsons (1960). See also other essays in this issue.