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In achievement settings, the types of motivation individuals develop are crucial to their success and to the ways in which they respond to challenges. Considering the competitive nature of medical education and the high stakes of medical practice, it is important to know what types of motivation (conceptualized here as achievement goals) medical students and physicians adopt and how these may differ depending on the nuances of their achievement settings. This is a cross-sectional survey study of medical students (N = 200) and practicing physicians (N = 202). The online questionnaire included measures of achievement goals (performance approach, performance avoidance, mastery approach, mastery avoidance) and background characteristics. Multivariate analysis of variance was used to examine differences in achievement goals of medical students and physicians. Education/career stage, medical specialty, and practice type were used as factors in the analyses. Despite the differences in achievement settings, striking similarities in the achievement goals among medical students and physicians were observed in this study. Both students and physicians were most likely to endorse mastery approach goals (the most adaptive type of motivation) and least likely to endorse performance avoidance goals (the least adaptive type of motivation). Significant differences were observed in mastery approach goals of students and physicians, depending on education/career stage. With respect to medical specialty, although distinct patterns in achievement goals emerged in the student and physician data, the observed differences were not statistically significant. Academic physicians had higher levels of performance goals than community-based physicians. Medical students and physicians thus self-reported themselves as highly mastery approach-oriented; nevertheless, our findings suggest that these goals are more prone to fluctuations than other achievement goals, depending on the stage of one's education/career. The results largely show that medical students and physicians endorse achievement goals that are beneficial for lifelong learning, well-being, and success.

Abstract: Context: North American studies have documented practice variations and deficiencies in end-of-life (EOL) cancer care, such as trends toward treating dying patients aggressively and disparities in access to palliative care or hospice services. Objectives: To assess the frequency of aggressive health care usage at the EOL and identify factors associated with receiving aggressive care among patients who died of colorectal cancer. Methods: Data from the Alberta Cancer Registry, in/outpatient hospital records, and cancer electronic medical records were linked. Death in an acute care hospital, chemotherapy use in the last 14 days of life, more than one emergency room (ER) visit, more than one hospital admission, and any intensive care unit (ICU) admission in the last 30 days of life were used as indicators of aggressive care. Logistic regression was used to identify risk factors associated with each indicator. Results: A total of 2074 patients were included: 50.1% died in an acute care hospital; 3.7% received chemotherapy in the last 14 days of life; and 12.5% had multiple ER visits, 9.5% had multiple hospitalizations, and 2.2% had an ICU admission during the last 30 days of life. Age had the strongest association with chemotherapy use. Geographical region of residence had the strongest association with multiple ER visits and hospitalizations and dying in an acute care hospital. Tumor stage and duration of disease were associated with the ICU admission. Conclusion: The percentage of patients who died in an acute care hospital is higher than the 17% U.S. benchmark. Other indicators of receiving aggressive EOL care are consistent with existing care quality benchmarks. The considerable regional variation, however, indicates potential for system improvements. [Copyright &y& Elsevier]

Background: Medical school poses many pressures and challenges for individuals aspiring to health careers. Only some students, however, experience high stress and exhaustion, whereas others adaptively respond to schooling demands and engage in lifelong learning practices. By drawing on three motivation theories - self-determination theory, self-theories of ability, and achievement goal theory - this study examined the relations among motivational constructs, stress, exhaustion, and lifelong learning in medical students., Methods: All medical students in a 4-year program were invited to complete a questionnaire containing measures of psychological need satisfaction, self-theories of ability, achievement goals, stress, exhaustion, lifelong learning, and background characteristics. Using structural equation modeling, we tested a structural model that combined the three motivation theories to explain stress, exhaustion, and lifelong learning in medical students., Results: A total of 267 medical students participated in the study (response rate 42%). The results largely confirmed the hypothesized relations, revealing that unmet psychological needs and a fixed mind-set were associated with maladaptive cognitions (i.e., the pursuit of avoidance goals) and psychological distress (i.e., high stress and exhaustion). In contrast, psychological need satisfaction and a growth mind-set had distinct pathways to beneficial cognitions (i.e., mastery approach goals) and lifelong learning practices in medical students., Discussion: Adaptive motivations, cultivated through personal and environmental factors, may help to protect medical students from psychological distress and enhance their growth as lifelong learners. Understanding the mechanisms and pathways to desirable and undesirable outcomes in medical students is critical for creating learning environments that will serve these students well., Competing Interests: None

Background: The rise of social media has led to growing concerns about the potential implications of 'unprofessional' postings by physicians and medical students on individuals, institutions, and the medical profession. Relevant and effective guidelines have been difficult to develop and enforce, and there is a need for students and physicians to consider how their online activities may be perceived in the context of their professional roles. The purpose of this project was to examine the Internet presence of a graduating Canadian medical school class by scanning students' public profiles on the social media site Facebook, incorporate this information into an educational activity addressing professionalism and social media, and evaluate the impact of this activity on student behavior., Methods: A systematic search for public Facebook profiles of each member of the class was conducted, and data were collected on the types of publicly visible material. These were presented as part of an educational session on social media and professionalism. One month later, the Facebook search was repeated., Results: Of 152 students in the class, profiles were found for 121 (79.8%). The majority of students used appropriately restrictive privacy settings; however, a significant minority had publicly visible information, including comments, photographs, location, and status as a medical student. The educational innovation was well received with more than 90% of students agreeing that this topic was important and well addressed. A follow-up search found that many students had altered their privacy settings to make less information publicly available., Conclusions: A small but significant proportion of students share potentially unprofessional content on social media. An interactive educational intervention, which includes specific disclosure of how participants appear to others on social media, resulted in a significant change in student behavior.

Male breast carcinoma is a rare condition. Few male breast cancer-specific epidemiological or clinical trial data are available - our understanding of male breast cancer thus comes from studies of female breast cancer, painting an inaccurate picture when it comes to determining contributing factors. Clinicians report an increase in diagnoses of male breast cancer but this has not been formally reported. We therefore undertook a review of data obtained from four western nations: England, Scotland, Canada and Australia. When adjusted for age, this review clearly showed an increase in the incidence of male breast cancer over a 15-year period. Reasons for the increased incidence are discussed in the context of suggested risk factors such as BRCA2 and lifestyle changes over the past few decades. The clinical management of male breast carcinoma is considered, in particular the potential role of aromatase inhibitors and fulvestrant and targeting pathways involving prolactin and androgen receptor.