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Prejudice impotence from vasectomy purchase malegra dxt master card, social stress impotence thesaurus buy cheap malegra dxt 130 mg line, and mental health in lesbian erectile dysfunction clinic raleigh purchase malegra dxt 130mg with amex, communities in the United States in 2011: A report from the National gay erectile dysfunction pills for diabetes order malegra dxt now, and bisexual populations: Conceptual issues and research evi Coalition of AntiViolence Programs. Employment, mental health, inter 09540120413331269567 nalized stigma, and coping with transphobia among transgender indi Nuttbrock, L. Latino lesbian, gay, bisexual, and transgender immi paredness of counselors in training to work with transgender clients: A grants in the United States. Hormonal therapy and sex among transgender women: Systematic review and metaanalysis. Normal life: Administrative violence, critical trans among sexualminority youths: Gender comparisons. Improving the lives of transgender older persistence of childhood Gender Dysphoria: A quantitative followup adults. Serving transgender youth: J082v03n01 04 Challenges, dilemmas, and clinical examples. Transgender youth of color and resilience: Negoti from transgenderlawcenter. Cultural difference and the therapeutic alliance: Sexualities in education: A reader (pp. Gender identity disorder and tioning students and families: A handbook for school professionals (pp. Some terms or definitions are not National Center for Transgender Equality), and profes universally accepted, and there is some disagreement sional literature. Professional Association for Transgender Health (Coleman Cisgender: an adjective used to describe a person et al. Cisgenderism may lead to prejudicial attitudes and Association, 2010; Coleman et al. Gender role may also refer to the queer, androgynous, or have other gender identities. Twospirit people are often re from the one associated with their sex assigned at birth. Psychologists strive to understand how mental health concerns may or may not be related to a Guideline 15. Guidelines for Psychological Practice with Transgender and Gender Nonconforming People. The frst step of the evidencebased practice process also asks a question, but it is a clinical question. The research questions and hypotheses in a research study discussed in the beginning of this chapter have diferent purposes than the clinical questions found in an evidencebased practice project. In a research study the research question and hypothesis lead to the development of a research study; the clinical question in an evidencebased practice project is the frst step in the development of an evidencebased practice project. At the beginning of this chapter you are going to learn about research questions and hypotheses from the perspective of the researcher, which, in the second part of this chapter, will help you to generate your own clinical questions that you will use to guide the develop ment of evidencebased practice projects. As a practicingthe research question and hypothesis as it aligns with the rest of the study. As a practicing nurse, the clinical questions you will develop (see Chapters 17 and 18) represent the frst stepnurse, the clinical questions you will develop (see Chapters 17 and 18) represent the frst stepnurse, the clinical questions you will develop (see Chapters 17 and 18) represent the frst step of the evidencebased practice process. Research questions are usually generated by situations that emerge fromtion or hypothesis. Research questions are usually generated by situations that emerge from practice, leading nurses to wonder about the efectiveness of one intervention versus anotherpractice, leading nurses to wonder about the efectiveness of one intervention versus anotherpractice, leading nurses to wonder about the efectiveness of one intervention versus anotherpractice, leading nurses to wonder about the efectiveness of one intervention versus anotherpractice, leading nurses to wonder about the efectiveness of one intervention versus another for a specifc patient population. For an investigator conducting a study, the research question or hypothesis is a key preFor an investigator conducting a study, the research question or hypothesis is a key preFor an investigator conducting a study, the research question or hypothesis is a key preFor an investigator conducting a study, the research question or hypothesis is a key preFor an investigator conducting a study, the research question or hypothesis is a key preFor an investigator conducting a study, the research question or hypothesis is a key preFor an investigator conducting a study, the research question or hypothesis is a key preFor an investigator conducting a study, the research question or hypothesis is a key preFor an investigator conducting a study, the research question or hypothesis is a key pre liminary step in the research process. The research questionresearch questionresearch question (sometimes called the problem statement) presents the idea that is to be examined in the study and is the foundation of thestatement) presents the idea that is to be examined in the study and is the foundation of thestatement) presents the idea that is to be examined in the study and is the foundation of thestatement) presents the idea that is to be examined in the study and is the foundation of thestatement) presents the idea that is to be examined in the study and is the foundation of thestatement) presents the idea that is to be examined in the study and is the foundation of thestatement) presents the idea that is to be examined in the study and is the foundation of the research study. The hypothesishypothesishypothesishypothesishypothesis attempts to answer the research question. HypothesesHypothesesHypothesesHypothesesHypotheses cancancancancan bebebebebe consideredconsideredconsideredconsideredconsidered intelligentintelligentintelligentintelligentintelligent hunches, hunches, hunches, hunches, hunches, guesses, guesses, guesses, guesses, guesses, ororororor predictionspredictionspredictionspredictionspredictions thatthatthatthatthat helphelphelphelphelp researchers seek a solution or answer a research question. Hypotheses are a vehicle for testingresearchers seek a solution or answer a research question. Hypotheses are a vehicle for testing the validity of the theoretical framework assumptions and provide a bridge betweenthe validity of the theoretical framework assumptions and provide a bridge betweenthe validity of the theoretical framework assumptions and provide a bridge betweenthe validity of the theoretical framework assumptions and provide a bridge betweenthe validity of the theoretical framework assumptions and provide a bridge betweenthe validity of the theoretical framework assumptions and provide a bridge betweenthe validity of the theoretical framework assumptions and provide a bridge between theory (a set of interrelated concepts, defnitions, and propositions) and the real world. In the scien(a set of interrelated concepts, defnitions, and propositions) and the real world. In the scien tifc world, researchers derive hypotheses and research questions from theories and subjecttifc world, researchers derive hypotheses and research questions from theories and subjecttifc world, researchers derive hypotheses and research questions from theories and subjecttifc world, researchers derive hypotheses and research questions from theories and subjecttifc world, researchers derive hypotheses and research questions from theories and subject them to empirical testing. Instead, it is through the hypotheses that the merit of a theory can be evaluated. For a clinician making an evidenceinformed decision about a patient care issue, a clinicalFor a clinician making an evidenceinformed decision about a patient care issue, a clinicalFor a clinician making an evidenceinformed decision about a patient care issue, a clinical question such as whether chlorhexidine or povidoneiodine is more efective in preventingquestion such as whether chlorhexidine or povidoneiodine is more efective in preventingquestion such as whether chlorhexidine or povidoneiodine is more efective in preventing central line catheter infections, would guide the nurse in searching for and retrieving the best available evidence that, combined with clinical expertise, and patient preferences, would provide an answer on which to base the most efective decision about patient care for this population. You will often fnd research questions or hypotheses at the beginning of a research article. However, because of space constraints or stylistic considerations in such publications, they may be embedded in the purpose, aims, goals, or even in the results section of the research report. Nevertheless, it is equally important for both the consumer and the producer of research to understand the importance of research questions and hypotheses as the founda tional elements of a research study. Although this section will not teach you how to formulate a research question, it is important to provide a glimpse of what the process of developing a research question may be like for a researcher. As shown in Table 21, researchResearch questions or topics are not pulled from thin air. As shown in Table 21, research questions should indicate that practical experience, critical appraisal of the scientifc literature, questions should indicate that practical experience, critical appraisal of the scientifc literature, questions should indicate that practical experience, critical appraisal of the scientifc literature, or interest in an untested theory was the basis for the generation of a research idea. The researchor interest in an untested theory was the basis for the generation of a research idea. The evaluator of a research study should be able to discern that the researcher has done the following:research study should be able to discern that the researcher has done the following:research study should be able to discern that the researcher has done the following:research study should be able to discern that the researcher has done the following:research study should be able to discern that the researcher has done the following:research study should be able to discern that the researcher has done the following:research study should be able to discern that the researcher has done the following: 1. Reviewed the relevant literatureed the relevant literatureed the relevant literature 3. Gaps in the literature a research idea may also be rural adults have higher rates of chronic illness and physicalural adults have higher rates of chronic illness and physicalhave higher rates of chronic illness and physical suggested by a critical appraisal of limitations that might be prevented by increased physicallimitations that might be prevented by increased physicallimitations that might be prevented by increased physicallimitations that might be prevented by increased physical the literature that identifes gaps in activity, yet few studies have been focused on helpingactivity, yet few studies have been focused on helpingactivity, yet few studies have been focused on helping the literature and suggests areas people increase their regular physical activity in ruralpeople increase their regular physical activity in ruralpeople increase their regular physical activity in rural for future study. For example, suppose a researcher told a colleague that her area of interest was pain as a prevalent problem for older adults. ure 21 illustrates how a broad area of interest (pain as a prevalent problem for older adults) was narrowed to a specifc research topic (persistent pain and its relationship to functional disability in older adults). Beginning the Literature ReviewBeginning the Literature ReviewBeginning the Literature Review The literature review should reveal a relevant collection of individual studies and systematicThe literature review should reveal a relevant collection of individual studies and systematicThe literature review should reveal a relevant collection of individual studies and systematicThe literature review should reveal a relevant collection of individual studies and systematicThe literature review should reveal a relevant collection of individual studies and systematicThe literature review should reveal a relevant collection of individual studies and systematicThe literature review should reveal a relevant collection of individual studies and systematic reviews that have been critically examined. Concluding sections in such articles, that is, thereviews that have been critically examined. Concluding sections in such articles, that is, the recommendations and implications for practice, often identify remaining gaps in the literature, recommendations and implications for practice, often identify remaining gaps in the literature, recommendations and implications for practice, often identify remaining gaps in the literature, recommendations and implications for practice, often identify remaining gaps in the literature, recommendations and implications for practice, often identify remaining gaps in the literature, the need for replication, or the need for extension of the knowledge base about a particularthe need for replication, or the need for extension of the knowledge base about a particularthe need for replication, or the need for extension of the knowledge base about a particularthe need for replication, or the need for extension of the knowledge base about a particularthe need for replication, or the need for extension of the knowledge base about a particularthe need for replication, or the need for extension of the knowledge base about a particularthe need for replication, or the need for extension of the knowledge base about a particularthe need for replication, or the need for extension of the knowledge base about a particularthe need for replication, or the need for extension of the knowledge base about a particular research focus (see Chapter 3).
If orthostatic hypotension is prom only with caution and in selected individuals with treatment inent or associated with gait or balance problems buy erectile dysfunction pills online uk buy 130 mg malegra dxt with amex, it may resistant symptoms (205 erectile dysfunction drugs online buy generic malegra dxt 130 mg line, 206) erectile dysfunction drugs over the counter canada purchase 130mg malegra dxt free shipping. Other zyme inhibition in the gut and firstpass metabolism in the causes of falls include bradycardia how to treat erectile dysfunction australian doctor buy malegra dxt 130mg on-line, cardiac arrhythmia, a liver. Potentially danger efficacy of this strategy, which can produce dangerous ous interactions, including hypertensive crises and seroto hypotension (210). Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition 43 b. In shortterm efficacy trials, all anti pirone or antidepressants (157, 204, 211). Possible treatments for this side effect in effects permitting, before changing to a different antide clude adding dietary salt to increase intravascular volume, pressant medication. In some instances, due to factors or use of the mineralocorticoid fludrocortisone. Pa peripheral edema, which may be helped by the use of sup tients who have achieved some improvement during the port stockings. The transdermal formu tom response have not been rigorously investigated with lation of selegiline appears to have a relatively low risk of fixeddose studies, and minimum effective doses have not sexual side effects (213). Therefore, the initial aches and insomnia; these side effects may diminish over doses and usual adult doses in Table 6 are intended to time with continued use. In general, patients who are tion; when patients are particularly vulnerable to the toxic older, are medically compromised, or have decreased abil effects of a medication and require the lowest possible ity to metabolize and clear antidepressant medications will effective dose; when there are concerns about patient ad require lower doses. In such patients, reduction of initial herence; and when there is concern that drugdrug inter and therapeutic doses to 50% of usual adult doses is often actions are adversely affecting antidepressant medication recommended, and dose escalations should be made at a levels. In time, genetic testing may help guide selection or slower rate than for younger and healthier adults. Doses dosing of antidepressants, but data are currently insufficient will also be affected by the side effect profile of medications to justify the cost of such tests (229). Early Patients who have started taking an antidepressant on in treatment, it is prudent to dispense only small quan medication should be carefully and systematically moni tities of such antidepressant medications and keep in mind tored to assess their response to treatment, the emergence the possibility that patients can hoard medications over of side effects, their clinical condition, safety, and adher time. Other somatic therapies cooperation with treatment, the availability of social sup ports, the presence of cooccurring general medical ill a. Patients in clinical trials lower when it is used in community settings than when it is appear to benefit from monitoring once a week or more. In clinical practice, the frequency of particularly those with significant functional impairment monitoring during the acute phase of pharmacotherapy who have not responded to numerous medication trials may vary and can be as often as multiple times per week in (239). The method of monitoring ficial and can be considered as a firstline treatment option. For some medications, particularly nortrip indicated as a firstline treatment for patients who have pre tyline, amitriptyline, desipramine, and imipramine, blood viously shown a positive response to this treatment modality drug levels correlate with both efficacy and side effects or who prefer it (239). Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition 45 1. Side effects of electroconvulsive therapy and any specifically indicated laboratory, radiologic, or Electroconvulsive therapy is a very safe treatment, and imaging studies) to define factors that may influence the there are no absolute contraindications to its use (239). In effects, mediated by changes in the autonomic nervous assessing indications for caution. Although data supporting this that generally lasts between 30 and 60 minutes (246). For ness, particularly when right unilateral electrode place many individuals, however, subjective memory (256) and ment is used (263). Most research has focused on individual, inperson, 2008 for use in individuals with major depressive disorder outpatient treatment, in part based on the needs and con who have not had a satisfactory response to at least one straints of research methods. However, research has also antidepressant trial in the current episode of illness. Although the primary patient factors should be considered in determining the studies used in these metaanalyses are highly overlapping nature and intensity of psychotherapy. Specific psychotherapies Patient factors, such as the nature and duration of depres sive symptoms, beliefs and attitudes toward psychotherapy, 1. Psychotherapy is that focus primarily on aspects of cognitive patterns and particularly useful in addressing the psychosocial stressors those that emphasize behavioral techniques can be used and psychological factors that have an impact on the devel alone, but are generally used in combination. However, one metaanalysis depressive symptoms by challenging and reversing these found no large differences in longterm efficacy between beliefs and attitudes and encouraging patients to change any of the major psychotherapies, including dynamic psy their maladaptive preconceptions and behaviors in real chotherapy, for mild and moderate depression (286). Nonetheless, in tivity scheduling (304, 305), selfcontrol therapy (306), patients who respond to medication, psychotherapy may social skills training (307), and problem solving (308). Be foster the development of social skills and confidence af havior therapy involves graded homework, scheduling of ter years of depressionrelated impairments (297). Behavior therapy has demonstrated efficacy, at times therapy that requires considerable time or patience may superior to cognitive therapy, in treating major depressive be poorly tolerated. Depending on what can reason tifying the current trigger of the depressive episode, facil ably be expected with the given type of psychotherapy, the itating mourning in the case of bereavement, promoting psychiatrist should consider a change in the intensity or recognition of related affects, resolving role disputes and Copyright 2010, American Psychiatric Association. Sometimes a goal of psy major depressive disorder is defined as a medical illness, chodynamic psychotherapy, brief or extended, may be to and the illness, rather than the patient, is blamed for the help the patient accept or adhere to necessary pharmaco symptoms. Studies trials than the efficacy in this phase of some other forms of have shown efficacy of this treatment in depressed pri psychotherapy. This research is reviewed in Part B, Sec mary care patients and patients with more severe depres tion V. Interpersonal psychotherapy can also Problemsolving therapy is a manualguided, brief treat be used as a monthly maintenance therapy to prevent ment lasting six to 12 sessions. The approach combines ele traits and who are single and not living with others (317). Some have advantages over therapies that do not focus on such studies have reported modest improvement in patients events directly. Although problem solv ing therapy has had limited testing for patients with major 3. Marital therapy and family therapy dynamic theories about the etiology of psychological Marital and family problems are common in the course of vulnerability, personality development, and symptom for mood disorders, and comprehensive treatment often de mation as shaped by development and conflict occurring mands assessing and addressing these problems. Some of these theories focus on conflicts related to pressive disorder but may also increase vulnerability to guilt, shame, interpersonal relationships, the management developing major depressive disorder or retard recovery of anxiety, and repressed or unacceptable impulses. A number of marital and family ther address developmental psychological deficits produced by apies have been shown to be effective in the treatment inadequacies or problems in the relationship between the of depression. Techniques include behavioral approaches child and emotional caretakers, resulting in problems of (338), problemfocused approaches (340), and strategic selfesteem, sense of psychological cohesiveness, and emo marital therapy (341, 342). Metaanalyses rent and past problems in interpersonal relationships, of the relative effectiveness of psychotherapeutic approaches selfesteem, and developmental conflicts associated with conducted in group format versus individual format have anxiety, guilt, or shame.
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Choosing general surgery: Insights into career choices of current medical students what medication causes erectile dysfunction cheap malegra dxt 130 mg visa. Contemporary trends in student selection of medical special ties: the potential impact on general surgery erectile dysfunction 32 malegra dxt 130 mg cheap. Numb and number: Once a hot specialty erectile dysfunction supplements cheap malegra dxt american express, anesthesiology cools as insurers scale back erectile dysfunction and diabetic neuropathy purchase malegra dxt in india. Evidence of a current and lasting national anes thesia personnel shortfall: Scope and implications. Dur ing your hospital clerkships, you will overhear these and many more statements from residents and attending physicians. As you learned from Chapter 3, there are many important factors to take into account when choosing a medical specialty. Each specialty requires a set of skills, a circle of qualities, and a certain type of disposition. Some of these intangibles are unique to that area of medicine; others overlap across many disciplines. But at some point during medical school, take some time out for an honest assessment of your values, character, and temperament. By tak ing a closer look at the specialties that best match your personality type, you will gain valuable information to help you make your decision. Instead, it means identifying your distinctive attributes, val ues, and affinities and finding the natural comfort zone where your true prefer ences lie as a physician. Although it is especially important for doctorsintraining to select a specialty that is the best match with their personality, best match does not mean it has to be perfect. Take a hard look at the physicians you have met and make sure that your personality type is well represented (rather than underrepresented) in the specialty that interests you. The notion that opposites attract will probably not lead to a long, satisfying medical career. For instance, most physicians would not dispute the idea that empathic, laidback medical students make better psychia trists, and strongminded, authoritarian, nononsense ones should become sur geons. In these examples, students find themselves most comfortable working sidebyside with other physicians who share their personality traits. When you get along well with your colleagues, patients end up receiving the best medical care possible. A group of surgeons sought to determine whether there were differences in the characteristics and temperament of physicians in three types of medical careers: surgical, primary care (family practice, internal medi cine, and pediatrics), and controllable lifestyle specialties (anesthesiology, der matology, emergency medicine, neurology, ophthalmology, pathology, psychia try, and radiology). They tend to overlook the fact that surgery requires a certain type of person who can handle its tasks and challenges. At the same time, how ever, surgeons were less creative than their colleagues in controllable lifestyle spe cialties (who were found to be the most withdrawn and rebellious). Another landmark study surveyed a group of medical students to determine any relationships between personality type and specialty choice. Future obstetriciangynecologists saw themselves as warm and helpful, but they were also emotionally vulnerable, uncomfortable around others, and very con cerned about appearances and making a good impression. Future pediatricians, who sought warm and close interactions with their patients, were the most ex troverted and sociable people. The study also found that students interested in surgery were more likely to be competitive, aggressive, and highly confident. They were the doctorstobe who carried a strong conviction that their actions could rapidly infiuence the course of events. When checking out all the different choices, medical students should keep in mind that more than one specialty could meet their preferences. For every per sonality type, it is possible to find a satisfying match with more than one area of medicine. If you are a visually oriented person, consider specialties like pathol ogy, dermatology, and radiology. Primary care specialties, like internal medicine and family prac tice, are great opportunities to have longterm, intimate patient relationships. If you prefer an actionoriented specialty that gives immediate gratification, then consider anesthesiology, any surgical subspecialty, and emergency medicine. The test enables you to learn more about how you perceive and judge others, whether in an occupational or social situation. It iden tifies your strengths and weaknesses and shows whether you value autonomy or prefer interdependence. You can do an Internet search for these, or simply log on to the official site of the Center for Applications of Psychological Type at <. For a fee, they will send you the official test and provide personalized expert feedback over the tele phone about your results and how to use their interpretation. When taking the test, be sure to answer every question truthfully; honesty is the only way to yield the most accurate results and help you pick the most appropriate specialty. Each index represents one of the four basic preferences (de scribed by Jung) about how every individual perceives and processes external stim uli and then uses that information to make some kind of cognitive judgment. Introverts pre fer to focus their interest and energy on an inner world of ideas, impressions, and reactions. Instead, in troverts prefer interactions with greater focus and depth, with others who are also good listeners and who think before they act or speak. Extroverts, on the other hand, derive their energy from external stimuli and tend to focus their interest on the outside world. They simply pre fer being engaged in many things at once, with lots of expression, impulsiv ity, and thinking out loud. Sensing (S) versus Intuition (N): What kinds of stimuli do you prefer when collecting, processing, and remembering informationfi They are sensi ble, matteroffact people who look at the reality of the world around them, rely on prior experiences, and take things literally. Intuitives, on the other hand, look beyond the facts and evidence for meanings, possibilities, con nections, and relationships. They are more imaginative and creative people who like to see the big picture and abstract concepts. Using intuition often means relying on a hunch or gut feeling rather than past experience.
That person could be an advisor erectile dysfunction in young buy discount malegra dxt 130 mg online, par ent erectile dysfunction at age 29 order 130 mg malegra dxt otc, supervising physician erectile dysfunction 22 buy generic malegra dxt 130mg, or even Aunt Betty at the annual family reunion erectile dysfunction acupuncture buy malegra dxt 130 mg line. You have to spend over $200, 000 for four years of rigorous education, followed by many long, tough years of onthejob training. Like life in general, many im portant decisions line the road to becoming a doctor. After slog ging through tedious premedical courses and the application process, you then made the choice of where to attend medical school. The medical school experi ence is more than just memorizing the arteries of the arm, holding retractors dur ing surgery, and learning how to use a stethoscope. Each and every medical stu dent has to go through four years of grueling examinations, sleepless nights on call, and tough clinical rotations. uring out what type of doctor to be is, in many ways, more dif ficult than deciding to become a physician. Once medical students settle on a specific niche within medicine, they become more than just future doctors. Graduating doctors have the freedom to choose from a wide variety of medical fields. Some are based strictly on an organ system, like the brain (neurosurgery and neurology), the heart (car diology), and the male genitourinary system (urology). Others provide compre hensive medical care for specific population groups, such as women (obstetrics and gynecology) and children (pediatrics). Another set of specialties share in com mon the fact that they are hospitalbased services. Medical specialties can also generally be divided into two main groups: primary care (longterm comprehen sive care) versus secondary/tertiary care (referralbased care). Generalist special ties like family practice, internal medicine, and pediatrics are considered primary care fields. More specialized areas such as gastroenterology, dermatology, and car diothoracic surgery fall into the latter category. As a result, most students have even less time for the proper selfassessment, research, and explo ration required to choose the right specialty. Every medical student agrees that it is the most difficult professional decision that they will have to make. In the end, many hastily choose their lifetime careers without having all the information they need to make an educated decision. This book is designed to help medical students make an informed choice by the time senior year rolls around. Deciding on a field of medicine is often de scribed as matching oneself with the characteristics of a particular specialty, such as lifestyle, intellectual challenge, technological focus, and research potential. There are three different types of onthejob training that com mence immediately following graduation from medical school. These avenues take young, inexperienced doctors and turn them into welltrained specialists, ready to cure disease and save lives. Choosing a specialty determines what form of further professional training is required after medical school. Medical students have to commit to their specialty to begin the next phase in training: residency. During the past 60 years, rapid advancements in medical science created a greater demand for specialists, which residency programs ex panded to meet. Depending on the specialty, residency consists of 3 to 7 years of additional formal training and study (under physician supervision). Residency takes it one step fur ther and confers the skills, knowledge, and experience necessary to practice med icine unsupervised in a given specialty. You work long hours for little pay and spend many nights sleeping in the hospital. In fact, residency earned its name from the old days when house staff physicians actually lived on hospital grounds, as resi dents. Through the National Resident Matching Program, graduating medical stu dents may enter residency training in 20 different specialties. But every year, statistical data from the residency match show that nearly all medical students enter 1 of only 20 areas. After deciding on a specialty for residency, many physicians later choose to subspecialize further by obtaining a fellowship, which can last any number of years. Examples include rheuma tology or infectious disease (internal medicine), vascular surgery (general sur gery), pain management (anesthesiology), and retinal surgery (ophthalmology). Because of all the subspecialties, there are over 60 different kinds of doctors out there! You can be an adolescent medicine specialist, critical care physician, or interventional radiologist. Because areas of subspe cialization are primarily of interest to current residentsintraining, they will not be a major focus of this book. It is important to remember, however, that these fields are all potential career paths. Do not exclude them from your mind while you are contemplating and exploring the 20 basic specialties. In the old days (prior to 1970), all graduating medical students completed a 1year rotating internship before en tering residency. This busy year consisted of all the core specialties: internal med icine, surgery, pediatrics, obstetrics and gynecology, and psychiatry. The goal was to provide broad handson training that would enable a new physician to work in the community as a general practitioner. After the demise of the formal intern ship in 1970, only the lingo lives on today. The old internship does still exist in a disguised form: the transi tional year residency. Medical Students Are Faced With More Choices Than Ever Back in the old days of medicine, the career options for a graduating medical stu dent were pretty simple: become a general practitioner, or. The discovery of inhalation anesthetics gave birth to anesthesiology, progress in drug therapy revolutionized psychiatry, and the development of the colonoscope created gastroenterology. Today, with nearly 60 specialties and subspecialties of medicine, nar rowing the choices down to one is more challenging than ever. Clinical Clerkships Have Many Limitations After making it through 2 hard years of basic sciences, medical students have to complete a series of clinical clerkships (rotations). The purpose of this hospital experience is twofold: (1) to acquire a basic fund of clinical knowledge in that specialty, and (2) to explore whether or not that field of medicine may be one you want to pursue. During this short period of time, medical students get limited exposure to that specialty. Anxiety over clerkship examinations and grades takes both time and mental energy away from focusing on the merits of the specialty. During a rotation, many students spend more time studying for the test or worrying about their daily per formance on rounds instead of discussing the pros and cons of that specialty with residents and attendings.