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Our study of pre-medical and medical students attending the Universities of British Columbia, Hong Kong and Otago, together with house surgeons, general practitioners, surgeons and psychiatrists in New Zealand, demonstrated many agreements regarding both positive and negative factors affecting their interest in psychiatry. Positive factors included: interest in human behaviour, personal aptitude, and quality of patient care. Negative factors included: the stress of practising psychiatry, faculty attitude and the quality of the science. Differences were determined by age of the students and cultural and personal experiences. We concluded that if more students are to be interested in psychiatry then psychiatrists will need to show that they enjoy their work and give effective treatment.

Dealing with patients' sex-related complaints is uncomfortable for many physicians. It can become more comfortable if the physician learns to apply his or her clinical knowledge of sexuality in combination with specific interpersonal interviewing skills. The level of comfort can be increased if the physician accepts his or her professional limitations in providing therapy and knows what other sources of care are available.

The psychiatry clerkship at the University of British Columbia (U.B.C.) emphasizes the teaching model of the student as primary therapist. In the adult program this takes the form of a ward in which clinical clerks are the primary medical agents. In the child program each clerk assesses and treats a new family referral. While the student-ward model has been described previously, this is the first report which attempts to evaluate some aspects of this innovative approach to teaching clinical psychiatry. Student knowledge, attitudes, personality attributes, and expectations were assessed at the beginning and end of the eight-week rotation, and the changes are described. Principal findings included significant differences in the following: psychiatric knowledge, attitudes about psychiatric illness, ratings of the students by the psychiatrist-supervisor, and some student personality characteristics. Most students had rotation experiences which went beyond prior expectations. The changes which occurred were thought to be important, although modest. The implications of the changes are discussed. The level of the patient care in the programs described compared favorably with similar situations in which residents are the primary therapists.

The treatment of vaginismus was the subject of grand rounds in the Department of Obstetrics and Gynecology at Vancouver General Hospital. Staff members of the UBC Sex Therapy Unit participated in the presentation of a case of unconsummated marriage.

The nature, incidence, prevalence, etiology and management of sexual problems in MS has not been well defined yet. Sexual dysfunctions in MS seem to be related to a combination of the neurological consequences of MS and the personal, partner and social reactions to this condition. A sexual history is valuable in defining the specific areas of concern, and bringing into focus the patient's and the couple's sexual resources. Physical examination and investigations may assist in clarifying the extent of the sexual impairment and disability, and its relationship to MS. Treatment strategies include: relevant information, education, physical rehabilitation and supportive therapy in combination with medical intervention, and when indicated, surgical treatment or sex therapy. Long-range prognosis with or without treatment is not clear yet.

Sex therapy has proven helpful for many patients with sexual dysfunctions. In judging the appropriateness of this new treatment procedure the clinician should determine the following: that a sexual dysfunction exists, that a stable couple relationship exists, that there are no major marital, psychiatric or physical problems that are etiologically important or that would interfere with treatment, and that both partners are willing to engage in a treatment program.