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The Anatomy Department at Tel-Aviv University Medical School offers its students an elective course of 26 didactic hours on human evolution. The course is open to students from all faculties, who must fulfill all academic requirements, without a prerequisite of a background in anatomy. Approximately 120 students attend annually, a third of them are nonmedical students who major in philosophy, archeology, and sociology. This article discusses the course's contributions to students' understanding of a scientific concept that a scientific theory can be contradicted by new evidence, because facts govern science. Also, research methods of applying scientific principles establish the understanding of the human body, which evidently contributes to health and medicine. In the classes, the students are divided into mini-groups of 2–3 students, while the lecturer moves among students to examine fossils. In addition, analogies, open-discussions, and explanations accompany the tangible experiences. The lecturer of the course is an experienced anthropologist–anatomist researcher. He is a role-model and a mentor, sharing with the students his belief that a scientist should be persistent in his research to overcome difficult circumstances. Students, regardless of their backgrounds, express high appreciation of the course in their feedback questionnaires. The message conveyed by this course is that not only knowledge counts but also its integration with scientific principles. This course teaches us that science can bring students from different areas to study together and share ideas. In conclusion, this is a unique course in the eyes of the faculty and students alike. Anat Sci Educ. © 2012 American Association of Anatomists.

CONTEXT The impact of faculty development activities aimed at improving the teaching skills of clinical instructors requires elucidation. Since 2003, all instructors at our school of medicine have been required to undertake a brief workshop in basic clinical instructional skills as a prerequisite for promotion and tenure. The impact of this has, so far, remained unknown. OBJECTIVE This study aimed to examine to what extent participation in a brief workshop can improve clinical instructors' performance in the long run, and which particular dimensions of performance are improved. METHODS The study included a sample of 149 faculty members who undertook a required workshop in basic instructional skills. The teaching performance of these faculty members was measured by student feedback a year after the workshop. The study used pre- and post-test design, with a comparison group of 121 faculty members. RESULTS Student ratings for 5 dimensions of clinical instruction increased significantly, but only for the study group who had participated in a workshop. The comparison group's ratings were unchanged. The highest improvement in the instructors' performance related to availability of teachers to students. CONCLUSIONS The study supports previous findings about the added value gained by longterm improvement of instructional skills after participation in even a brief workshop. The meaningful improvement in instructor availability to students is associated with the workshops' emphasis on a learner-centred approach and the need to provide continuous feedback.

The purpose of this study was to determine if self-reported teaching style beliefs were different among faculty at a U.S. and an Israeli dental school. Teacher-centered practices refer to beliefs that the teacher holds the subject matter expertise and students are generally passive learners who must be told what to think. Student-centered practices refer to beliefs that students must learn how to construct their own understanding. Student-centered teaching is directed towards enabling students to think about complex issues. Twenty-seven of fifty-eight (47.37 percent) faculty at a dental school in the United States and thirty of thirty-four (88 percent) Israeli dental faculty teaching in basic science courses completed the Teaching Behavior Preferences Survey (TBPS). The TBPS is a thirty-item instrument that measures two domains of teaching styles--teacher-centered (TC) and student-centered (SC)--and four subdomains: methods of instruction (MI), classroom milieu (CM), use of questions (UQ), and use of assessment (UA). Findings revealed that there were no significant differences in student-centered and teacher-centered teaching practices and methods of instruction, classroom milieu, and use of questions. There was a significant difference between the U.S. and Israeli groups in their reported use of assessment. The U.S. faculty reported a greater preference for student-centered assessment practices than did the Israeli faculty.

More than three thousand years of Jewish historical and scholarly writings have addressed the problematic relationship between anatomical dissection for the purpose of medical education and Judaism, which values the wholeness and sanctity of the human body. The Department of Anatomy at Tel Aviv University's Sackler Faculty of Medicine has sought to bridge the gap between science and Jewish religious–cultural values. The Department requires students to conduct laboratory dissections on cadavers in an ethical and respectful manner. Student emotions are also addressed by the Department as students are encouraged to share their apprehensions and concerns about participating in dissections in discussion groups. At the same time, the high academic standards of the medical school are strictly upheld, ensuring that each student has a thorough knowledge of human anatomy. Teaching anatomy in Israeli medical school involves reconciling two conflicting approaches to dissection: (1) The scientific–medical approach, which views the human body as inert material and anatomical dissection as a means of studying anatomy and gaining medical knowledge. (2) A Jewish religious point of view, which perceives anatomical dissection as a threat to the sanctity of a human body and leads to the defilement of those participating in the dissection. In this article, the views of major Jewish scholars regarding dissection are presented and discussed in relation to their implementation in the dissection theater. These views are examined in an anthropological light based on observations in the dissection room and interviews with students and faculty members. The findings reflect the emotions and concerns of Israeli medical students at the Sackler Faculty of Medicine in particular as well as those of the Israeli–Jewish population as a whole. In the dissection theater, medical students must gain a comprehensive understanding of human anatomy while dealing with their own personal ethical, cultural, and religious views on death and dying. Confronting these issues enhances both personal growth as individuals and professional behavior as future physicians. Clin Anat. 19:442–447, 2006. © 2006 Wiley-Liss, Inc.

The study compares aspects of the career development of working nurses, graduates of a BA degree program, which runs on two tracks--university (UG) and college (CG). Two hundred nurses participated in the study, 86 of them (43%) UG and 114 (57%) CG. Participants were asked about their academic backgrounds, career advancement and satisfaction with their studies. Results indicated no major differences in professional advancement between the graduates of the two tracks. College-graduates were significantly older with lower previous academic achievements. Both BA programs promoted nurses and enabled career advancement, especially so for the college-graduates who would not, otherwise, have been able to make this progress.

The aims of this study were to determine whether harassment occurs in the authors' school, the Sackler Faculty of Medicine at Tel Aviv University, and to address the possible influence of cultural background on the perception of harassment. The unique makeup of the school was utilized, with two separate programs for American and Israeli students trained at the same sites and by the same faculty. A two-part questionnaire was developed that included students' reports on the occurrence of harassment, at what stage of their studies, by whom and its nature as well as demographic data. In the second part, students reported on their perception of harassment. Seven common scenarios were presented, and they were asked to indicate (on a four-point scale plus a non-applicable option) to what extent each scenario constituted harassment. A total of 115 Israeli and 81 American students in their clinical years responded during 2000-2001. About 50% experienced harassment, mainly in the clinical years. Significant differences were identified between the Israeli and the American students in their: (1) reporting of the amount (Israeli 59% vs. American 38%) and nature of harassment, and (2) perception of harassment (differed in six out of the seven scenarios), that can be related to their different cultures. These findings suggest that medical school faculty should be made aware of cultural differences in students' perception of harassment, thus enabling them to adapt their approach towards the students and take action to prevent its occurrence.

SUMMARY Two factors have caused major changes in the gender composition of the Israeli medical profession in recent years: (i) a wave of immigration from the former USSR, which increased the doctor population by approximately 70% and which included a majority of women physicians, and (ii) the entry of more Israeli women into medical school. This report presents the current gender status of the Israeli medical profession, regarding students and physicians, and the choice of medical specialty and academic seniority, and compares gender differences in Israel with those in other countries. Traditional patterns of specialization persist in Israel, with women still concentrated in primary care (family medicine, paediatrics and psychiatry). In addition, women still face obstacles in entering the more prestigious (mainly surgical) specialties. Whilst the number of women in academic medicine has increased over the last decade, women are still concentrated in the lowest echelons of academic medicine. However, the steady trend towards the feminization of medicine will inevitably lead to an increase of women in all areas of the medical profession. Because cross-cultural studies have repeatedly revealed that women doctors have a more humanistic and personalized approach to patient care, a higher ratio of women in the profession should have a qualitative effect in this direction, despite the bureaucratic and fiscal constraints incumbent upon practising doctors. As more women become role models for medical students, their approach will influence the education of the doctors of the future.

In an attempt to develop a model to measure the competence of physicians providing emergency care under difficult field conditions, 75 Israeli army medical corps physicians were evaluated through the use of four instruments: a debriefing interview, peer assessment, selfassessment and written examination. The special on-site assessment model was designed to examine actual events, enabling an assessment of performance in real situations rather than simulated cases. Significant positive correlations were found between the results of the written examination and the peer evaluation on two of four measures (r = 0.36, P = 0.001; r = 0.23, P = 0.05) as well as on the two measures regarding self-evaluation and peer evaluation (r = 0.54, P = 0.001; r = 0.38, P = 0.05). It was found that those physicians who were trained in the army's medical officer course scored significantly higher on the written examination (P = 0.001) and were rated more highly by their senior peers (P = 0.048) than those who did not receive such training. It was concluded that it is advantageous to use a combination of knowledge (written examination) and performance (peer assessment or self-assessment) measures in order to arrive at a more comprehensive assessment of competence. In addition, the written examination format should be expanded and developed to include more clinical vignettes requiring treatment decisions, making this instrument a more clinically oriented measure of physician competence in trauma care.

Summary Background: Educators claim that conflicts and teacher–student miscommunications interfere in achieving optimal learning outcomes. Context: Conflicts arise when clinical instructors communicate in a patronising fashion, expressing values that are not those of their medical students. This paper presents our approach of coping with such conflicts. It is based on the notion that language is comprised of developmental levels. The objective is to switch the instructor’s lower level of language from an uncontrolled reaction to a high level of efficient communication. Innovation: During our faculty-development workshops, we piloted sessions consisting of vignettes depicting instructor–student conflicts. The workshop participants were asked to react and discuss questions on their feelings in similar conflicts, and their immediate speech reaction to students. The workshop’s facilitator pointed out that there was no one right solution. She singled out the reaction that takes into account the student’s personality, avoiding imposing solutions. The feedback on these sessions was very favourable, indicating a high level of satisfaction. Implications: The positive feedback is very encouraging. We believe that our workshops amplify the desired effective instructor–student communication, and suggest that the success of this intervention is partly achieved by selecting problematic issues of communication, and adjusting them to the current needs of our faculty members. In order to reproduce our approach, we suggest that other institutions should define their own values and communication code. We recommend them to use the same technique of intervention among a small group in an empowering atmosphere of discussion, using their own situations.

In Israel, the transition to clinical training in hospitals is the first direct encounter of the medical student with the reality of the profession. This is a significant socialization step for his upcoming professional decisions.This study aimed to identify how this encounter influences students' perceptions of career choice, physician's character and preclinical studies.Fourth year Israeli medical students at the Tel Aviv University voluntarily completed a questionnaire before and after their first clinical clerkship. The questionnaire was comprised of 30 5-point Likert scale statements and 3 multiple choice questions with the possibility to add remarks.The random response rate was 90% (81/90) before the clerkship and 82% (90/110) at its end. Results indicate that the students are satisfied with their medical studies at both junctures. However, after the clerkship, 23% of the students consider alternatives to clinical medicine compared with only 6% before, and 16% would rethink studying medicine. Physicians are perceived as professional, compassionate, respectful to colleagues and actively participating in students' education. Physicians' levels of workload and bitterness are evaluated as high and moderate, respectively, while their levels of reward and satisfaction with medicine are evaluated as low and moderate, respectively. Their evaluation of the contribution of preclinical studies as preparation for clinical studies had not changed after the clerkship and was moderate, and earlier exposure to patients and clinical relevancy of the learned subjects were preferred.The students enter the medical world highly satisfied, and this feeling shall be maintained until the stage of being independent physicians and choosing their specialties. The picture that evolved, in which a high proportion of the students consider alternatives to clinical medicine, is disappointing. Educators should be aware of their role model function not only in knowledge and skills, but also in behavior and communication with patients. The students pointed to necessary changes in the medical curriculum to make basic sciences more relevant to clinical medicine. A broader study at different stages of studies in the rest of the medical faculties in Israel may be needed.

Background: Cultural differences have been discussed as a potential factor influencing students' perception and motivation towards their studies. At the Sackler Faculty of Medicine, Tel-Aviv University, two separate programs coexist for American and Israeli medical students. Both are taught at the same sites and by the same faculty, thus enabling cultural comparisons. Our aim was to examine the differences of two medical student groups, American and Israeli, regarding their satisfaction with studies, view of the educational workload, and their perceptions of physician characteristics. Methods: During the academic year 2007-2008 we administered an anonymous questionnaire to the two groups immediately after their first clinical clerkship in internal medicine. The response rate was 82% (90 out of 110) for the Israelis and 93% (53 out of 57) for the Americans. Results : Americans, compared to the Israelis, are significantly more satisfied with their medical studies, consider fewer alternatives to future careers in clinical medicine, feel less of a workload, and hold a more positive opinion of physician characteristics. Conclusions: Cultural differences affect students' perception of their studies, mentors and future careers. Medical educators should be sensitive to the effects of students' background which influence academic and professional attitudes and find ways to strengthen their commitment to the profession.

This paper explores gender differences among hospital residents' performance of clinical tasks in sleep- derived situations. Two different research instruments were employed to investigate the physicians' performance: an objective measure assessing the effects of sleep loss on performance by means of a computer game, and a subjective measure, a self-evaluation questionnaire investigating physicians' assessments of the effects of sleep loss on their professional performance. The results reveal no significant differences in objective performance between men and women as obtained by the computer game after a night shift. However, significant gender differences in self- assessment appeared in the self-reported questionnaire in the domains of technical abilities, decision-making and general functioning. Women residents reported a significant decline in some components of their performance after a night shift, while male residents report only a marginal effect on their performance. The major contribution of this study is in its actual applications in developing optimal work schedules and organizational interventions to minimize fatigue and increase safety.

The need to deepen the teaching of oncology was recognized by the Sackler Faculty of Medicine. In 2004, a weekly short clerkship was introduced into the 6th year curriculum, aiming to expose students to a variety of cancer diseases and treatments and to internalize the comprehensive approach to the patient and his family by the multi-professional team.To present students' reactions to their experiences in oncology in order to learn about the clerkship's contribution and to find ways to improve the training.A questionnaire was circulated to students at the end of their experiences. The response rate was 87% (out of 83), of which 55% were women. The answers were summarized by qualitative and quantitative methods.The students perceived the change in their attitude to cancer patients as a result of the acquisition of knowledge and their exposure to treatments of the diseases and patients (75%). They highly appreciated the implementation of the patient-doctor relationship and the multi-disciplinary teamwork (over 50%), transforming the oncologist into a different physician from his colleagues (70%), and more optimistic as to the prognosis. Twenty-five percent of the students expressed their interest in becoming involved with oncology in the future. While women noted the behavioral aspects of oncology significantly more than men, men indicated a greater appreciation of the knowledge and technologies they encountered. No relationship was found with the occurrence of cancer in the students' families.With the growing need to deepen physicians' empathy with patients and their families, especially with long-term diseases and health problems, oncology departments were found to serve as a unique site, suitable for training students. This was asserted by the students' reactions to the clerkship, as expressed in this study. The students furthermore expressed their preference for broader training exposure to palliative care and pain relief, and increased involvement in clinical work rather than didactics.

Many medical school curricula include training for ethical considerations, legal comprehension, implementation of patients' rights, awareness of cultural differences, and communication skills (ELCE).To explore medical students' perceptions of their ELCE training during the clinical phase as well as the relationship between humanistic practice skills' experiences and the quality of clinical training.A cross-sectional survey was carried out in two cohorts during their clinical year period at Tel Aviv University's Sackler Faculty of Medicine at the end of their Internal Medicine and Surgery clerkships in the 2002 academic year. The research tool was an 18 item Likert-type questionnaire (ELCEQ), based on the literature of biomedical ethics, legal aspects and behavior of practice skills. The content validation of the questionnaire was established by consulting experts among the school's faculty. It was circulated among the students by representatives of the Unit of Medical Education.The response rate was 88%. Students reported only a few opportunities for gaining experience in humanistic practice skills. A weak correlation was found between students' assessment of the quality of clinical training and their experiences in humanistic practice skills.A wider and more relevant range of active experiences in humanistic practice skills should be available to students during the clerkships. Correspondingly, there is a need for the clinical faculty to find innovative ways to internalize their task as role models and ensure that students acquire and are able to practice those skills.

Complementary medicine is gaining in public popularity, yet medical school curricula usually ignore it.To determine whether senior medical students are interested in learning principles of complementary or alternative medicine, to check their degree of familiarity with it, and to suggest a format for such studies in the medical curriculum.Senior medical students (n = 117) were surveyed by an anonymous questionnaire.Seventy-nine percent of the senior medical students were interested in studying complementary or alternative medicine in medical school, and 65% were interested in applying these techniques to treat patients. Eighty-seven percent of students were familiar with some techniques of complementary medicine.Senior medical students are interested in studying complementary and alternative medicine in medical school and in applying these techniques in practice.

The importance of health promotion and disease prevention in health policy and clinical practice is widely accepted in many countries. However, a large number of medical schools do not dedicate a significant part of their curriculum to these aspects. In Israel, there are no reports on the training of the future physician towards his or her role as health promoter in general, or in the areas of cardiovascular and cancer diseases specifically.To examine the preparation of Israeli medical students for the role of health promoter in cancer and cardiovascular diseases.The study was carried out over 2 years in two of the four medical schools in Israel: the Sackler Faculty of Medicine at Tel Aviv University and the Faculty of Health Sciences at Ben-Gurion University in Beer Sheva. The students (n = 172, 70% response rate) were surveyed during 1999-2000 by means of a questionnaire, which included assessment of their training towards the role of health promoter, their clinical experiences and exposure to patients at different stages of illnesses at various medical sites, and the specific skills and relevant knowledge they acquired.Most of the students' learning experiences occurred in hospitals with patients at the treatment stage and little time was dedicated to prevention, especially in the community. They demonstrated better knowledge, skills and satisfaction with their learning experiences in CVD than in cancer; and reported having insufficient exposure to several common cancer diseases and lacking examining skills for early detection of cancer. The students in Beer Sheva had significantly more interaction with patients at different stages of CVD and acquired more examination skills than the Tel Aviv students.A change in the curriculum is urgently needed: namely training medical students in community settings and preparing them to promote the well-being of their patients, including prevention. Attention should be given to launching new learning modes in the pre-clinical and clinical curriculum. We propose that: a) pre-clinical courses include prevention techniques in CVD and cancer, problems of cancer patients, and some examining skills; and b) the clinical phase should integrate oncology concepts and total cancer and CVD care into existing clerkships in the hospitals and in the community.

Diagnosis and treatment planning are considered to be the basis for successful clinical dentistry, however, these skills are difficult to teach and evaluate. At the Department of Diagnosis and Treatment Planning, Tel Aviv University Dental School, a 3-year teaching programme has been developed. The goals of the programme are to teach a systematic pattern of data collection from history, clinical examination, imaging modalities and models, and to use this data to identify the patient's problems and to arrive at a final diagnosis, to develop a treatment plan, taking into account all relevant information, and to consult experts when needed, to train in case presentation, and to deal with peer response. The program includes 20 h of lectures and 30 h of exercises in the 4th year, developing at least 8 full treatment plans per student in the fifth year, a 1 30-min weekly panel seminar during the final year, and a final integrative examination at the end of the 6th year.

Teaching statistics to medical students is a challenging and often unrewarding task. However, few would argue the need for statistics in the medical school curriculum. In recent years, there has been a growing call for teaching only statistical concepts in medical schools. We strongly oppose this opinion and offer an alternative approach. In this article, we present our experience in teaching statistics to medical students at the Sackler School of Medicine, Tel-Aviv University, Israel. We then present the results of a recently held survey regarding the long-term contribution of the statistical curriculum to our students in different phases of their studies. We conclude by suggesting a new integrative statistical program, which incorporates the study of statistics into the entire medical curriculum.

The authors compare innovative learning strategies in medical education today with the traditional educational methods of Jewish Talmudic study. These methods began to be developed in yeshivas (the highest Jewish educational institutions) in the third century BC and continue to be used in yeshivas today. The teaching in thousands of yeshivas of Talmudic study worldwide emphasizes student-centered, problem-based, small-group, and lifelong learning. Further, in the yeshivas rote memorization is discouraged; students are selected on the basis of merit rather than social status; and the teachers (particularly master teachers) are expected to act as role models for all aspects of living. Over the centuries, the yeshiva has been slightly modified and specialized, and the number of students has increased, but the institution has retained its basic instructional format. The authors briefly describe each aspect of Talmudic study and how it relates to current educational practices in medical schools. They argue that comparing these two educational institutions--the yeshiva and medical school--is valuable, in that the history of the yeshiva educational system, which has successfully produced generations of creative scholars, educators, and leaders, as well as an enormous body of literature, validates the innovative teaching approaches being used in medical schools today.

A heterogeneous group of 77 physicians on compulsory or reserve military service were exposed to a 5-day course in trauma management, specifically designed for military medical personnel. Cognitive knowledge of trauma care delivery of the medical officers was assessed by means of multiple-choice written tests, which were held before and upon completion of the course. The significantly improved (p less than 0.0001) scores of the post-course test demonstrate the value of a condensed trauma educational program. Analysis of the background variants (i.e., medical education, military, and residency training, and time since graduation) revealed that the relatively short but intensive course sufficed to surmount the difficulties inherent in instructing a student body composed of individuals with dissimilar professional experience. We advocate the institution of a compact course in trauma treatment, with the specific aim of enhancing the medical officer's knowledge in this critical field of medical care.

OBJECTIVES : We examined the quality of instruction in a continued medical education course and the correspondence between the residents and lecturers evaluations of the program. MATERIALS AND METHODS : Resident psychiatrists and instructors completed structured evaluation forms immediately following each lecture in a psychiatry course for one academic year. RESULTS : Residents' and lecturers' evaluations of goal achievement, but not general ratings of lecture quality correlated positively. Instructors' enthusiasm, clarity and appropriateness of subject matter and encouragement of independent thinking, but not audio-visual aids significantly correlated with resident's positive evaluations. CONCLUSIONS : Ongoing evaluation of classroom lectures by resident psychiatrists may provide valuable feedback to instructors and impact the quality of medical education. The classic role of the teacher organization and enthusiasm are the most important components of quality education.

The present study compared two populations: medical students and faculty as to their definition of essential traits of the ‘good physician’. Each group was further divided into the two phases of medical education. The preclinical phase included preclinical students and preclinical faculty, and the clinical phase included two faculty subgroups—surgeons and internists and students in their clinical clerkships.The study was conducted in two phases. In the first phase (the pilot study), faculty and students (n = 90) specified 24 traits in a random fashion. These traits were made the basis of a structured questionnaire which was administered in the second phase. In phase 2, all participants (n = 388) were requested to grade the five most important traits on a 1–4 scale.The results show a remarkable general agreement on the desirable traits among all participants. However, there is a significant difference in the ordering of the five most important traits among the subgroups. The jive most important traits perc...

This study points out the significant role of senior teachers in the process of instruction. It also asserts the consistency and reliability of student assessments of instruction, and the correlation between these assessments and the students' achievement. The study was conducted on groups rather than individual students. The assumption was that when teaching is carried out in groups, it is preferable to relate to the evaluation expressed by the whole group, and its correlation with achievement. The data included 51 student groups studying in 15 departments affiliated with the medical school in 12 hospitals: paediatrics (3), psychiatry (5), gynaecology (4) and surgery (3). The results emphasize the role of senior teachers in the process of instruction. It was found that a high positive correlation exists between senior teachers' direct involvement in teaching and students' academic achievements. However, a low correlation was found between students' assessments of the overall departmental teaching and their academic achievements. Thus, it appears that achievement is not directly influenced by the quality of teaching as perceived by the students, but rather by other factors, with the exception of a positive correlation between the contributions of the department heads to instruction and students' achievement.

Summary Construction of multiple choice questions in histology is often hampered by the difficulty in finding alternatives to the correct answer which will be neither trivial nor ludicrous. An additional problem appears when the student performance on the morphological and the functional aspects needs to be assessed. A method of test construction is presented which includes ‘multi-dimensional’ questions. The questions reflect the objectives of the course and performance is evaluated differentially according to the importance attributed to their content.‘Essential knowledge’ is more highly rewarded than knowledge deemed secondary by the course's planners.

In medical schools, the factory visit is an important ingredient of occupational health instruction at all levels. Usually the time allotted for teaching this subject in the undergraduate curriculum is limited; as a response to this constraint, the Tel Aviv University Sackler Faculty of Medicine has used its associated teaching hospitals as the "factory" since 1982. Following an introductory discussion, the students are divided into small groups and sent to various departments of the hospital--wards, kitchen, laundry, maintenance workshop, X-ray department, and surgery--to observe and evaluate the work environment. Following this activity, the students reconvene and discuss the health implications of what they have seen. This way of providing the factory visit is well accepted by the students, saves time, and contributes directly to the students' awareness of their own working environment.

In view of low admission rate to medical schools, a large number of applicants are rejected annually. This population is denied the fulfillment of its occupational goal and must decide either to reapply to medical school or to choose a different occupational path. The present study focused on the possible career paths of rejected applicants, their persistence in reapplication and eventual admittance. The closeness to medicine of the alternative career was examined by two dimensions: the situs and the status. The career paths were viewed with respect to pre-admission cognitive criteria and occupational status of the alternative choices as compared to medicine. The study's random sample comprised one-third of the unaccepted applicants to the Tel-Aviv University School of Medicine for the 1970 academic year. The research follow-up (n = 208) of the applicants was conducted in 1981. The results showed a strong determination on the part of the unaccepted applicants to persist in their choice of medicine: 59% of the subjects reapplied and graduated from medical school either in Israel or in other countries. This group was found to be significantly more persistent in its number of reapplications than subjects who turned to an alternative career path. Thus, persistence was rewarding. When an alternative occupation was chosen, the tendency was towards careers unrelated to medicine but with a similarly high occupational status. No significant differences were found in the pre-admission cognitive criteria between those who studied medicine and those who chose an alternative career. Motivation and determination seemed to be the dominant factors in the attainment of one's choice of medicine as a profession.