This article explores medical students' experiences and coping strategies when confronting patient loss in their 3rd and 4th years of their programs. Much of the literature on the impact of patient losses focuses on physicians. This article joins a handful of works aimed at how medical students experience and cope with patient loss. In-depth interviews with 20 medical students provided rich descriptions of their varying experiences coping with death. Consistent with previous work, students experience substantial emotional stress coping with patient deaths, though some were more difficult to bear than others, such as when the dying patient was a child or when treatment errors could have contributed to deaths. Common coping mechanisms included talking through their emotions, thrusting themselves into continuing their rounds, crying, participating in infant death rituals, and turning to religion. When deaths occurred, senior personnel who exhibited empathy toward the deceased and tolerance toward the students' emotional responses were lauded and made the process easier. Also emotionally daunting, in many instances, was dealing with the families of dying patients. Most of the students did not view death as a failure, contrary to much earlier literature, except in instances in which human error or decision making may have played a part in causing the death of a patient.

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This chapter is a state of the art review of the research and theoretical writing on urban poverty. We reveal that there has been an ebb and flow in the study of urban poverty in America. The social reform movement of early twentieth century, responding to the dislocation that accompanied rapid industrialization, prompted a number of descriptive and muckraking studies of poverty in urban areas. At roughly the same time, sociologists at the University of Chicago conducted a prodigious volume of research on urban life, including a number of ethnographic studies on poverty that were far more analytical and systematic than those of the social reformers. However, by the late 1930s scholarly research on urban poverty was on the wane, only to be revived again in the 1960s following the rediscovery of poverty and the emergence of the Great Society program. We point out that the subject of urban poverty and the structure of the family has drawn considerable attention from researchers since the mid-1960s and has helped to raise the level of national interest in the problems of the inner city and the crystallization of a sizable ghetto underclass. It is emphasized, however, that with the emergence of longitudinal data sets many assumptions about the intergenerational transmission of poverty and persistent poverty in the inner city have been challenged. We furthermore maintain that research on urban poverty and migration has raised questions and generated new insights on the contribution of the urban migrant to the current problems of innercity poverty and social dislocations; and that several recent studies, possibly representing a trend in urban poverty research, have provided significant insights on the relationship between poverty and welfare dependency. However, we point out that since the results of the public policy research are so mixed, it would be risky to draw policy recommendations from them. On the other hand, the most recent studies of the effects of the Reagan budget cuts (the Omnibus Budget Reconciliation Act of 1981) on the working poor are clear and consistent: they reveal the nature of the federal government's dramatic retreat from the Great Society programs of the 1960s.

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The author presents an overview of the settlement patterns of the major Hispanic groups in poverty as well as selected indicators of their poverty-related problems. Key competing explanations for these poverty-related problems are examined and policy directions are offered.