The Firstborn Phenomenon Among Psychiatric Residents
There has been a reawakening of interest in the study of birth order. Investigations have shown a significant preponderance of firstborn children in such areas as medical school. They have also shown that firstborns have a greater achievement level and different personality characteristics than other children. In support of this, the authors present their findings of residents' responses to a questionnaire regarding their training; of 160 subjects who responded, 92 were firstborn children.
We thank Daniels and colleagues for their comments on our report ([1][1]). Given that the Cleveland Clinic is the main referral center of patients with germline PTEN mutations in the United States, it is certainly possible that ascertainment bias may exist, an issue we acknowledged in our report.