Open Access Open Access  Restricted Access Subscription or Fee Access

An Institutional Evaluation of Medical Student Interest in Care for the Underserved

David Anthony, Paul George, Marina MacNamara, Shmuel P Reis, Julie Scott Taylor

Abstract


Background and Objectives: The United States of America is currently experiencing a shortage of physicians caring for underserved populations, perpetuated in part by increasingly negative attitudes during medical school towards working with these populations. The objective of this study is to provide a baseline assessment of the attitudes of all medical students at our institution towards caring for the underserved that will then guide the development, implementation and evaluation of a multi-pronged, 5-year intervention.

Methods: For this mixed methods, cross-sectional study, we administered the validated Medical Student Attitudes Towards the Underserved (MSATU) survey to all 4 classes at one medical school within one academic year. Statistical analysis was performed through bivariate analyses followed by multivariate regression analyses for significant bivariate associations. Three focus groups involving a total of 23 second-, third- and fourth-year medical students provided qualitative data.

Results: The survey response rate was 72% (n= 280/395). Higher MSATU scores were significantly associated with an interest in a primary care career and with prior work with the medically underserved. We found no significant association between score and year of training. Focus group participants cited: (1) exposure to underserved populations and (2) clinician role models as major factors affecting their attitudes towards the underserved.

Conclusions: In our cross-sectional analysis, student attitudes towards underserved populations did not decline over the span of 4 medical school classes. Ongoing research will attempt to understand more deeply the relationship between medical student characteristics and the decision to care for underserved patients after graduation.


Keywords


Attitude of health personnel, person-centered healthcare, undergraduate medical education, vulnerable populations

Full Text:

PDF

References


Rosenblatt, R.A., Andrilla, C.H., Curtin, T. & Hart, L.G. (2006). Shortages of medical personnel at community health centers: implications for planned expansion. Journal of the American Medical Association 295 (9) 1042-1049.

Crandall, S.J., Volk, R.J. & Loemker, V. (1993). Medical students’ attitudes toward providing care for the underserved. Are we training socially responsible physicians? Journal of the American Medical Association 269 (19) 2519-2523.

Crandall, S.J., Volk, R.J. & Cacy, D. (1997). A longitudinal investigation of medical student attitudes toward the medically indigent. Teaching and Learning in Medicine 9 (4) 254-260.

Woloschuk, W., Harasym, P.H. & Temple, W. (2004). Attitude change during medical school: a cohort study. Medical Education 38 (5) 522-534.

Frank, E., Modi, S., Elon, L. & Coughlin, S.S. (2008). U.S. medical students’ attitudes about patients’ access to care. Preventive Medicine 47 (1) 140-145.

O’Toole, T.P., Gibbon, J., Harvey, J. & Switzer, G. (2002). Students’ attitudes toward indigent patients. Academic Medicine 77 (6) 586.

Chen, D., Lew, R., Hershman, W. & Orlander, J. (2007). A cross-sectional measurement of medical student empathy. Journal of General Internal Medicine 22 (10) 1434-1438.

Newton, B.W., Barber, L., Clardy, J., Cleveland, E. & O’Sullivan, P. (2008). Is there hardening of the heart during medical school? Academic Medicine 83 (3) 244-249.

Hojat, M., Vergare, M.J., Maxwell, K., Brainard, G., Herrine, S.K., Isenberg, G.A., Veloski, J. & Gonnella, J.S. (2009). The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine 84, 1182-1191.

Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M.R., Wirtz, M., Woopen, C., Haramati, A. & Scheffer, C. (2011). Empathy decline and its reasons: a systematic review of studies with medical students and residents. Academic Medicine 86 (8) 996-1009.

Chen, D.C., Kirshenbaum, D.S., Yan, J., Kirshenbaum, E. & Aseltine, R.H. (2012). Characterizing changes in student empathy throughout medical school. Medical Teacher 34 (4) 305-311.

Tavakol, S., Dennick, R. & Tavakol, M. (2011). Empathy in UK medical students: differences by gender, medical year and specialty interest. Education for Primary Care 22 (5) 297-303.

Crandall, S.J., Reboussin, B.A., Michielutte, R., Anthony, J.E. & Naughton, M.J. (2007). Medical students’ attitudes toward underserved patients: a longitudinal comparison of problem-based and traditional medical curricula. Advances in Health Sciences Education: Theory and Practice 12 (1) 71-86.

Grbic, D. & Slapar, F. (2010). Changes in medical students’ intentions to serve the underserved: Matriculation to graduation. AAMC Analysis in Brief – Data and Analysis 9 (8). Available at: https://www.aamc.org/data/aib/archive/. Accessed April 25, 2013.

Stepien, K.A. & Baernstein, A. (2006). Educating for Empathy. A Review. Journal of General Internal Medicine 21 (5) 524-530.

Mullan, F., Chen, C., Petterson, S., Kolsky, G. & Spagnola, M. (2010). The social mission of medical education: ranking the schools. Annals of Internal Medicine 152 (12) 804-811.

Lawson, S.R., Hoban, J.D. & Mazmanian, P.E. (2004). Understanding primary care residency choices: a test of selected variables in the Bland-Meurer model. Academic Medicine 79 (Supplement 10) S36-39.

Berg, K., Majdan, J.F., Berg, D., Veloski, J. & Hojat, M. (2011). Medical students’ self-reported empathy and simulated patients’ assessments of student empathy: An analysis by gender and ethnicity. Academic Medicine 86 (8) 984-988.

Wayne, S., Timm, C., Serna, L., Solan, B. & Kalishman, S. (2010). Medical students’ attitudes toward underserved populations: changing associations with choice of primary care versus non-primary care residency. Journal of Health Care for the Poor and Underserved 21 (2) 438-447.

Staiger, D.O., Auerbach, D.I. & Buerhaus, P.I. (2011). Health care reform and the health care workforce - the Massachusetts experience. New England Journal of Medicine 365 (12) e24.

Ku, L., Jones, E., Finnegan, B., Shin, P. & Rosenbaum, S. (2009). How is the primary care safety net faring in Massachusetts? Community health centers in the midst of reform. Kaiser Commission on Medicaid and the Uninsured. March, 2009. Available at: http://www.kff.org/healthreform/upload/7878.pdf. Accessed April 25, 2013.

HRSA grant #D56HP20688.




DOI: http://dx.doi.org/10.5750/ejpch.v4i4.1043

Refbacks

  • There are currently no refbacks.