Medical Students’ Attitudes Toward Underserved Patients: A Longitudinal Comparison of Problem-Based and Traditional Medical Curricula

Springer Science and Business Media LLC - Tập 12 - Trang 71-86 - 2006
Sonia J. S. Crandall1, Beth A. Reboussin2, Robert Michielutte1, Jennie E. Anthony1, Michelle J. Naughton2
1Department of Family and Community Medicine, Wake Forest University School of Medicine Medical Center Boulevard, Winston, Salem, USA
2Department of Public Health Sciences, Wake Forest University School of Medicine Medical Center Boulevard, Winston, Salem, USA

Tóm tắt

Medical education has been shown to negatively influence student attitudes toward certain types of patient populations. Past research does not inform current educational practice because today’s medical school environment is different from when most of the published research was conducted. There are more female students, curricular innovations such as problem-based learning have changed the framework for educational delivery, and longitudinal studies, which could inform when interventions may be needed, are uncommon. The purposes of this longitudinal, prospective cohort study were to compare the attitudes of Problem-based learning and Traditional curriculum students toward providing care for medically indigent patients as they progressed through the four-year undergraduate medical education curriculum, and to determine if gender differences were apparent and persisted over time. Attitudes of one cohort of students enrolled in separate curricula were studied. The outcome measure was the Medical Student Attitudes Toward the Underserved questionnaire, which was administered three times. A linear mixed effects regression analysis was performed to examine changes in factor scores over time and whether these changes differed between Problem-based and Traditional students, and males and females. Longitudinal findings revealed that commitment to caring for the medically underserved was greater when students entered medical school than when they graduated. Students in both curricula, as well as male and female students, experienced increasingly negative attitudes over the four year period. Decline in attitudes toward medically underserved patients was similar to previous research results. This study showed that attitudes of students were not influenced by the preclinical curriculum they experienced.

Tài liệu tham khảo

Albanese M.A. (1993). Problem-based learning: A review of literature on its outcomes and implementation issues. Academic Medicine 68(1): 52–81 Ayanian J.Z. (1994). Race, class and the quality of medical care. Journal of the American Medical Association 271: 1207–1208 Bickel J. and Ruffin A (1995). Gender-associated differences in matriculating and graduating medical students. Academic Medicine 70(6): 552–559 Cariaga-Lo, L.D., Crandall, S.J.S., Conner, D., Georgesen, J. & Greek, D. (1997). Developing attitudes of social responsibility in the professions: The impact of medical students’ gender and personality attributes. Paper presented at the Annual Meeting of the American Educational Research Association, Chicago IL Christakis D.A. and Feudtner C (1993). Ethics in a short white coat: The ethical dilemmas that medical students confront. Academic Medicine 68: 249–254 Crandall S.J., Volk R.J. and 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.S., Volk R.J. and Cacy D.S (1997). A longitudinal investigation of medical student attitudes toward the medically indigent. Teaching and Learning in Medicine 9(4): 254–260 Cronbach L.J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika 16: 297–334 Davies D.P. and Shortland G (1993). Are medical students missing out?. Medical Teacher 15(1): 93–98 Des Marchais J.E. (1993). A student-centered, problem-based curriculum: 5 years’ experience. Canadian Medical Association Journal 148: 1567–1572 Eron L.D. (1958). The effect of medical education on attitudes: A follow-up study. Journal of Medical Education 33: 25–33 Feudtner C. and Christakis D.A (1994). Making the rounds. The ethical development of medical students in the context of clinical rotations. Hastings Center Report : 6–12 Feudtner C., Christakis D.A. and Christakis N.A (1994). Do clinical clerks suffer ethical erosion? students’ perceptions of their ethical environment and personal development. Academic Medicine 69: 670–679 Finucane P., Allery L.A. and Hayes T.M (1995). Comparison of teachers at a “traditional” and an “innovative” medical school. Medical Education 29: 104–109 Finucane P.M., Johnson S.M. and Prideaux D.J (1998). Problem-based learning: Its rationale and efficacy. Medical Journal of Australia 168: 445–448 Gordon L.V. and Mensh I.N (1962). Values of medical school students at different levels of training. Journal of Educational Psychology 53(1): 48–51 Gray R.M., Moody P.M. and Newman W.R.E (1965). An analysis of physicians’ attitudes of cynicism and humanitarianism before and after entering medical practice. Journal of Medical Education 40: 760–766 Guthrie E.A., Black D., Shaw C.M., Hamilton J., Creed F.H. and Tomenson B (1995). Embarking upon a medical career: Psychological morbidity in first year medical students. Medical Education 29: 337–341 Haidet P., Dains J.E., Paterniti D.A., Hechtel L., Chang T. and Tseng E. (2002). Medical student attitudes toward the doctor-patient relationship. Medical Education 36(6): 568–574 Iglehart J. (1997). Forum on the future of academic medicine: Session I–setting the stage. Academic Medicine 72(7): 595–599 Johnson S.M. and Finucane P.M (2000). The emergence of problem-based learning in medical education. Journal of Evaluation in Clinical Practice 6(3): 281–291 Kalishman, S., Mines, J., Skipper, B., Serna, L. & Skipper, E. (2002). A study of the relationship of a medical school curriculum to the attitudes of students toward service in medicine. Paper presented at the American Educational Research Association, New Orleans, LA Kane R.L. and Olsen D.M (1975). Attitude changes among medex and medical students. Journal of Medical Education 50(9): 895–897 Kaufman D.M. and Mann K.V (1996). Comparing students’ attitudes in problem-based and conventional curricula. Academic Medicine 71(10): 1096–1099 Kleinbaum D.G., Kupper L.L., Muller K.E. and Nizam A (1998). Applied Regression Analysis and Other Multivariate Methods. Duxbury Press, Pacific Grove, CA Kopelman L. (1983). Cynicism among medical students. Journal of the American Medical Association 250(15): 2006–2010 Lumpkin J.R. (1985). Validity of a brief locus of control scale for survey research. Psychological Reports 57: 655–659 Lyons N. (1987). Ways of knowing, learning and making moral choices. Journal of Moral Education 16(3): 226–239 Merrill J.M., Camacho Z., Laux L.F., Lorimor R., Thornby J.I. and Vallbona C (1994). Uncertainties and ambiguities: Measuring how medical students cope. Medical Education 28: 316–322 Merrill J.M., Camacho Z., Laux L.F., Thornby J.I. and Vallbona C (1991). Influences on professional qualities. How medical school shapes students’ orientation to patients’ psychological problems. Academic Medicine 66(9): S4–6 Merrill J.M., Laux L.F., Lorimor R., Thornby J.I. and Vallbona C (1995). Authoritarianism’s role in medicine. American Journal of the Medical Sciences 310(3): 87–90 Merrill J.M., Laux L.F., Lorimor R., Thornby J.I. and Vallbona C (1996). Personal and professional qualities of medical students. Using attribution theory models to predict senior medical students’ perceptions of patients and career choice. Academic Medicine 71(11): S67–69 Miller L.B. and Erwin E.F (1961). Attitude changes in medical students during a comprehensive care program. Journal of Medical Education 36: 442–428 Mills R. J., & Bhandari S. (2003). Health insurance coverage in the united states: 2002. Retrieved July 30, 2005, from http://www.census.gov/prod/2003pubs/p60–223.pdf Moore-West M., Harrington D.L., Mennin S.P., Kaufman A. and Skipper B.J (1989). Distress and attitudes toward the learning environment: Effects of a curricular innovation. Teaching and Learning in Medicine 1: 151–157 Moore G.T., Block S.D., Style C.B. and Mitchell R (1994). The influence of the new pathway curriculum on Harvard medical students. Academic Medicine 12: 983–989 Nickens H.W. (1995). The role of race/ethnicity and social class in minority health status. HSR: Health Services Research 30: 151–162 Noddings N. (2002). Educating Moral People. A Caring Alternative to Character Education. Teachers College Press, New York Norman G.R. and Schmidt H.G (1992). The psychological basis of problem-based learning: A review of the evidence. Academic Medicine 67: 557–565 Patenaude J., Niyonsenga T. and Fafard D (2003). Changes in students’ moral development during medical school: A cohort study. Canadian Medical Association Journal 168(7): 840–844 Pathman D.E. and Riggins T.A (1996). Promoting medical careers in underserved areas through training. Family Medicine 28(7): 508–510 Peters A.S., Greenberger-Rosovsky R., Crowder C., Block S.D. and Moore G.T (2000). Long-term outcomes of the new pathway program at Harvard medical school: A randomized controlled trial. Academic Medicine 75: 470–479 Price J., Price D., Williams G. and Hoffenberg R (1998). Changes in medical student attitudes as they progress through a medical course. Journal of Medical Ethics 24(2): 110–117 Reinhardt A.M. and Gray R.M (1972). A social psychological study of attitude change in physicians. Journal of Medical Education 47(2): 112–117 Rezler A.G. (1974). Attitude changes during medical school: A review of the literature. Journal of Medical Education 49(11): 1023–1030 Ring J.J. (1991). The right road for medicine. Professionalism and the new American medical association. Journal of the American Medical Association 266(12): 1694 Roche W.P., Scheetz A.P., Dane F.C., Parish D.C. and O’Shea J.T (2003). Medical students’ attitudes in a pbl curriculum: Trust, altruism, and cynicism. Academic Medicine 78(4): 398–402 Satterwhite R.C., Satterwhite W.M. and Enarson C (2000). An ethical paradox: The effect of unethical conduct on medical students’ values. Journal of Medical Ethics 26(6): 462–465 Seifer S.D. (1998). Service-learning: Community-campus partnerships for health professions education. Academic Medicine 73(3): 273–277 Seifer S.D. and Connors K (2000). Improved student learning and community health: The CCPH faculty service-learning institute. Academic Medicine 75(5): 533–534 Singleton R.A., Straits B.C. and Straits M.M (1993). Approaches to Social Research. Oxford University Press, New York Strahan R. and Gerbasi K.C (1972). Short, homogeneous versions of the Marlowe-Crowne social desirability scale. Journal of Clinical Psychology 28: 191–193 Swick H.M. (2000). Toward a normative definition of medical professionalism. Academic Medicine 75(6): 612–616 Testerman J.K., Morton K.R., Loo L.K., Worthley J.S. and Lamberton H.H (1996). The natural history of cynicism in physicians. Academic Medicine 71(10 Suppl): S43–45 Vernon D.T. and Blake R.L (1993). Does problem-based learning work? A meta-analysis of evaluative research. Academic Medicine 68(7): 550–563 Wolf T.M., Balson P.M., Faucett J.M. and Randall H.M (1989). A retrospective study of attitude change during medical education. Medical Education 23(1): 19–23 Wolf T.M., Randall H.M. and Tynes L.L (1991a). Perceived mistreatment and attitude change by graduating medical students: A retrospective study. Medical Education 25(3): 182–190 Wolf T.M., Randall H.M. and Franklin F.A (1991b). Psychosocial changes during the first year of medical school. Medical Education 25: 174–181 Xu G., Rattner S.L., Veloski J.J., Hojat M., Fields S.K. and Barzansky B (1995). A national study of the factors influencing men and women physicians’ choices of primary care specialties. Academic Medicine 70(5): 398–404