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

Abstract

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.

Provider and clinic cultural competence in a primary care setting

“…In this study, female, family practice and liberal providers had power/assimilation attitudes that were more empathetic toward the challenges faced by minority racial groups living in a Euro-Caucasian dominated society. The association between female gender and a more positive attitude toward treating minorities has also been found in studies with medical students (Crandall, George, Marion, & Davis, 2003;Crandall, Reboussin, Michielutte, Anthony, & Naughton, 2007;Gurung & Mehta, 2001). Female physicians are more likely to attend to the psychosocial needs of patients and to encourage patient participation.…”

Aprendizagem Baseada em Problemas na formação médica e o currículo tradicional de Medicina: uma revisão bibliográfica

“…Nesse sentido, seria importante ter não só uma avaliação de resultados, mas também uma análise dos diferentes processos. Para isso, seria importante que, no conjunto dos estudos analisados, houvesse mais estudos qualitativos, uma vez que esses estudos, como observam Crandall et al 7 , poderiam focalizar o que aconteceu ao longo dos cursos para compreender e comparar as características de estudantes cujas atitudes melhoraram ou declinaram durante a formação. Além disso, para se ter uma avaliação mais aprofundada dos efeitos desse modelo de formação, seria importante comparar o cotidiano da prática dos graduandos com o cotidiano da prática profissional dos egressos dos cursos tradicionais.…”

A Longitudinal Comparison of Pharmacy and Medical Students' Attitudes Toward the Medically Underserved

“…Thus, educators must consider how servicelearning experiences within the formal curricula can promote ''responsible professionalism and personal sacrifice'' fundamental to the practice of medicine. 6,7 Because health care professionals frequently interact with uninsured or indigent patients, it is important to uncover explicit attitudes towards vulnerable groups before learners begin their professional careers and to determine when educational experiences should be implemented to influence positive change. 7 Attention must be paid to the students' intention to perform services for these vulnerable patients and how these intentions are influenced by underlying attitudes.…”

“…6,7 Because health care professionals frequently interact with uninsured or indigent patients, it is important to uncover explicit attitudes towards vulnerable groups before learners begin their professional careers and to determine when educational experiences should be implemented to influence positive change. 7 Attention must be paid to the students' intention to perform services for these vulnerable patients and how these intentions are influenced by underlying attitudes. The theory of planned behavior, which is well supported by empirical evidence, espouses that ''intentions to perform behaviors of different kinds can be predicted with high accuracy from attitudes toward the behavior, subjective norms, and perceived behavioral control.…”

“…7,18 Historically, interpretations of these findings have differed, although most educators would agree that medical school ''constitutes a strong socializing experience.'' [19][20][21][22][23] Several studies have assessed medical students' attitudes about the elderly, 24,25 patients with HIV, 26,27 educational process changes, [28][29][30][31] comprehensive medical care effects, 32 and expectations of values and behaviors.…”