Attitudes towards social issues in medicine of five health science faculties

Medical students attitudes toward and intention to work with the underserved: a systematic review and meta-analysis

BACKGROUND

Experts in the field of medical education emphasized the need for curricula that improve students' attitudes toward the underserved. However, some studies have shown that medical education tends to worsen these attitudes in students. We aimed at systematically reviewing the literature assessing the change in medical students' attitudes toward the underserved and intention to work with the underserved throughout medical education, the sociodemographic and educational factors associated with favorable medical student attitudes toward and/or intention to work with the underserved and the effectiveness of educational interventions to improve medical student attitudes toward and/or intention to work with the underserved.

METHOD

We conducted a systematic review on MEDLINE, Scopus, and Web of Science databases. Three investigators independently conducted the electronic search. We assessed the change in medical students attitudes toward the underserved by computing a weighted mean effect size of studies reporting scores from validated scales. The research team performed a meta-analysis for the sociodemographic and educational factors associated with medical students attitudes toward and/or intention to work with the underserved.

RESULTS

Fifty-five articles met the inclusion criteria, including a total of 109,647 medical students. The average response rate was 73.2%. Most of the studies were performed in the USA (n = 45). We observed a significant decline of medical students attitudes toward the underserved throughout medical education, in both US and non-US studies. A moderate effect size was observed between the first and fourth years (d = 0.51). Higher favorable medical students attitudes toward or intention to work with the underserved were significantly associated with female gender, being from an underserved community or ethnic minority, exposure to the underserved during medical education and intent to practice in primary care. Regarding educational interventions, the effectiveness of experiential community-based learning and curricula dedicated to social accountability showed the most positive outcome.

CONCLUSIONS

Medical students attitudes toward the underserved decline throughout medical education. Educational interventions dedicated to improving the attitudes or intentions of medical students show encouraging but mixed results. The generalizability of our results is impeded by the high number of studies from the global-North included in the review.

Evaluation of medical interns' attitudes towards relevant aspects of medical practice

Introduction:

In traditional medical school curriculum, sixth-year is the moment in which students experience medical practice more intensively. Attitudes can be considered predictors of behaviors and actions. Evaluating them contributes to improve medical training.

Objective:

To evaluate attitudes during medical internship considering medical practice and associated factors in a Brazilian public university.

Method:

Cross-sectional study that included 69 students, based on a structured questionnaire and an attitude scale (Colares, 2002). We used descriptive statistics, with classification of the attitude tendency, clusters analysis and F-statistics.

Results:

The average age of the participants was 25.1±1.9, and 56.5% of them were male. Students presented positive attitudes to emotional aspects in organic diseases, primary health care, the medical contribution to the scientific advancement of medicine, and other aspects of medical activity and health politics; there were conflicting attitudes concerning mental illness and negative attitudes concerning death.

Conclusion:

Results show the need for interventions in order to reduce the identified conflicting and negative attitudes.

Educational Experience and Changes in Learning and Value Preferences

Education attempts to instill certain values, as well as knowledge and skills, in students. Yet, examination of value changes is infrequent, and the findings of existing studies are equivocal. This article reports on a study of value and learning preference changes in occupational therapy students. Two small groups of undergraduate and graduate students completed the Rokeach Value Survey, the Learning Preference Inventory, and an educational values inventory (developed by the first two authors) at the beginning of their professional education and again while on affiliation. Four other groups completed the instruments once: undergraduate and graduate students in the first semester of the professional program, and undergraduate and graduate students in the second semester. For the students who participated in the study twice, undergraduates were more likely than graduates to rearrange their value priorities, and changes were more likely to occur with educational values than Rokeach values. However, although individuals may have changed substantially, when subjects were treated as a group changes tended to be masked. Comparisons of first semester, second semester, and affiliating undergraduates and graduates revealed few differences among groups, although again, educational values differed more than Rokeach values. Because the study seems to suggest that individuals are affected in varying ways by their education, a major implication is that a methodology for examining the impact of professional education must account for initial differences in students.

Developing and Evaluating Medical Humanities Problem-Based Learning Classes Facilitated by the Teaching Assistants Majored in the Liberal Arts: A Longitudinal Crossover Study

Although medical humanities courses taught by teachers from nonmedical backgrounds are not unusual now, few studies have compared the outcome of medical humanities courses facilitated by physicians to that by teaching assistants majored in the liberal arts. The objectives of this study were to (1) analyze the satisfaction of medical students with medical humanities problem-based learning (PBL) classes facilitated by nonmedical teaching assistants (TAF) majored in the liberal arts, and those facilitated by the attending physicians (APF) and (2) examine the satisfaction of medical students with clinical medicine-related and clinical medicine-unrelated medical humanities PBL classes.A total of 123 medical students, randomly assigned to 16 groups, participated in this study. There were 16 classes in the course: 8 of them were TAF classes; and the others were APF classes. Each week, each group rotated from 1 subject of the 16 subjects of PBL to another subject. All of the 16 groups went through all the 16 subjects in the 2013 spring semester. We examined the medical students' satisfaction with each class, based on a rating score collected after each class was completed, using a scale from 0 (the lowest satisfaction) to 100 (the highest satisfaction). We also conducted multivariate linear regression analysis to examine the association between the independent variables and the students' satisfaction.Medical students were more satisfied with the TAF (91.35 ± 7.75) medical humanities PBL classes than APF (90.40 ± 8.42) medical humanities PBL classes (P = 0.01). Moreover, medical students were more satisfied with the clinical medicine-unrelated topics (92.00 ± 7.10) than the clinical medicine-related topics (90.36 ± 7.99) in the medical humanities PBL course (P = 0.01).This medical humanities PBL course, including nonmedical subjects and topics, and nonmedical teaching assistants from the liberal arts as class facilitators, was satisfactory. This pedagogical approach of student-centered, nonmedical topics, nonmedical facilitators, and small groups, which is associated with a deep approach to learning medical humanities, should be highly encouraged.

Narrative means to humanistic ends

BACKGROUND

Efforts to "rehumanize" medical education through curriculum reform and program development have been numerous and ongoing in recent years. One particularly intriguing contribution has come from the area of narrative studies. It is now common to use literature in general, and physician--patient narratives in particular, both to expand students' understanding of the clinical encounter and to sensitize them to the humanistic aspects of medicine.

DESCRIPTION

In this article, we describe the process by which we have introduced key insights from and elements of narrative theory into our 1st-year clinical skills program. Rather than limiting our efforts to the use of literature and to the description of individual narrative encounters, however, we have framed our entire course as an exercise in narrative construction. We refer to this process as "narrative structuring."

EVALUATION

A combination of short essays on topics related to the various literary materials utilized in the course, written reports on ethical aspects of the clinical cases presented in the clinical skills sessions, and student journaling are integral components of the evaluation of this course.

CONCLUSION

Characterizing our course in terms of narrative structuring serves both to integrate the various elements of our complex curriculum around a common theme and to remind both students and faculty alike of the privileges and responsibilities we share as we participate in the writing of one another's stories.

Medical career choice and practice location: early factors predicting course completion, career choice and practice location

AIMS

The overall aim of the study was to identify the factors that best predict medical career choice and practice location.

METHOD

A longitudinal, cohort study was conducted. This followed 2 cohorts of students, numbering a total of 229 students, who commenced medical studies at the University of Western Australia in 1984 and 1989. Data concerning the students' sociodemographic backgrounds, admission scores and personality characteristics were collected in Year 1. Regression analyses were performed to identify the student characteristics that best predicted course completion, a choice of general practice 4 years after graduation and a rural location of practice.

OUTCOMES

We found that students who had lower university admission scores and who were less outgoing were less likely to complete the course. Students who were male, had a father in medicine and were more creative and abstract in their thinking and more conscientious and rule-bound were more likely to choose a specialist career. A rural background was found to be the most important predictor of both rural general and specialist practice.

Effect of year in school on medical students' perceptions evaluated with the Cognitive Behavior Survey, Attitudes Toward Social Issues in Medicine Survey, and Learning Environment Questionnaire

BACKGROUND

We administered selected scales from the Cognitive Behavior Survey, Attitudes Toward Social Issues in Medicine survey, and Learning Environment Questionnaire. We gathered data from other medical schools to put our results into context.

PURPOSE

To present results on these scales from our own and other medical schools to identify the effects of "year in school" on the results.

METHODS

We searched for articles that had cited the articles that originally presented the scales we used. We organized the results by type of curriculum and presented data from multiple points in each course.

RESULTS

With a few exceptions, the data suggest that students' perceptions of their cognitive behaviors, their attitudes to social issues in medicine, and their impressions of the medical school learning environment deteriorate as they proceed through the course. In the case of PBL and hybrid curricula, this may represent a reversal of gains conferred by these curricula during the early phases of the course.

CONCLUSIONS

These data provide a starting point for further study of some of the influences on students' perceptions of medical curricula as they proceed through the course.

Influence of type of curriculum on students' perceptions of the medical course: a compilation of results from the Cognitive Behavior Survey, Attitudes Toward Social Issues In Medicine survey, and Learning Environment Questionnaire

BACKGROUND

This study administered selected scales from the Cognitive Behavior Survey, Attitudes Toward Social Issues in Medicine survey, and the Learning Environment Questionnaire. Data were gathered from other medical schools to put results into context.

PURPOSE

To present results on these scales from other medical schools and to compare the effects of type of curriculum on the results.

METHODS

Articles that had cited the articles that originally presented the scales used were searched for. Results were organized by type of curriculum and effect sizes were calculated where possible.

RESULTS

Within the limits of small numbers of studies so far, problem-based learning (PBL) curricula appear to have much more positive effects on students' reported cognitive behaviors than do hybrid curricula. Both have substantial positive effects on students' perceptions of the learning environment (PBL medium to large; hybrid small to medium). Neither appears to have much effect on students' attitudes toward social issues in medicine.

CONCLUSION

These data provide a starting point for further study of some of the effects of curricular interventions.

Effects of a revised preclinical curriculum on students' perceptions of their cognitive behaviors, attitudes to social issues in medicine, and the learning environment

BACKGROUND

A modular, systems-based preclinical curriculum acceptable to faculty members who had rejected problem-based learning was introduced in 1997.

PURPOSE

To evaluate to what extent the new curriculum is meeting some of its major goals.

METHODS

We administered selected scales from 3 survey instruments to the last 2 classes in the old curriculum and the first 3 in the new curriculum. We also compared our results with those from other medical schools that had used the same scales.

RESULTS

The new curriculum has had positive effects on students' perceptions of the learning environment (effect sizes mostly small to medium, d = .03 to .60) but less effect on their attitudes to social issues in medicine or on their preference for conceptualization versus memorization when studying (most effect sizes below small; largest d = .026). Our results are similar to those for problem-based learning curricula for the learning environment scales and to traditional curricula for the cognitive behavior scales.

CONCLUSIONS

Some of the goals for the new curriculum are being achieved almost to the levels reported for problem-based curricula.

A classification system of social problems: concepts and influence on GPs' registration of problems

OBJECTIVES

(1) To test lists of problems in the three axes of well-being (physical, mental, and social) with the GPs' collaboration (2) To place the resulting classification in the context of other ones aiming at collecting data about psycho-social aspects of life (assessment, index and classification systems). (3) To test if GPs would be induced to record psychological and social problems more often in their everyday practice, after having been trained to look more closely at them, inter allia with the use of classification and codes.

METHOD

The lists of problems have been initiated by the WHO Department of Mental Health and discussed at an international symposium; they were then tested on the field, first at an international level, then in Belgium. After discussion by 4 Belgian GPs' Teaching Units, they were then improved. In all surveys concerned, general practitioners were asked to collaborate in three ways: opening their usual medical records and collaborating to prospective phases, including one "test phase," i.e., a training session, recording problems with the use of coding lists, and looking for the proper code. Retrospective and prospective approaches were used both before and after this test phase.

RESULTS

(1) The original lists of problems have been improved on the basis of the findings in medical files and in the survey. (2) A conceptual framework is presented for recording social problems, either in everyday practice (i.e., in health records) or in research settings, e.g., for social surveys. It is biaxial: domains and types of problem. (3) Training GPs for using such a coding system drastically increases the number of psycho-social problems, but only during the prospective phases. In the long run older habits prevail again; only the overall number of contacts mentioning a reason increases, together with the number of "other" reasons for encounter (requests, ...).

CONTENTS

(1) Main concepts (section 1). (2) Various tools for measuring psychosocial problems and well-being (section 2). (3) New conceptual fanmework for a classification of psychosocial problems ( 2.2.3). (4) Using the lists: influence on MDs' recording propensity (section 3).

Compassionate-empathic physicians: personality traits and social-organizational factors that enhance or inhibit this behavior pattern

Compassionate-empathic physicians (CEPs) are desired by patients, but rarely found in medical settings. The purpose of this study was to promote our understanding of this gap by determining personal characteristics that distinguish CEPs from other physicians, and organizational factors that might enhance or inhibit physicians' compassionate-empathic behavior (CEB). In the first stage of the study, three groups of physicians who differed in their compassionate-empathic pattern of behavior toward patients were identified by a sociometric questionnaire distributed to 324 physicians in a general hospital. In the second stage, almost all of these physicians (N = 308) were asked to fill out a self administered structured questionnaire, and 214 (69.5%) responded. Comparisons among the three groups show that the physicians identified as CEPs, more than other physicians, are younger, have fewer years in medical practice, and score higher on pro-social, non-stereotypic attitudes toward patients and on empathy measures. Their self-esteem is, however, similar to that of the non-CEPs. The CEPs express similar levels of satisfaction with work on most dimensions, but they report more emotional exhaustion (burnout) than other physicians. A consensus among all physicians was found with regard to two rank orders: (a) the important qualities for being "a good physician"; and (b) the important qualities for being promoted in the hospital. However, while empathic behavior was considered the most important quality for being "a good physician", it was ranked as the least important for being promoted in the hospital. The conclusions can serve as a scientific base for improving methods of selection of medical students, and for re-evaluating the existent criteria for promoting medical staff in general hospitals.

Attitude change amongst nursing students towards Australian aborigines

A pre-test and post-test impact evaluation design was used to determine if attendance at a workshop conducted by Australian aboriginal health personnel improved the attitudes of nursing students towards Aborigines. A three-hour workshop attended by first year nursing students comprised an introduction, video and discussion. A self-administered questionnaire, consisting of socio-demographic background questions and attitude rating scale, was used to measure students' attitudes before and after the workshop. The Wilcoxon signed rank test and paired t-test were used to test for significant improvement in students' total attitude scores. Multiple regression analysis was conducted to determine if socio-demographic variables contributed to the changes in the students' attitude scores. Complete data were collected from 246 students. Results indicate improvement in attitude scores. Socio-demographic variables did not contribute to these scores.

Medical students, Aborigines and migrants: evaluation of a teaching programme

In spite of evidence of poor communication between Aboriginal patients and doctors, there are few reports of educational efforts to overcome this problem. This paper describes a brief teaching programme for fourth-year medical students that was aimed at improving their knowledge of, and attitudes towards, Aboriginal and migrant patients. It comprised a lecture, a clinical contact with an Aboriginal or migrant patient, and a tutorial. Evaluation of the programme by the "before-and-after" measurement of student attitudes and knowledge showed a modest improvement in some attitudes, although there was an increased tendency to see all Aborigines as the same. Students' knowledge improved in one of the areas that were tested but not in the other. Teaching in this area could be improved further by more clinical contacts, videotaped consultations, and a student log-book.

Questionnaire construction and question writing for research in medical education

This booklet describes the basic principles of questionnaire construction and design using examples applicable to research in medical education. It is intended for medical educators and researchers who plan to construct questionnaires to gather data about a course, curriculum component or medical education programme. An easy-to-use list of problems to consider when writing questions for a questionnaire is provided. As well, information is provided about the structure of a questionnaire and of the covering letter sent to potential respondents.

Curricular influences on preventive-care attitudes

Attitudes are one of the most important outcomes of medical education, but little is known about curricular influences on specific attitudes. This study examined changes in attitudes toward 20 preventive-care services in a cohort of 175 medical students. Specifically, a cohort of medical students was followed over a 30-month interval that spanned the period from medical school entry through the first 6 months of clinical clerkships. Perceived importance, as well as student confidence in the ability of primary-care physicians to provide 20 preventive-care services, was examined. Importance ratings for preventive-care services remained stable, while levels of confidence in the ability of physicians to provide the services increased. Implications of the results are discussed in relation to the possibilities for emphasizing disease prevention content in medical education.

Variations in the diagnosis of psychosocial disorders: a general practice observation study

The factors that influence the interpretation and treatment of psychosocial complaints by general practitioners are discussed. The assessment of complaints differs considerably from one GP to another, in the sense that one will attach significance to psychological and sociological factors in many more cases than another. We investigate the effect of physician characteristics and their styles of communication on their bias over psychosocial assessments and treatment, and the way these effects are interrelated. The interpretation and eventually the treatment of complaints by 30 GPs (complaints presented at approx. 50 consultations per GP) were studied. Data of treatment and communication were collected from observation of the videotaped consultations, data of interpretation were collected on questionnaires for each consultation; doctor characteristics were inventarized by questionnaire. The following results can be reported. When a doctor communicates with a patient in an open manner, more complaints are interpreted as 'non-somatic' and treated as such. The same is the case among doctor's with a 'general medical' approach, rather than a 'clinical' one, when we look at interpretation. The effect on treatment is less marked. Practice characteristics and a GP's subjective feeling of competence have greater consequences for treatment than for judgement. There is not much interaction between the discerned effects.

Attitudes toward social issues in health care: a cohort analysis

Attitudinal change toward psychosocial issues in health care was tested through a cohort analysis of 190 nursing students at four successive undergraduate levels. The topics examined were: consistency and variability of attitudes toward social issues in health care and relationship between scale performance and age. Attitudinal change among nursing students at four successive undergraduate levels was tested in the present study using a modification of the Attitudes Towards Social Issues in Medicine (ATSIM) Inventory, an instrument composed of seven subscales dealing with various aspects of health care. Techniques used included analysis of variance and Levene's test of the equality of variances. The findings confirmed a process of professional socialization in nursing education with respect to the attitudes of nursing students toward health care issues.

Maintenance of psychosocial attitudes in medical students

Attitudes of medical students towards the psychosocial aspects of illness is of serious concern to medical educators. It is thought that medical students are overwhelmingly disease-oriented and not sufficiently sensitive to the role of the psychological, emotional, sociological and economic factors in the etiology and management of illness. In the present study the ATSIM (Attitudes Towards Social Issues in Medicine) was presented to third year medical students and compared with their responses obtained 2 years previously when they were first year students. The data suggest that third year medical students have positive attitudes towards certain psychosocial issues (the importance of social factors as determinants of health or illness, the role of preventive medicine in maintaining health, the role of physician-patient interactions in patient care). These attitudes were positive during the students' first year and have been maintained during the course of medical school. These finding are contrary to previous studies which indicate a deterioration in attitudes during the course of medical school.

Attitudes of pharmacy students towards psychosocial factors in health care

An attitude scale was administered on a cross-sectional basis to pharmacy students in 3 professional years and alumni 1 year post-graduation. The instrument, previously used in a study of social awareness among Canadian health professional students, revealed, on application, that social attitudes tended to decline as students progressed through school. Students with prior degrees had generally higher scores. Male students generally held stronger views than did female students, whether favorable or unfavorable.

Attitudes towards psycho-social factors in medicine: an appraisal of the ATSIM scale

As the importance of psycho-social factors in medicine is increasingly stressed, it is believed that attitudes towards psycho-social issues in medicine should be taken into account in the selection of medical students. The first step of a longitudinal study concerning the impact of medical studies on the students of a French-Canadian University gave us the opportunity to appraise the adequacy of Parlow & Rothman's (1974) ATSIM scale, a measure of attitudes towards psycho-social issues in medicine. We found the following correlations: (1) High scores on the ATSIM scale were negatively correlated with a relatively closed value system (high scores for dogmatism), (2) openness towards psycho-social factors in medicine and empathy were positively correlated, (3) There was a stronger correlation between the ATSIM scale and acceptance of absortion for social conditions than between acceptance of abortion for physical risks and this scale (this shows the social orientation of the ATSIM scale), and (4) hight scorers on the ATSIM scale seem to be more 'sensitive, forthright and expedient' than low scorers. Our results suggest that Parlow & Rothman's (1974) ATSIM scale might be a useful tool in the selection of medical students and further research is needed.