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Are We Training Socially Responsible Physicians?

Sonia J. S. Crandall, PhD; Robert J. Volk, PhD; Vicki Loemker, MD

JAMA. 1993;269(19):2519-2523.

Abstract
Objective.
—To investigate the association between attitudes toward caring for the medically indigent and years of medical training.

Design.
—Questionnaire comparing attitudes of first-year medical students (MS-Is) and fourth-year medical students (MS-IVs).

Setting.
—Southwest medical school.

Participants.
—A total of 83 (67%) male and 41 (33%) female MS-I and 65 (73%) male and 24 (27%) female MS-IV volunteers.

Main Outcome Measure.
—Self-report, attitudinal scale developed for this study that provided a measure of overall attitudes, perceived societal expectations, physician/student responsibility, personal efficacy, and provision of basic services and expensive procedures.

Results.
—Overall attitudes were significantly less favorable for MS-IVs (95% confidence interval [CI], 99.6 to 106.2) than MS-Is (95% CI, 109.5 to 114.3, P<.0001). Except for basic services (P=.46), MS-IVs had worse attitudes on all attitudes subscales. Male MS-IVs reported significantly less favorable attitudes than male MS-Is in the areas of general attitudes (P=.03) and physician/student responsibility (P=.01). Female medical students showed no significant differences across classes (P>.05). Except for physician/student responsibility, female medical students' attitudes were more favorable than those of males, regardless of class.

Conclusions.
—The MS-IVs are less favorably inclined toward caring for the medically indigent than MS-Is, though these differences are apparent only for males. Further research is needed to explore why females appear to be more resistant to attitude changes, and what educational interventions are necessary to better train physicians to respond to national health care issues.

(JAMA. 1993;269:2519-2523)

Author Affiliations
From the Department of Family Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (Drs Crandall and Loemker) and the Department of Family Medicine, University of Texas Medical Branch, Galveston (Dr Volk).

Footnotes
Reprint requests to the Department of Family Medicine, University of Oklahoma Health Sciences Center, 800 NE 15, Suite 503, Oklahoma City, OK 73104 (Dr Crandall).

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