The Attitudes of Medical Students - Essay Example

Running head: Article Critique. The Attitudes of Medical Article Critique Institution: Abstract. Lester and Masson explore the attitude of medical students towards the homeless, and conclude that medical school contributes towards a negative shift in attitude, due to personal clinical contact with the homeless, and the behavior of senior staff, who serve as role-models. The study uses as specially designed and validated Attitude Towards the Homeless Questionnaire, administered before and after the period of undergraduate study, and a structured interview of the top scoring respondents. While a small but statistically significant negative shift is present, the limitations of the study must be addressed, particularly the assumption that it is the medical school experience alone which is responsible for this shift. The Attitudes of Medical Students: Article Critique Report. Neil Masson & Helen Lester, in their article, The attitudes of medical students towards homeless people: does medical school make a difference? (Medical Education 2003; 37:869–872), explore the attitudes of medical students towards the homeless in England. This study is of particular relevance in the context of the inaccessibility of adequate medical care to the homeless 4.3% of the population. This inaccessibility is attributed to the negative attitudes of medical professionals towards the homeless. Masson and Lester explore the changes in the attitudes of medical students towards the homeless, and conclude that there is a significant negative change by the end of the five-year undergraduate period. The study employs a specially designed and validated questionnaire: the Attitudes Towards the Homeless Questionnaire (ATHQ), with twenty points, associated with the causes of, and the students’ attitudes towards, homelessness, and the students’ motivation in pursuing a medical career. The questionnaire, which takes five minutes to complete, was posted to 211 freshmen at the University of Birmingham in 1997. It was again sent to the original respondents in 2002, during their final clinical placement. The two sets of data were then analyzed for variance. A group of twelve students, six with the most positive changes in scores, and six with the most negative, underwent personal interviews, dealing with attitudes towards the homeless, the factors which influenced these attitudes and the perceived role of medical school in fostering these attitudes. The results show a small but significant shift towards negative attitudes over the five years of medical studies. There is a mean score difference of 1.66 ± 0.8 between the two sets of data. Independent variables, such as age and sex, are eliminated. Analysis of the interviews reveal that personal interaction with the homeless, whether positive or negative, depending on the circumstances, and the overt, or implied, derogatory attitudes observed in teachers’ behavior towards the homeless, are the factors which the interviewees cite as influencing their own attitudes. Lester and Masson acknowledge that using a single medical school as the sample site, and the absence of a control group of non-medical students, is a limitation of the study. However, there is undoubtedly a small but significant negative change in attitude, which may be largely attributed to the nature of personal, direct contact with the homeless and to the perceived attitude of mentors. On this basis, the authors stress the importance of structured positive contacts, and the positive effects of role-modeling, in developing a healthy attitude in medical professionals towards the homeless. Analysis Introduction. Evidence from previous studies has shown that the significant 4.3% of the population of the United Kingdom which is homeless, has the greatest need for medical care, but often fails to secure adequate medical services. This is attributed to the negative attitudes of doctors, and the absence of specialized training for the treatment of the homeless. Earlier studies have focused on the progressive negative changes measured in the attitude of medical students, such as reduced humanitarianism, increased cynicism and a heightened focus on career goals. Lester and Masson attempt to explore a new aspect: the change in the attitude of students towards the homeless over the five-year period of their undergraduate medical studies. The main experimental question of the article is: Does medical school make a difference in the attitudes of medical students towards homeless people? Lester MB, BCH, FRCGP, MA, MD, is eminently qualified to undertake this study, as her experience in the Department of Primary Care at the University of Birmingham, is centered on health care. Her earlier article, Barriers to primary health care for homeless people- the general practitioner perspective. Eur J Gen Pract 2001;7:6–12, also deals with the same topic. The absence of any funding may be considered an indication of freedom from vested interests. Lester and Masson’s study is undoubtedly relevant in the present day scenario of increasing homelessness. The need for medical care to be based on a strict neutrality of approach, and accessible to anyone in need, irrespective of social or economic status, is also beyond contention. The findings are consistent with earlier studies which demonstrate a negative shift in attitudes over the period of medical training. These earlier studies on the attitudes of medical students could have been definitively cited by the authors. Method. The twenty-point ATHQ, with a maximum score of 100, specially designed and validated by Lester and Masson, deals with opinions about the causes of homelessness, willingness to associate with the homeless and the purpose of choosing a medical career. The respondents’ anonymity is preserved, and demographic details of age, sex, career goals, and the respondents’ frequency of contact with homeless people over the past five years, are gathered. Data is analyzed by SPSS, and by the Analysis of Variance (ANOVA). While the ATHQ is validated, the questions themselves appear to be skewed towards the negative connotation of homelessness. The direction of the questions prompts a definition of homelessness as a social evil, encourages assumptions that the homeless are prone to bad habits, and engenders an impression of the homeless being an unnecessary drain on public resources. A more subtle, unbiased approach may have elicited responses better reflective of true attitudes. Results. The results show mean ATHQ scores of 76.3± 0.6 and 74.7± 0.9 for 1997 and 2002 respectively, indicating a small but statistically significant negative shift in attitude, during the five-year period in medical school. The interviews indicate that the change is due to personal clinical contact with homeless people, and to professional socialization: attitudes and values acquired from teachers and peers, who serve as role-models. It is broadly concluded that negative clinical exposure to the homeless, and the observation of inferior treatment meted out to them by senior staff, are significant factors which influence the students’ own attitudes. The correlation between the negative shift in attitude, and the contribution of medical school towards this shift, is not sufficiently established by the responses to the ATHQ. It is only the interviews which elicit the cited influence of school and professional socialization. More emphasis on the medical school experience in the questionnaire may have provided unambiguous clarity on this issue. Discussion. Lester and Masson acknowledge that confining the sample to students of a single medical school, and the absence of a control group of non-medical students, are limitations of the study. These limitations must be addressed before any definite conclusions can be made. Negative attitudes towards the homeless may be the norm in all strata of society, and the study does not conclusively link the medical school experience to the reinforcement of this attitude. However, the negative shift in attitudes over the study period, measured by the ATHQ and interviews, is significant enough to conclude that there is a negative change in the attitudes of medical students towards the homeless, and to attribute this change to unfavorable personal clinical contact with the homeless and the influence of role-models. The authors’ use of the study results to justify their call for a medical training to include structured contact with the homeless, and the positive guidance of senior medical staff as role-models, may be accepted. The restructuring of the medical curriculum, to include value-based and ethical training, will definitely yield benefits. One avenue of potential research which arises from Lester and Masson’s study is the attitude of medical students towards ethnic differences in the people in need of medical services. Such studies could definitely play a major role in identifying any prejudices in the medical profession, calculate the role, if any, of the medical school and the medical curriculum in inculcating such prejudices, and bring about the required reforms. This will bring the medical profession closer to the ideal of achieving fair and equitable service to all sections of society. Read More