Medical Education and Medical Students' Attitudes Toward Three Concepts of Comprehensive Care.

Abstract

The need for producing "comprehensive" physicians, that is, physicians whose orientation will be more preventive, humanistic and social, has been increasingly recognized over the last three decades. Since medical schools are the educational institutions m and ated to train physicians, the purpose of this study was to determine the comparative effects of different medical schools on students' preventive, human and social orientation. The study consisted of a cross-sectional mail survey of the attitudes of students enrolled in one of three medical schools: the University of Michigan (U of M) Medical School, Wayne State University (WSU) School of Medicine, and Michigan State University (MSU) College of Human Medicine. These schools were selected because they are known to differ in general orientation. Within each school, freshmen, juniors, and recent graduates were surveyed. Of the 713 students r and omly selected to participate in the study, 82.2 per cent returned their completed questionnaires. Indexes constructed to measure students' attitudes proved to be reasonably valid and reliable. Analyses done on students' ratings of their respective schools have confirmed the assumption that the three medical schools differed substantially in general orientation. Of the three medical schools, MSU College of Human Medicine obtained the highest scores on the scales measuring the school's preventive, patient and psychosocial orientations, whereas the U of M Medical School was perceived as the most research oriented. Using analysis of covariance, the comparative influence of the three educational institutions was examined after statistical adjustment was made to compensate for initial differences among students of the three schools. Although the general hypothesis that medical schools influence students' attitudes could not be rejected on the basis of the study findings, the school's influence did appear to be rather modest. When initial differences among students of the three schools were controlled, MSU graduates did not appear to be any more preventive and socially oriented than their U of M and WSU colleagues. With respect to students' human orientation, there were some differences between graduates of the three medical schools (mainly between WSU and MSU students). However, the differences were far from impressive, and it was not possible to conclude that they resulted from the medical school's influence rather than from imperfect statistical control of initial differences in students' input characteristics. Analyses of the pattern of attitude change with increasing medical training, although not statistically significant, gave some evidence for a decrease in preventive and human concerns as students progressed in their clinical training. Further analyses indicated that students' characteristics prior to beginning medical school explained more of the attitudinal variance than the type of medical schools students attended. Highly significant positive relationships were found between students' preventive, human and social orientation and their input characteristics, e.g., (1) interest in primary care medicine, (2) interest in the social sciences, (3) educational background in the social sciences, and (4) being female. The results attest to the importance of the selection process in determining what type of physicians medical schools will graduate. Considering the importance of medical students' initial interests and attitudes, the appropriateness of establishing admission criteria based almost exclusively on students' academic qualifications and cognitive assessment in the natural sciences should be re-examined. The need for providing students with adequate role models of "comprehensive" physicians is also discussed.