Attitudes of faculty, housestaff, and medical students toward clinical practice guidelines.

PURPOSE: To examine attitudes of faculty, housestaff, and medical students toward clinical practice guidelines. METHOD: In a 1997 cross-sectional survey, a two-part, 26-item, self-administered questionnaire was mailed to all faculty, housestaff, and medical students in the department of internal medicine at Case Western Reserve University School of Medicine. The questionnaire asked for demographic information and attitudes toward clinical guidelines. RESULTS: Of 379 persons surveyed, 254 (67%) returned usable questionnaires: 56% of the medical students, 70% of the housestaff, and 73% of the full-time faculty. Medical students reported learning about guidelines predominantly during clerkships in internal medicine (71%) and pediatrics (68%). Overall, the respondents agreed most strongly that guidelines are "useful for the care of common problems," and least strongly that guidelines are "difficult to apply to individual patients" and "reduce physician options in patient care." Faculty were more likely to consider guidelines a "good educational tool" and less likely than were medical students and housestaff to agree that they promote "cookbook medicine." Of 11 influences on clinical decision making, the three groups together rated practice guidelines eighth or ninth. The use of guidelines for academic investigations was rated most appropriate, overall. In terms of their appropriateness, faculty consistently rated the use of guidelines more favorably except for use in malpractice suits. CONCLUSION: Faculty, housestaff, and medical students have significantly different perceptions of and attitudes toward clinical practice guidelines. Further studies are needed to explain the reasons for these differences. Considerable education and involvement must occur at all levels for practice guidelines to be successfully implemented and understood.     

Clinicians' perceptions of clinical decision support integrated into computerized provider order entry

Computerized provider order entry systems can improve patient care by integrating clinical decision support. Decision support is most effective when its content and delivery are acceptable. The authors report the results of a multifaceted survey of the attitudes of housestaff and medical student users of a provider order entry system with integrated decision support at an academic medical center. The survey contained 16 items covering four themes: efficiency, quality of care, results reporting and embedded guidelines. Responses were captured using a five point Likert scale, and were compared using ANOVA and Bartlett's testing. Out of 491 housestaff and 128 medical students, response rates were 47 and 29%, respectively. Among respondents, 72% agreed or strongly agreed that the provider order entry system improves the quality of care that they provide, 54% that the decision support usually help them to provide quality patient care, and 62% that it improves the efficiency of order entry. Respondents were least likely to agree that the display of prior laboratory results influenced their decision to order a subsequent test. There were no significant differences between subspecialties and by advancing years of training among housestaff. Respondents agreed that the integrated clinical decision support enhanced their medical training.     

Sleep behaviors and attitudes among internal medicine housestaff in a U.S. university-based residency program.

PURPOSE: Physicians-in-training are susceptible to fatigue given their prolonged duty hours. Sleep deprivation has been shown to alter perceptions of sleepiness and performance. This study examined the state of sleepiness and attitudes about sleep and performance of work- and non-work-related tasks among incoming and current housestaff; and how rotation, call cycle, and call status are related to acute and chronic sleep deprivation and perceptions of sleepiness. METHOD: A survey instrument was administered in June 2001 to 53 incoming interns and 79 current housestaff at the University Pennsylvania School of Medicine, a university-based internal medicine residency program. RESULTS: All 132 participants (100%) completed the instrument. Acute sleep deprivation was experienced by 34% of the current housestaff and 64% of current housestaff were chronically sleep deprived. Current housestaff admitted to the possibility of dozing while performing various work-related tasks such as writing notes in charts (69%), reviewing medication lists (61%), interpreting labs (51%), and writing orders (46%). At least half of all respondents felt their patients received good care despite residents' sleepiness and as many believed sleep deprivation was a necessary part of training. Nearly half (48%) of current housestaff rotating on a ward service reported acute sleep deprivation, as did 81% of those who were postcall. Over two-thirds of the housestaff on wards and in the ICU reported chronic sleep deprivation. Subjective sleepiness did not vary much across rotations, call cycle, and call status. CONCLUSION: Chronic and acute sleep deprivation contribute to residents' fatigue. Education could be targeted at attitudes. Further investigation of factors contributing to chronic sleep deprivation in this population is warranted.     

Views of managed care--a survey of students, residents, faculty, and deans at medical schools in the United States

BACKGROUND AND METHODS: Views of managed care among academic physicians and medical students in the United States are not well known. In 1997, we conducted a telephone survey of a national sample of medical students (506 respondents), residents (494), faculty members (728), department chairs (186), directors of residency training in internal medicine and pediatrics (143), and deans (105) at U.S. medical schools to determine their experiences in and perspectives on managed care. The overall rate of response was 80.1 percent. RESULTS: Respondents rated their attitudes toward managed care on a 0-to-10 scale, with 0 defined as "as negative as possible" and 10 as "as positive as possible." The expressed attitudes toward managed care were negative, ranging from a low mean (+/-SD) score of 3.9+/-1.7 for residents to a high of 5.0+/-1.3 for deans. When asked about specific aspects of care, fee-for-service medicine was rated better than managed care in terms of access (by 80.2 percent of respondents), minimizing ethical conflicts (74.8 percent), and the quality of the doctor-patient relationship (70.6 percent). With respect to the continuity of care, 52.0 percent of respondents preferred fee-for-service medicine, and 29.3 percent preferred managed care. For care at the end of life, 49.1 percent preferred fee-for-service medicine, and 20.5 percent preferred managed care. With respect to care for patients with chronic illness, 41.8 percent preferred fee-for-service care, and 30.8 percent preferred managed care. Faculty members, residency-training directors, and department chairs responded that managed care had reduced the time they had available for research (63.1 percent agreed) and teaching (58.9 percent) and had reduced their income (55.8 percent). Overall, 46.6 percent of faculty members, 26.7 percent of residency-training directors, and 42.7 percent of department chairs reported that the message they delivered to students about managed care was negative. CONCLUSIONS: Negative views of managed care are widespread among medical students, residents, faculty members, and medical school deans.     

Do clerkship experiences affect medical students' attitudes toward chronically ill patients?

PURPOSE: To measure changes in medical students' attitudes toward chronically ill patients, and to identify experiences, specifically during clerkships, that contributed to students' attitudes. METHOD: A cohort of students from five U.S. medical schools voluntarily participated in three surveys longitudinally administered before and after required clinical rotations. The first two questionnaires were identical and asked for demographic information and pre-matriculation experiences with chronically ill patients. The third was modified to include questions about clinical experiences with chronically ill patients. Responses from the first and third questionnaires were linked for analysis. RESULTS: A total of 502 of 695 students (69%) completed both the first and the third questionnaires. Many students (36%) had had pre-matriculation experiences with chronic illness. After clinical training, 25% of the respondents stated that they would seek another career specialty if the incidence of chronically ill patients increased in their chosen field, compared with the 9% who responded so before clinical training (p <.001). While 73% of the students had favorable perceptions toward chronically ill patients, and 91% felt involved in care, significantly fewer students (p <.01) had had positive patient care experiences when working with residents (57%) and attendings (59%). Gender, age, prior experiences, and school site were not associated with attitudinal changes. CONCLUSION: Students begin medical school with positive attitudes toward caring for chronically ill patients, but this perception depreciates with clinical experience, which may affect specialty decisions. Contributing factors may include adequate role modeling by residents and attendings and a perceived discrepancy in the quality of care patients receive.     

Indian medical students' views on immigration for training and practice.

PURPOSE: To assess the attitudes of medical students in India about participating in graduate medical education in the United States and other countries and in subsequent clinical practice in those countries. METHOD: A total of 240 students who were attending their final year at two medical schools in Bangalore, India, were surveyed during 2004. Surveys were completed by 166 (69%) of the students. RESULTS: Among the responding students, 98 (59%) thought of leaving India for further training abroad. Of those who wished to leave, 41 (42%) preferred the United States, 42 (43%) preferred the United Kingdom, and 9 (9%) preferred Canada, Australia or New Zealand. Only two students preferred the Middle East. Most who favored training in the United States indicated that they intended to remain after training, whereas fewer than 20% of those who favored training in the United Kingdom had such intentions. While more than 60% perceived greater professional opportunities in the United States than in India, approximately 75% were concerned that the United States had become less welcoming after the terrorist attacks of 9/11, and similar numbers were concerned about the examination administered by the Educational Commission on Foreign Medical Graduates. Conversely, the majority of respondents felt that opportunities for physicians in India were improving. CONCLUSIONS: While optimism about future medical careers in India is increasing, the interest of Indian medical students in training and subsequently practicing in the United States remains high.     

The attitudes and experiences of trainees regarding disclosing medical errors to patients

PURPOSE: To measure trainees' attitudes and experiences regarding medical error and error disclosure. METHOD: In 2003, the authors carried out a cross-sectional survey of 629 medical students (320 in their second year, 309 in their fourth year), 226 interns (159 in medicine, 67 in surgery), and 283 residents (211 in medicine, 72 in surgery), a total 1,138 trainees at two U.S. academic health centers. RESULTS: The response rate was 78% (889/1,138). Most trainees (74%; 652/881) agreed that medical error is among the most serious health care problems. Nearly all (99%; 875/884) agreed serious errors should be disclosed to patients, but 87% (774/889) acknowledged at least one possible barrier, including thinking that the patient would not understand the disclosure (59%; 525/889), the patient would not want to know about the error (42%; 376/889), and the patient might sue (33%; 297/889). Personal involvement with medical errors was common among the fourth-year students (78%; 164/209) and the residents (98%; 182/185). Among residents, 45% (83/185) reported involvement in a serious error, 34% (62/183) reported experience disclosing a serious error, and 63% (115/183) had disclosed a minor error. Whereas only 33% (289/880) of trainees had received training in error disclosure, 92% (808/881) expressed interest in such training, particularly at the time of disclosure. CONCLUSIONS: Although many trainees had disclosed errors to patients, only a minority had been formally prepared to do so. Formal disclosure curricula, coupled with supervised practice, are necessary to prepare trainees to independently disclose errors to patients by the end of their training.     

Understanding physicians' attitudes toward people with Down syndrome

Understanding attitudes of physicians toward people with Down syndrome is important because of the influence physicians have on the future of individuals with Down syndrome. However, few previous studies have assessed these attitudes. Using data from the 2008 DocStyles© survey, an annual online survey conducted in the United States, we assessed attitudes of physicians toward people with Down syndrome using a survey that included questions about opinions toward inclusive educational settings and workplaces, previous relationships with people with Down syndrome, and comfort in providing them with medical care. Approximately 20% of participants agreed that students with Down syndrome should go to special schools, and nearly a quarter agreed that including students with Down syndrome in regular classrooms is distracting. While 76.0% of respondents felt comfortable providing medical care to people with Down syndrome, 9.8% reported feeling uncomfortable, and 14.3% reported feeling neutral. Results showed that attitudes that supported inclusion and comfort with providing medical care were more commonly reported among non‐Hispanic white physicians, those who had previous relationships with people with Down syndrome, pediatricians, and physicians working in a group or hospital setting. These data are helpful to guide the development of training materials and curricula for healthcare providers regarding Down syndrome. Published 2011 Wiley‐Liss, Inc.     

Attitudes of preclinical and clinical medical students toward interactions with the pharmaceutical industry.

PURPOSE: Medical school is a critical time for physicians in training to learn the professional norms of interacting with the pharmaceutical industry, yet little is known about how students' attitudes vary during the course of training. This study sought to determine students' opinions about pharmaceutical industry interactions with medical students and whether these opinions differ between preclinical and clinical students. METHOD: The authors surveyed medical students at Harvard Medical School (HMS) from November 2003 through January 2004 using a six-question survey. The authors then analyzed how responses differed among the classes. RESULTS: Out of 723 questionnaires, 418 were returned--an overall response rate of 58%. A total of 107 (26%) students believed that it is appropriate for medical students to accept gifts from pharmaceutical companies, and 76 (18%) agreed that the medical school curriculum should include events sponsored by the pharmaceutical industry. Many students--253 (61%)--reported that they do not feel adequately educated about pharmaceutical industry-medical professionals' interactions. Preclinical and clinical students had similar opinions for the majority of their responses. Finally, students who reported feeling better educated about pharmaceutical industry interactions tended to be less skeptical of the industry and more likely to view interactions with the industry as appropriate. CONCLUSIONS: Students' opinions about interactions with the pharmaceutical industry were similar between preclinical and clinical students, suggesting that the current medical school experience may have limited impact on students' views about interactions with the pharmaceutical industry.     

Medical students' attitudes toward gay men

ABSTRACT: BACKGROUND: Healthcare providers' attitudes toward sexual minorities influence patient comfort and outcomes. This study characterized medical student attitudes toward gay men, focusing on behavior, personhood, gay civil rights, and male toughness. A cross-sectional web-based anonymous survey was sent to medical students enrolled at the University of California, Davis (N= 371) with a response rate of 68%. RESULTS: Few respondents expressed negative attitudes toward gay men or would deny them civil rights. More negative responses were seen with respect to aspects of intimate behavior and homosexuality as a natural form of sexual expression. Men and students younger than 25 years old were more likely to endorse negative attitudes toward behavior as well as more traditional views on male toughness. CONCLUSIONS: We show that an important minority of students express discomfort with the behavior of gay men and hold to a narrow construction of male identity. These findings suggest that competency training must move beyond conceptual discussions and address attitudes toward behaviors through new pedagogical approaches.     

Knowledge and attitudes towards complementary and alternative medicine among medical students in Turkey

ABSTRACT: OBJECTIVE: This study aims to examine knowledge and attitudes towards Complementary and Alternative Medicine among medical students in Turkey, and find out whether they want to be trained in Complementary and Alternative Medicine (CAM). METHOD: S: A cross-sectional study was carried out between October and December 2010 among medical students. Data were collected from a total of seven medical schools. FINDINGS: The study included 943 medical students. The most well known methods among the students were herbal treatment (81.2%), acupuncture (80.8%), hypnosis (78.8%), body-based practices including massage (77%) and meditation (65.2%), respectively. Acupuncture, aromatherapy, herbal treatment and meditation were better known among female participants compared to males (p<0.05). Females and first year students, generally had more positive attitudes. A larger proportion of female students compared to male students reported that a doctor should be knowledgeable about CAM (p=0.001), and this knowledge would be helpful in their future professional lives (p=0.015). Positive attitudes towards and willingness to receive training declined as the number of years spent in the faculty of medicine increased. CONCLUSION: Majority of the medical students were familiar with the CAM methods widely used in Turkey, while most of them had positive attitudes towards CAM as well as willingness to receive training on the subject, and they were likely to recommend CAM methods to their patients in their future professional lives. With its gradual scientific development and increasing popularity, there appears a need for a coordinated policy in integrating CAM into the medical curriculum, by taking expectations of and feedback from medical students into consideration in setting educational standards.     

Attitudes and opinions of medical staff towards computers.

The attitudes and opinions of 120 medical staff and 22 medical students towards the use of computers in medicine were assessed through a self-administered questionnaire. More than 60% of the respondents have never used computers. Age, sex, nationality and employment status correlate with computer usage. Students, interns, residents and consultants above 50 years of age have poor attitudes towards computers. This category of respondents believe that computers are important but not essential for medical practice. A higher proportion of those who showed positive attitudes to computers had no prior formal training in computer usage. However, they expressed their desire to attend computer training programs. There is a great need to emphasize automation in the undergraduate and postgraduate medical training to cope with improved technology in the practice of medicine. In fact about 90% of the respondents in this study demanded that computer training and applications be introduced in the medicine curriculum either at undergraduate, postgraduate or both levels.     

When should students learn essential physical examination skills? Views of internal medicine clerkship directors in North America.

PURPOSE: To determine whether any consensus exists among internal medicine clerkship directors regarding when students should acquire proficiency in selected physical examination (PE) skills. METHOD: In 2004, the annual survey of Clerkship Directors in Internal Medicine (CDIM) included a question about the timing of PE-skills proficiency. (CDIM members are from 123 U.S. and Canadian medical schools.) A total of 259 members (123 institutional and 136 individual members) were asked the following question about 39 common physical examination skills, selected using a consensus process among the authors and members of the CDIM Council: "When in the medical school curriculum should medical students acquire proficiency for the following skills?" RESULTS: There were 157 respondents, an overall response rate of 60%. There were 89 (72%) responding institutional members and 68 (50%) responding individual members. Respondents agreed that 31 (80%) of the skills should be learned by the end of the clerkship year. However, considerable variability existed regarding when in the curriculum those skills should be learned: for only 18 of 39 skills was there 80% agreement on skills-learning timing. CDIM members were divided on whether normal examination findings should be learned before or during the clerkships. CONCLUSIONS: Variability existed among CDIM members regarding their expectations for the timing of student physical examination learning in the undergraduate medical curriculum. Creating a common vision among clerkship directors and faculty regarding what neophyte clinicians must learn to do and when they are expected to be able to do it will help to address the issue of physical examination proficiency standards of medical students.     

Empathy, humanism, and the professionalization process of medical education.

This study sought to identify the common stages in the development of capacities contributing to humanistic medical care in young physicians, as revealed by their dreams about medical school and training. Using a databank of approximately 400 dreams dreamt by non-patient students and housestaff at a major academic medical center, the author traces the development of the two components of humanistic medicine: empathy and humanistic attitudes. The "critical episodes" of medical education produce in young physicians emotional and psychological defenses affecting their ability to interact with patients in an empathic and altruistic manner. Medical educators need to reevaluate the traditional curricular milestones and pedagogic style to help foster the development of medical humanism.     

The effect of medical education on primary care orientation: results of two national surveys of students' and residents' perspectives.

PURPOSE: To examine changes among a nationally representative sample of students and residents in their orientations toward primary care as reflected in their attitudes toward the psychosocial and technical aspects of medicine and their perceptions of the academic environment for primary care. METHOD: Confidential telephone interviews of stratified national probability samples of first- and fourth-year medical students and residents were conducted in 1994 and 1997. The 1997 survey included 219 students and 241 residents who had also been interviewed in 1994. Participants were asked about their attitudes toward addressing psychosocial issues in medicine and their perceptions of faculty and peer attitudes toward primary care. Responses were compared over time and across groups. RESULTS: Between the first and fourth years of medical school, there was a decline over time in students' reported orientations to socioemotional aspects of patient care (61.6% versus 42.7%, p =.001) and their perceptions that working with psychosocial issues of patients made primary care more attractive (56.3% versus 43.5%, p =.01). This pattern continued for 1997 residents (PGY-3), who were even less likely to say that addressing psychosocial issues made primary care more attractive (26.9%). For fourth-year students in 1994 who became PGY-3 residents in 1997, there was an increased perception that non-primary-care house officers and specialty faculty had positive attitudes toward primary care (20.8% versus 33.0%, p =.005; 28.3% versus 45.7%, p <.0001; respectively). CONCLUSIONS: Between 1994 and 1997 students and residents perceived a positive shift in the attitudes of peers and faculty toward primary care. During the course of their education and training, however, the students experienced an erosion of their orientations to primary care as they progressed through medical school into residency.     

Cultural competency training for third-year clerkship students: effects of an interactive workshop on student attitudes

With an increasing awareness of health disparities, medical schools are challenged to develop training in cultural competency for their students. We developed and evaluated the effectiveness of an interactive workshop designed to improve third-year students' attitudes, beliefs and cross-cultural communication skills. METHODS: At the start of a six-week required family medicine clerkship, 196 medical students participated in small group (20-24 students) workshops. Didactics included facts about health disparities and a model of cultural competency. During a skill-building component, students were exposed to live vignettes portraying ineffective and effective cross-cultural doctor-patient interactions. Impact on students' attitudes, perceived bias and knowledge of techniques was assessed by comparing pre- and postworkshop scores. RESULTS: Participants increased their cultural awareness on most items of a cultural awareness scale. Fifty-five-, 71- and 66% of the sample agreed or strongly agreed the program was valuable, appropriate and effective, respectively. Conversely, only 17-, 6- and 9% of the sample disagreed or strongly disagreed, respectively. CONCLUSIONS: A workshop for third-year students led to an increase in cultural awareness and was considered appropriate and valuable. Further study, including longitudinal training and evaluation, is needed regarding effective methods to increase cultural competence in clinical practice.     

Medical students' perceptions of medical education research and their roles as participants.

PURPOSE: To better understand whether medical students perceive medical education research as important to their medical training and whether published opinions about why medical students participate in research are accurate. METHOD: In 2003-04, 896 first- through fourth-year medical students at Kansas City University of Medicine and Biosciences College of Osteopathic Medicine were asked to complete an online eight-item questionnaire by responding Yes or No to each question. Responses were tallied by year of medical training and converted into numbers and percentages. Chi-square analysis was used to compare response rates among first- through fourth-year students and responses between preclinical and clinical students. RESULTS: A total of 524 students (58.5%) completed the questionnaire. A total of 488 (93%) medical students believed medical education research should be conducted to improve their medical training, 477 (91%) did not feel coerced to participate in studies because of faculty members' positions of authority, and 398 (76%) did not believe they would receive better grades, recommendations, and/or other favors. Four hundred sixty-eight (89%) students were not concerned with their confidentiality as study participants, while 326 (62%) wanted special protections. Response rates by year of medical school were not significantly different (p > .05). Responses of preclinical and clinical students for six of the eight questions were significantly different (p < .05). CONCLUSIONS: Medical school decisionmakers should recognize that students value medical education research. Published opinions about why medical students participate in studies are incongruent with medical students' views. Full review of medical education studies by Institutional Review Boards may be unnecessary and inappropriate.     

Research during pediatric residency: predictors and resident-determined influences.

PURPOSE: Participation in research during residency is thought to be a strong predictor of future research activity; however, the proportion of residents who actually engage in research is small. This study examined (1) which factors are associated with research during residency; (2) which factors influence residents' abilities to conduct research; and (3) the number of residents conducting research in a research-oriented training program. METHOD: One hundred fifteen pediatrics residents were asked at a housestaff retreat to complete a questionnaire about their attitudes toward research. Comparisons between those who were or were not conducting research during residency were made using chi-square or Fisher exact tests; stepwise logistic regression was used to identify factors associated with conducting research during residency. RESULTS: The response rate was 95% (n = 110, or 82% of the residency program). Respondents were representative of postgraduate year, gender, and residency track. Although 92% of respondents reported having conducted research before residency, only 18% were currently involved in research (p <.001). Fifty-five percent reported interest in conducting research. Advanced degrees and future career plans influenced their decisions to do research (p <.05). Respondents were more likely to conduct clinical research than basic science or laboratory-based research (14% versus 3% of all respondents, p =.007). The most commonly identified influences to conducting research were availability of time (97%), personal interest in research (84%), availability of opportunities (76%), and mentors on hand (72%). CONCLUSION: Interest in research during residency is high, but participation in research is low. There are several influences to the types and amounts of research conducted during pediatrics residency.     

Knowledge and attitudes concerning medical genetics amongst physicians and medical students in Cameroon (sub-Saharan Africa).

PURPOSE: Little is known about physician's knowledge of, and attitudes toward genetics in sub-Saharan Africa. METHODS: Survey of 101 pre-clinical, 95 clinical medical students, and 110 physicians, in Cameroon. RESULTS: The awareness of DNA diagnosis was poor: 0, 2.2, and 1.2%, respectively, for sickle cell anemia. The majority of the respondents considered genetic counseling as indispensable (97.6, 98.9 and 100%); and prenatal diagnosis as acceptable. The acceptance of medical abortion increased with the level of medical education (62.6, 74.7 and 90.7%). Sickle cell anemia was considered as a "serious disease" by a greater majority of respondents than Down syndrome (P < 0.001). But, in all three groups, the acceptance of termination of affected pregnancy "if the respondent's own child was affected" was lower for sickle cell anemia than Down syndrome (22.4 versus 40.2%, 10.8 versus 29.3% and 36.1 versus 70.4%). CONCLUSIONS: The data suggest a poor knowledge of genetic tests among medical students and physicians. This cohort appears to accept the principles of medical genetics. Our data emphasized a need to introduce genetics and to develop research on its ethical and social implications in Cameroon.