Medical students' improved attitudes toward prevention of cardiovascular diseases from entry to graduation. Preventive Cardiology Academic Cooperative Research Group of the National Heart, Lung, and Blood Institute.

First-year medical students have been previously reported to have positive attitudes about disease prevention, in general, and about cardiovascular disease prevention, in particular. Whether medical school experiences exert a positive, negative, or neutral effect on prevention-oriented attitudes in medical students is not known. We assessed attitudes toward heart disease prevention in 770 entering medical students enrolled at six selected American medical schools, each having some curricular emphasis on preventive cardiology, and repeated the attitude survey near graduation in the 750 fourth-year students enrolled in the six schools. Response rates were similar at each of the schools for each administration and averaged 88% in entering students and 74% in the graduating students. We used two mean attitude scores, ranging from 1.0 to 5.0 on a Likert scale, 5.0 representing the most positive attitude. The score treating the importance of primary prevention increased from 4.08 +/- 0.39 to 4.35 +/- 0.41. The attitude score concerning the importance of research in preventive cardiology also increased from 3.65 +/- 0.56 to 3.90 +/- 0.64 (P less than .0001 for both comparisons of first-year to fourth-year students). Analyses by school revealed similar increases, as did analyses for men, women, whites, and nonwhites. The results indicate that positive attitudes toward heart disease prevention can become even more positive during medical school. The perpetuation of positive attitudes should contribute to improved clinical prevention behaviors when these graduates embark on careers in medicine.     

Attitudes towards community medicine: a comparison of students from traditional and community-oriented medical schools

OBJECTIVE: To compare the attitudes towards community medicine of first and final year students from two Australian medical schools. METHOD: In 1995, medical students from Newcastle University (a problem-based, community-oriented curriculum) and Adelaide University (a more traditional lecture-based curriculum) were asked to complete the Attitudes to Community Medicine questionnaire. This is a valid and reliable 35 item survey assessing six key domains of community medicine. The two medical schools differ in their methods of selection and curriculum delivery, and also in curriculum content. RESULTS: Response rates averaged 95% for first year and 81% for final year students. Students selected into both medical schools were found to have positive attitudes with respect to most aspects of community medicine. However, those entering Newcastle had more positive attitudes toward community medicine overall than their Adelaide counterparts. They also scored more positively on subscales relating to holistic care and evaluation of health care interventions. Students who were older and female scored more positively on some subscales, but correction for age and gender did not change the conclusions about medical school differences. CONCLUSION: This study suggests that selection criteria, and probably curriculum style and emphasis, have an influence on the attitudes that medical students possess and later develop toward community medicine.     

Attitudes to social issues in medicine: a comparison of first-year medical students with first-year students in non-medical faculties

The emphasis on academic achievement in medical student selection has given rise to the fear that students entering medicine may comprise a homogeneous group with tendencies towards academic and scientific pursuits rather than humanistic and person-oriented health care. The Attitudes to Social Issues in Medicine (ATSIM) scale was administered to first-year Australian medical students and first-year students in other faculties including students with significantly lower academic performance measured by high school examination scores. The medical student group was found to be less conservative towards general social issues than students enrolled in commerce and science faculties and scored equally with arts students. Greater conservatism was, however, apparent in those areas which most closely affect the doctor's role. Medical students were less positive than other student groups in their attitudes towards increased government control of the medical profession, the contribution of allied health professionals and the importance of social aspects of illness. On attitudes to issues such as prevention and doctor-patient relationships which do not challenge the knowledge base or traditional role and status of the medical profession, however, medical students demonstrate equal or greater concern compared with other student groups.     

Factors influencing physicians' orientation toward prevention

We examined the influence of various background characteristics as well as other variables such as personal health practices, specialty choice, and political orientation, on the attitudes of medical graduates toward the physician's role in prevention. The study was part of a 1979 survey conducted in three U.S. medical schools. The results revealed that graduates who believed more strongly in the physician's role in prevention tended to be in primary care training, had a more liberal political orientation, and came more often from physician families. These graduates also believed more strongly that physicians ought to be role models for their patients in health habits. However, they did not manifest better personal health practices than physicians less oriented toward prevention. There was also a medical school effect, although it could not be determined whether this represented the influence of the curriculum or of the selection process into medical school.     

An initial explanatory model of medical students'' preferences for patient types

Previous studies suggest that medical students and doctors may express a range of positive and negative attitudes and behaviours towards patients. As an initial attempt to understand how attitudes toward patients are formed, first-year medical students were asked to describe their feelings about six categories of patients. These reactions were then correlated with the students' social background, social values and perception of these conditions.     

Health promotion beliefs and practices of fourth-year medical students

Little is known about medical student beliefs about health promotion issues or about their prevention practices with patients. We administered a questionnaire about health promotion beliefs and practices to fourth-year medical students in a required course, "Preventive Medicine in Clinical Practice," at the University of Maryland School of Medicine. During a three-year period we surveyed 343 students. A majority of students believed that most of 23 health behaviors were of some importance to health promotion, and their responses were similar to those of practicing physicians in prior studies. Most students reported that they assessed preventive practices in their patients but did not feel well prepared to counsel patients about health issues. Students reported they were currently unsuccessful in modifying patient health behaviors and expressed limited optimism about future success in helping patients change health promotion behaviors with further training and support. There were no differences between students entering primary care specialties and other students. Information about medical student health promotion and disease prevention beliefs and practices can be applied in curriculum development.     

Inventory of knowledge and skills relating to disease prevention and health promotion

An inventory of the knowledge and skills appropriate for the instruction of medical students in the disciplines of disease prevention and health promotion was developed by a steering committee of medical practitioners and teachers, with the input of over 70 colleagues. The inventory, which is intended as a guide for curriculum planners, defines the fundamentals of subject areas appropriate for the general education of all physicians, including the skills and knowledge related to delivery of personal disease prevention/health promotion services, quantitative methods, health services organization and delivery, and community dimensions of medical practice, as well as attitudes and philosophy.     

Social issues in medicine: a follow-up comparison of senior-year medical students'' attitudes with contemporaries in non-medical faculties

A comparison of first-year medical students' attitudes to social issues in medicine with attitudes of non-medical first-year students in 1983 found that the medical group was less conservative towards general social issues but more conservative in relation to those areas which closely affect the doctor's role, particularly the place of allied health professions and government intervention in health care. This paper reports a follow-up study of the same groups of students when they had reached senior years in their respective courses. While medical student conservatism on general social issues continues to be no greater than other student groups there is a marked increase in conservatism of attitudes towards government involvement in health care and regulation of costs. Attitudes to allied health professions and preventive care remain unchanged but senior medical students are significantly less likely to recognize social factors as determinants of illness than they were when they commenced the study of medicine. Specific curricular attention to social and behavioural medicine does not appear to counteract the predominantly biomedical perspective students experience in teaching hospitals, the major venue for their clinical education.     

Attitudes and beliefs about musculoskeletal pain and its association with pain neuroscience knowledge among physiotherapy students in Israel

Background

Physiotherapy has a vital role in helping patients manage and overcome musculoskeletal pain. Healthcare providers’ beliefs about pain are associated with the beliefs of their patients. This study evaluated the attitudes, beliefs and level of pain neuroscience knowledge among Israeli Bachelor-level physiotherapy students.

Methods

First-year (n?=?29, before pain course), second-year (n?=?28, immediately after pain course and before clinical placements), and fourth-year (n?=?28, post-clinical placements) physiotherapy students completed the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS, range 15–105, lower scores indicate a more positive attitude) to assess pain attitudes and beliefs. The Neurophysiology of Pain Questionnaire (NPQ, range 0–19, higher scores indicate more pain-related knowledge) was also completed to measure pain neuroscience knowledge. Two separate one-way ANOVAs with post hoc analyses were used to compare HC-PAIRS and NPQ results between the three groups of students. Pearson correlations were determined between HC-PAIRS and NPQ.

Results

HC-PAIRS scores of the first-year students were significantly higher than those of second- and fourth-year students (p?=?0.011, p?<?0.001, respectively), with no difference between second- and fourth-year students; indicating that first-year students had less-positive attitudes toward the ability of individuals with musculoskeletal pain to function. Similarly, NPQ scores showed that first-year students differed from second- and fourth-year students (p?<?0.001, p?<?0.001, respectively). The HC-PAIRS and NPQ correlation among the fourth-year students yielded a moderately negative association (r?=???0.462, p?=?0.01), indicating that pain neuroscience knowledge was associated with less belief that chronic pain justifies disability.

Conclusions

A specific curriculum about pain during physiotherapy undergraduate education contributes to a more positive evidenced-based attitude to musculoskeletal pain and patient function. The association between pain neuroscience knowledge and positive attitudes and beliefs regarding pain were enhanced after clinical placements, demonstrating that learning improves when integrated into practice. Due to the impact of pain training and the expected benefits to patient care, health policy decision makers and educators should verify that the pain curriculum is current with the best research evidence. Future studies with larger samples that include students from other healthcare disciplines, including medicine are warranted.

     

Health care reform as perceived by first year medical students

Our study objective was to evaluate the attitudes of first year medical students toward the health care system using a self administered questionnaire to all first year medical students at the medical schools in the University of California system. Of 631 students surveyed, 94% comleted the instrument. Students were asked about their attitudes toward and familiarity with concepts in health services, access to care, and managed care. Our findings indicated that most students were unfamiliar with concepts related to health services. Students were concerned about access to care; sixty-six percent of students favor a national health insurance plan. A majority of students supported allowing patients access to the current health care system regardless of the cost or utility of a medical test or procedure. Thirty-nine percent felt that rationing health care in any form (transplants, access to the intensive care unit, etc.) is contrary to the way medicine should be practiced. 72% felt that practicing physicians had a major responsibility to help reduce health care costs. When asked about specific changes intended to control health costs, students identified reform of medical malpractice system (63%) and increased spending on preventive health (60%) as the two proposals most likely to be effective. Students generally held negative attitudes toward managed care organizations; only 10% would chose to receive their care in HMOs. We conclude that first year medical students generally have little understanding of the health care system. Despite this, they hold strong opinions about access to care, managed care organizations and strategies intended to reduce health care spending. It is up to medical educators to find creative methods of introducing these content areas into an already bulging curriculum.Funds for this study were generously provided by the L.K. Whittier Foundation. Samuel A. Skootsky's salary was in part supported by Southern California Edison.     

The association between Colombian medical students' healthy personal habits and a positive attitude toward preventive counseling: cross-sectional analyses

Background  

Physician-delivered preventive counseling is important for the prevention and management of chronic diseases. Data from the U.S. indicates that medical students with healthy personal habits have a better attitude towards preventive counseling. However, this association and its correlates have not been addressed in rapidly urbanized settings where chronic disease prevention strategies constitute a top public health priority. This study examines the association between personal health practices and attitudes toward preventive counseling among first and fifth-year students from 8 medical schools in Bogotá, Colombia.     

Do conventional and innovative medical schools recruit different students?

A mail questionnaire was used to survey the social and demographic characteristics, educational background, attitudinal profiles and expected career choice of 243 first-year students enrolled in three US medical schools. The aim was to determine whether different types of schools selected different types of students. Two schools were considered as conventional whereas one school was considered as innovative both in its admission policies and in its curriculum which emphasizes a biopsychosocial approach to health care. The survey achieved an 84% response rate. The results showed no difference in students' career expectations. Students recruited in the innovative school, however, differed from students recruited in the conventional schools with regard to their social and demographic characteristics, educational background and attitudinal profiles. This study suggests that as some medical schools are innovating in their curriculum and admission policies, new types of medical students are entering medicine. Implications of these results are discussed.     

Health care providers' attitudes toward nutrition

A survey questionnaire, assessing general attitudes toward the importance of nutrition in the prevention of disease and the maintenance of good health, was administered to physicians, nurses, dentists, and technicians at five U.S. Army medical centers. The various groups of health care specialists differed significantly on many items concerning the importance of good nutrition and eating habits for maintenance of good health and for recovery from illness, as well as on items concerning the importance of nutrition knowledge and training in their health care professions. More agreement was found among the groups on items concerned with the relationship between disease states and dietary factors and the effectiveness of health education programs in the prevention of various diseases. Self-reports of personal health habits did not correlate with scores on survey items concerned with the importance of good nutrition, suggesting that personal attitudes toward nutrition may be unrelated to other health practices.     

深圳市中学生预防艾滋病干预措施评价

目的 探索在中学开展预防艾滋病（AIDS）有效干预模式及其效果评价。方法 对深圳市10所中学初一、高一学生进行预防艾滋病健康教育干预前后相关知识、态度及行为的变化进行比较。结果 （1）知识方面：干预后,学生预防AIDS基本知识平均得分初一男生由7.47提高到10.21（满分为15）;初一妇生从7.17提高互10.21;高一男生从10.30提高到11.09;高一妇生从9.58提高到10.55。（2）态度方面:对待HIV/AIDS患采取正向态度明显提高,男生由22.6％上升到34.9%;女生由24.4%上升到41.5%。（3）行为方面：同学可以运用更多的信息来源获取有关知识。结论 学校预防AIDS教育干预措施以帮助学生增强抵御HIV／AIDS的能力,树立正向的态度,但要由知识转变行为还需要一定的时间、综合的干预和社会的多方支持。     

The Aging Game: improving medical students' attitudes toward caring for the elderly

OBJECTIVES: The objective of this study was to evaluate the effectiveness of a modified aging game to enhance medical students' attitudes toward caring for elderly patients, enhance empathy for elderly patients, and improve general attitudes toward the elderly. DESIGN: Preintervention and postintervention study PARTICIPANTS AND SETTING: All 84 students from 2 first-year medical school classes INTERVENTION: The aging game takes place over a period of 3 hours with a group of 10 to 12 students and 5 to 6 facilitators, and includes experiential learning about polypharmacy, medication cost, loss of functional status, semi-independent living, and living in a long-term care facility. MEASUREMENTS: Scores obtained through a modified Maxwell and Sullivan questionnaire, and the Aging Semantic Differential (ASD). RESULTS: There was a statistically significant improvement in 6 of the 8 attitudes toward caring for elderly and a statistically significant increase in empathy towards elderly patients following the aging game. There was a statistically significant change on 23 out of 32 ASD questions. There was no evidence of differences in the scores from pre-course to post-course by gender age group, interest in Family/Internal Medicine, or prior geriatric experience. Following the game, 77 (93%) of the students said they would take the course if not mandatory (P = .0001). A majority stated the aging game added significantly (61.5%) or moderately (37.3%) to their knowledge and skills in patient care for the elderly. CONCLUSION: A simulation experience like the aging game is an effective method of increasing the empathy and attitudes toward caring for the elderly early in the medical school curriculum. Longitudinal assessment of the effect of the aging game in maintaining the positive effect on empathy and attitudes toward caring for the elderly and especially in clinical practice needs to be done.     

Comparative study of the attitudes of students and nurses to physician-assisted suicide--first results

While the popular media and the professional literature deal with the topic of euthanasia intensively, the problems of physician-assisted suicide received insufficient attention in Hungary. The authors review the most important details of the physician-assisted suicide. A twelve-item scale to measure attitude toward PAS (constructed and validated by G. Domino) was administered to the samples of Hungarian social science, medical students and nurses. The distributions of responses for the 12 items for the social and medical samples are compared and discussed. Also a cross-cultural comparison was made with an American student sample examined by Domino. The social science students who have the fewest personal experiences with serious, or terminally ill patients are the most liberal group, characterised by the most permissive attitudes toward PAS. Nurses who have everyday contact and experience with these patients are the most conservative; they show more or less conclusively the lowest acceptability rate of PAS. The attitudes of medical student's group, of the would-be physicians are between them, and they are the most controversial and ambivalent. Future research is necessary to get more information about attitudes toward physician-assisted suicide.     

Medical students' illness-related cognitions

Medical Education 2011: 45: 1241–1250 Context Doctors do not follow guidance when managing their own health and illness. This behaviour may start at medical school. This study aimed to investigate whether inappropriate responses to illness are an issue for medical students and, if so, to identify the determinants of students’ responses to illness. Methods We undertook a qualitative study using framework analysis to explore the views of medical students at two UK medical schools. Results Eight focus groups carried out with 35 medical students identified four main themes in students’ cognitions about their intended behaviour: not using usual patient pathways; informal consultation; self‐treatment, and keeping going when ill. The reasons or assumptions underlying these beliefs referred to: time and resources, including wider issues such as responsibility to colleagues; stigma and attitudes of others including regulatory bodies; beliefs about themselves in terms of taking on the patient role and issues relating to coping and self‐sufficiency; the behaviour and attitudes of peers; patient safety considerations; patients’ views about sick doctors; barriers to accessing care; the ease of self‐care, and uncertainty about ability to self‐care. Conclusions Many different factors related to medical students’ beliefs about illness. Conflicts occur among student needs to be seen as competent and dedicated to medicine, to protect personal privacy, to maintain convenience, and to seek care appropriately in order to be fair on colleagues and protect the public. These conflicts were complicated by perceptions of the system, peers and doctors as unsupportive of ill health except by facilitating informal access to care. Beliefs underlying intentions are similar between doctors and medical students, but further research is needed to fully determine how and when these beliefs are formed.     

生活技能教育对医学生健康相关态度及行为影响

目的探讨生活技能教育教学对医学生健康相关态度及行为的影响。方法2006—2011年,在北京大学医学部开设《生活技能教育与心理健康促进》选修课,每年9周,18个学时。采用参与式教学方法,以改善大学生心理社会能力为切入口。通过课程前后的问卷调查,对有关学生健康相关态度及行为的教学效果进行评估。结果课程教学后学生健康相关行为和态度较教学前有了明显转变,学生心理社会能力“总分”、“好”、“有能力”3个方面评分均高于课程教学前,差异均有统计学意义（均有P〈0．05）。结论生活技能教育在医学生健康相关态度及行为方面的干预是有效的。     

Hopes and concerns of a first-year medical school class

Summary. To assess the hopes and concerns of first-year medical students, the 1991 Oregon Health Sciences University (OHSU) Medical School class was surveyed during orientation. Using qualitative research methods, student responses were grouped into general categories. The most common ‘hopes’ were to provide personal care and develop relationships with patients, to attain self-fulfilment, and to enjoy the personal challenge and variety of medicine. Common ‘concerns’ were family issues, outside intervention into medicine, and loss of self. The hopes and concerns of this class revolve primarily around personal issues, rather than issues relating to their local community or to society. This information may be useful in student counselling and curriculum development. Further research is necessary to evaluate changes in this class's attitudes over time. The methodology of this study may be useful in the evaluation of the attitudes of subsequent first-year medical school classes at OHSU, and at other institutions.     

Children's perceptions of health and illness: images and lay concepts in preadolescence

Despite a growing body of research into children's concepts of illness, many basic questions still remain. This study aims to describe 8- to 11-year olds' lay beliefs of health, illness, health promotion and disease prevention. Children responded to open-ended questions about health and illness by drawing and writing their responses. Two primary schools of two small towns of Békés County, Hungary, were invited to participate. The sample consisted of 128 primary school students (57% males and 43% females), one class from each of Grades 3, 4 and 5 within each location. Consistent with previous findings, the children of this sample have considerable knowledge about health, illness and disease risks. In addition, they seem health conscious and hold positive attitudes toward health and health promotion. Many respondents demonstrated a biomedical approach to health. At the same time, holistic views of health were also common. Children's past experiences (e.g. trivial infections) may play an important role in their concepts of disease causation. Ideas about health promotion were especially varied, with a few children describing complex guidelines.