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.     

Physical therapy on trial: the rationale, organization, and impact of a mock trial on physical therapy students' attitudes toward and confidence in research

A learning activity, debate with a mock trial format, provides opportunities for physical therapy students to develop skill and confidence in learning to evaluate research critically, to formulate opinions regarding the credibility of the available evidence for a therapeutic approach to patient care, and to substantiate their choice of treatments with persuasive arguments and analytic rebuttals. The purposes of this study were to (1) describe the mock trial learning activity within a professional physical therapy curriculum and (2) determine whether the mock trial positively influenced students' attitudes toward research and confidence in their ability to interpret and apply research findings to clinical practice. A structured questionnaire was distributed to the 48 students at key points during the academic program to measure the overall effects of the physical therapy curriculum and the specific effects of the mock trial learning activity. There was an increase (p < 0.05) in the students' confidence in their ability to interpret and apply research after participating in the mock trial. The overall responses to the modified Attitudes-to-Research scale indicated that the physical therapy students generally held positive and optimistic attitudes toward research. These attitudes were maintained over the entire experience within the curriculum. If attitudes predict behavior, these future practitioners are more likely to be physical therapists who critically appraise and use evidence to determine practice.     

Attitudes toward the elderly among students of health care related studies at the University of Salamanca, Spain

INTRODUCTION: This study uses a cross-sectional approach in terms of evaluating attitudes toward the elderly among health sciences students. The aim of this study was to measure attitudes among final year pregraduate students of seven health care careers. METHOD: A cross-sectional study was conducted with final year students of medicine (M), occupational therapy (OT), physiotherapy (P), nursing (N), psychology (Ps), social work (Sw), and dentistry (D). The data was collected using the validated Spanish version of the questionnaire that uses the Aged Semantic Differential (ASD), a scale developed by Rosencrantz and colleagues. Additional information about sociodemographic characteristics of students was collected. RESULTS: A total of 472 valid questionnaires were collected; 54% of the students showed positive attitudes toward the elderly. Female students had more positive attitudes than male ones. The Ps and P students showed a high interest in choosing geriatrics as their speciality (36%), while only 16% of the medical students considered it among their career options. DISCUSSION: Pregraduate health care students' attitudes tend to be less positive concerning older people's capacity for self-determination. Therefore, it would be advisable to enhance continuous interaction among healthy aged people and students of the named specialities during their specific training. The fact that the N students had less positive attitudes toward the elderly, while they were also more likely to take action, and the fact that the Ps and Sw students had more positive attitudes might suggest a need to enhance and combine the approach to the care of the older people in nursing with the psychological and life course approaches.     

A comparison of interprofessional perceptions and working relationships among health and social care students: the results of a 3-year intervention

A longitudinal quantitative study in an English faculty of health and social care explored the effects of a pre-qualifying interprofessional curriculum for students from 10 professional programmes. Students on the interprofessional curriculum completed questionnaires containing four attitude scales on entry to the faculty, during their second year and at the end of their final year. At qualification, 581 students (76.9% of those qualifying) completed scales concerning their communication and teamwork skills, their attitudes towards interprofessional learning, their perceptions of interaction between health and social care professionals, and their opinions about their own (inter)professional relationships. Questionnaires were completed at both entry and qualification by 526 students (69.8% of those qualifying), and at all three points by 468 students (61.9% of those qualifying). A comparison group of 250 students (67.6% of those qualifying) on the previous uniprofessional curricula also completed questionnaires at qualification. Students on the interprofessional curriculum showed no significant change in their self-assessment of their communication and teamwork skills between entering the faculty and qualification. However, there was a negative shift in their attitudes to interprofessional learning and interprofessional interaction. Nevertheless, most students were positive about their own professional relationships at qualification. Students with previous experience of higher education were comparatively positive about their communication and teamwork skills, as were female students about interprofessional learning. However, the strongest influence on students' attitudes at qualification appeared to be professional programme. This suggests that interprofessional education does not inhibit the development of profession-specific attitudes. Students who qualified on the interprofessional curriculum were more positive about their own professional relationships than those who qualified on the previous uniprofessional curricula. These data suggest that experiencing an interprofessional curriculum has an effect on students' attitudes at qualification, particularly with regard to their positive perception of their own professional relationships.     

Implementation and evaluation of an interdisciplinary health professions core curriculum.

An interdisciplinary core curriculum has been implemented in the College of Health Professions at Armstrong Atlantic State University since spring 1996. The curriculum is designed to provide students with the knowledge, skills, and values necessary for interprofessional practice. The courses are taught by interdisciplinary teams and are offered as electives or as part of major requirements in nursing, health science, physical therapy, dental hygiene, medical technology, radiologic sciences, and respiratory therapy. In addition to ongoing evaluation methods, a survey designed to assess the student and faculty perceptions of the experience has been conducted. Both groups agreed that the experience has had a positive impact on the students' professional performances, patient interactions, understanding of the health care delivery system, and health career preparation. Faculty agreed that teaching in an interdisciplinary team was a positive experience. The collaboration among the health professions' faculty has resulted in increased respect for one another and for others' disciplines. Although the experience places an additional burden on their workload, they agreed that the experience is beneficial, their efforts are worthwhile, and they would be willing to continue to teach interdisciplinary courses.     

The effect of first year mental health fieldwork on attitudes of occupational therapy students towards people with mental illness

Background and Aims:  Despite recent initiatives to reduce stigma towards people with mental illness, negative attitudes persist both in the community and among health professionals. Fieldwork experience has been identified as the most powerful way of modifying the attitudes of health professional students. Research to date suggests that later placements tend to have a more positive effect on attitudes than do earlier placements. However, inconsistencies within the literature suggest that it is the nature of the fieldwork experience that is the critical factor. We set out to investigate whether a program of fieldwork that included a tutorial component would bring about positive attitudinal change in first year occupational therapy students.
Methods:  We conducted secondary analysis of data collected from first year students before and after first year fieldwork experience in mental health settings. Student statements were rated to identify positive versus negative attitudes, and attitudinal themes were analysed.
Results:  Quantitative analysis revealed that students made significantly more statements reflecting positive attitudes following fieldwork than they did before. From pre- to post-fieldwork, attitudinal themes changed from: people with mental illness as different, fear of people with mental illness, and a deficit focus of mental illness, to: the 'ordinariness' of people with mental illness, students' understanding of people with mental illness, and an enabling approach to people with mental illness.
Conclusions:  A program of fieldwork that includes a structured tutorial component can bring about positive changes in the attitudes of first year students towards people with mental illness.     

Who serves the underserved? Predictors of physician care to medically indigent patients

Using a national sample of 466 doctors, this work is the first to determine how sociodemographic characteristics, family lives, educational experiences and work environments combine over the life course to shape physician attitudes and behaviors toward serving the medically indigent. Survey data reveal that most physicians have positive experiences with indigent patients, and feel responsible for providing care for the needy. On average, one-quarter of doctors' patients are medically indigent, and physicians provide six hours of charity care per week. Multivariate regression and path analyses indicate that disparate social forces predict humanitarian attitudes and behaviors of physicians. Physician attitudes toward the indigent are shaped largely by socializing forces, including medical education and relationships with mentors. In contrast, care of indigent patients is driven by physician attitudes and by characteristics of medical practice such as specialty and practice setting. Implications for scholarship and for medical education, practice and health policy are discussed.     

Adapting and implementing a long-term nutrition and physical activity curriculum to a rural, low-income, biethnic community

This study adapted an urban-based school nutrition program for delivery in a rural community. Specific aims were to adapt the curriculum; expand it to include physical activity; determine effectiveness on students' attitudes, knowledge, and self-efficacy; and assess teachers' impressions. Three cohorts were established: 173 students taught by a resource teacher, 170 students taught by classroom teachers, and 187 students who did not receive the curriculum. Pre- and posttest surveys measured outcomes, and classroom teachers were observed and interviewed. The curriculum was shown to be effective in enhancing student outcomes for both the resource teacher and classroom teacher cohorts. Teachers reported that lessons needed to be simplified and that children enjoyed them. Findings support the transferability of an urban-based nutrition curriculum to a rural community and the need for students to receive health education annually.     

Sexual health: the role of sexual health services among homeless young women living in Toronto, Canada

Recent statistics indicate limited condom use, high STI (sexually transmitted infection) rates, and a general lack of knowledge about reproductive and sexual health among homeless youth. This research focuses on the experiences of homeless female and transgendered youth, providing an insider's perspective on shaping sexual health interventions. This qualitative research is based on life history interviews and participant observation with eight homeless young women who reflect the diversity of the homeless population in Toronto, Ontario, Canada. Their particularized sexual experiences and health-seeking behaviors illustrate the range of issues faced by this community, speaking to the efficacy of current health promotion strategies. Too often faced with judgmental health and social service providers who they perceive to undermine their agency and empowerment, these women highlight the challenges they face when seeking sexual and reproductive health services and information. In addition to speaking to the struggles and frustrations they face in regard to their sexual health and the services with which they choose to interact, the women provide suggestions for improved care. From these, the authors include key recommendations for the provision of culturally competent, sex-positive, and nonjudgmental health services with the hope that health practitioners and promoters can learn from these experiences, both positive and negative, when caring for and supporting young women living in exceptional circumstances.     

A health professional students' cultural competence and attitudes toward the poor: the influence of a clinical practicum supported by the National Health Service Corps

To provide quality health care today, practitioners must be culturally competent. Funding sources, such as the federal government, recognize the need to prepare culturally competent clinicians. The mission of the National Health Service Corps (NHSC), a federal program, is to increase access to primary care services and reduce health disparities by assisting in the preparation of community-responsive, culturally competent primary care clinicians. This study evaluated an NHSC program that funded, in part, health professional students' educational programs. Following their participation in an NHSC-supported clinical experience, students were assessed on their cultural competence, perceptions of the poor, and intention of serving in an underserved community. Health professional students completed a survey before and after the clinical practicum. Participants included students who were studying to be physicians, physician assistants, social workers, and nurse practitioners. Results of the study found no change in students' cultural competence after their clinical practicum. Although they remained in the "culturally aware" stage, they were not considered either "culturally proficient" or "culturally competent." However, their attitudes toward those in poverty were more positive than in previous studies of health professionals. The greatest impact from the students' clinical experience was their increased intention to practice in an underserved community following their practicum. They found their experience with the underserved to be rewarding, challenging, and humbling. Documenting the influence that government-funded programs have on health professional students is extremely important in studies such as this.     

Queer periods: attitudes toward and experiences with menstruation in the masculine of centre and transgender community

Menstruation has long been viewed as an important aspect of women’s health. However, scholars and healthcare providers have only recently begun to recognise that transgender men and people with masculine gender identities also menstruate, thus little is known about their attitudes toward and experiences with menstruation. A sample of masculine of centre and transgender individuals with a mean age of 30 years was recruited online to complete measures of attitudes toward menstruation and menstrual suppression and to answer exploratory questions about their experiences managing menstruation. Participants reported mixed attitudes toward menstruation, but generally positive attitudes toward menstrual suppression. Many participants said that they try to avoid public restrooms during menstruation because of practical and psychological concerns. Implications of our findings for the transgender health are discussed.     

Service Learning in an Occupation-Based Curriculum: Student Commentary

Recent trends toward occupation-based practice and the move toward masters-level occupational therapy (OT) education has forced OT educators to reevaluate their programs to meet the needs of the contemporary health care environment. Service learning is one way to bridge the gap between theory and practice. The Master of Occupational Therapy (MOT) Program at Cleveland State University (CSU), in keeping with its focus on occupation, incorporates three service-learning components into its curriculum. This paper, written by a second-year MOT student at CSU, discusses two of these experiences in depth. The first, which took place at a homeless shelter, included both a didactic and “clinical” component, with an emphasis on community-based mental health OT services. The second, which included a training component and a structured program, involved co-leading after-school social-emotional learning groups for low-income urban youth. Both experiences served to expand the clinical skills and reasoning of the MOT students while introducing both the students and agencies to the role of OT in non-traditional community settings. Based on these experiences, the author highly recommends that all masters-level OT programs should, if they have not done so already, institute service learning as a core component of their curricula, in order to prepare their students for contemporary OT practice.     

The earlier,the better: the effect of early community contact on the attitudes of medical students to older people

BACKGROUND: Early clinical contact for medical students is an important curricular innovation. We wished to determine if early contact with older people in the second year of a more vertically integrated medical undergraduate programme influenced attitudes to older people and if any effect was synergistic with the effect of an existing fourth year course. SUBJECTS: Second and fourth-year medical students. METHODS: We used a modified version of the Rosencranz-McNevin semantic differential on ageing to assess attitudes of medical students before and after a one-week early community contact week. Some second-year students were followed into fourth year and the effect on their attitudes of a health care of the elderly course was measured. We compared these data with attitude scores from an earlier cohort of students who had undertaken the fourth-year but not the second-year component. RESULTS: Contact with older people during second-year had a significantly favourable effect on attitudes to older people, especially for students who saw older people in the community rather than in rest homes. The attitudes towards older people of students who had undertaken a fourth-year clinical health care of the elderly attachment were significantly better on two of three subscales than those of fourth-year students who had not seen older people during their second year. CONCLUSION: Contact with older people early in a medical student's training, and within a more vertically integrated programme, has a positive effect on attitudes to older people. This effect may be synergistic with contact later in training.     

Attitudes of physical therapist students toward physical therapist assistants before and after full-time clinical internships

Development of attitudes of physical therapists (PTs) toward physical therapist assistants (PTAs) begins during their professional education, and attitudes are influenced further by clinical experiences. The purpose of this study was to understand attitudes of student PTs toward PTAs. We surveyed 66 clinical intern students enrolled in an entry-level master of physical therapy program. PT students received the same survey before and after their full-time clinical internship. Eleven Likert scale items were used to assess students' attitudes toward PTAs in the areas of competence, financial remuneration, and job security. One item was designed to determine whether PT students' level of contact with PTAs influenced attitudes. A random sample of 13 (20.9%) students who returned surveys were asked to participate in a telephone interview designed to enrich the quantitative data. After item analysis, five of the scale items were eliminated from the analyses due to poor internal consistency. Cronbach's alpha of the remaining six scale items was 0.75. Survey results reveal that PT students maintain an overall positive attitude toward PTAs before and after full-time clinical internship. Qualitative interview data support this finding. Students' attitudes in specific areas of PTA competence were negative and positive, however. The negative attitude may have been based on the students' beliefs that PTAs are not competent to perform physical therapy in situations that are changing or unpredictable. Positive attitudes may have been reflective of the students' beliefs that PTAs are competent to implement established plans of care. Student ranking of four professional issues showed a significant difference before and after full-time clinical internships.     

What students bring to medical school: attitudes toward health promotion and prevention

INTRODUCTION: Health care providers' positive attitudes toward prevention and health promotion are important in achieving national health care goals. Limited studies of incoming medical students have been conducted that measure predictors of positive attitudes toward health promotion and prevention. METHODS: Data were obtained from a 1993 curriculum evaluation survey of first-year students at five different medical schools in California. Attitudes toward health promotion and prevention were measured using a nine-question Prevention Attitude Scale (PAS). We developed 2 multivariate linear regression models using demographics, education choices, and personal social values and beliefs to predict PAS scores. We also performed bivariate analysis. RESULTS: Five hundred ninety-nine completed surveys were analyzed, with a response rate of 95%. Mean PAS score was 36.47 +/- 3.7 on a 0 to 44 scale. Female gender, Democratic party preference, and a planned specialty choice in preventive medicine or primary care predicted the highest PAS scores on bivariate analysis (p < 0.002). Significant correlation ( p < 0. 001) was shown between PAS scores and 2 additional scales regarding beliefs in associations of social factors and illness and in the importance of caring for the poor. Linear regression model using personal social values and beliefs explained 34% of the variance, as opposed to the demographic model that explained only 9% of the variance. CONCLUSIONS: In the schools studied, participating first-year medical students had moderately positive attitudes toward health promotion and prevention, as measured by PAS scores. In designing curriculum to improve medical students' attitudes toward health promotion and prevention, medical educators may need to consider other personal and social values held by medical students and to address the "political" aspects of health promotion and prevention. Future studies are needed to longitudinally follow medical student attitudes.     

Interprofessional Experiences and Attitudes Toward Interprofessional Health Care Teams Among Health Sciences Students

This study examined how the interprofessional experience, including education and practice, affects graduate health science students’ attitudes toward interprofessional practice in health care teams. Data were collected from 227 graduate students, using the Attitudes toward Health Care Teams (ATHCT) scale. Both social work and other health science students had positive attitudes toward interprofessional collaboration with regard to its ability to improve the quality of a patient’s care. The results from hierarchical linear regression analyses demonstrated that female students, older students, and students with longer interprofessional practice experiences had more positive attitudes toward interprofessional collaboration in health care teams. Based on these results, implications for interprofessional education are discussed.     

Impact of an interprofessional community-based educational experience on students' perceptions of other health professions and older adults

Caring for older adults has become increasingly complex due to multiple health and societal factors. The purpose of this study was to evaluate the impact of an interprofessional community-based educational project on students' attitudes toward other health care professions and older adults. A pretest and posttest quasi-experimental research design was implemented with 64 participating students from four health care professions (nursing, occupational therapy, physical therapy, and pharmacy). These students completed the Interdisciplinary Education Perception Scale (IEPS) and Survey of Attitudes on Aging Scale (SAAS) before and following an educational experience with older adults. Qualitative data were collected through student reflection journals and focus groups with participating students. The results of the study showed that interprofessional community-based learning had a significant impact on some students' attitudes toward older adults. The difference between pretest and posttest reached a statistically significant level on the SAAS in occupational therapy (p = 0.013) and physical therapy students (p = 0.044). No significant differences, however, were found between the pretest and posttest in pharmacy (p = 0.097) or nursing students (p = 0.144). Similarly, the experience also had a positive impact on some students' perceptions of other health care professions as measured by the IEPS. A significant difference was found between the pretest and posttest in occupational therapy (p = 0.000) and physical therapy students (p = 0.028). This study indicates that interprofessional community-based learning can be an effective method for some students to increase their understanding and respect toward other health professionals and older adults.     

Interdisciplinary didactic instruction at academic health centers in the United States: attitudes and barriers

Interdisciplinary care is a method of providing patient care through a team approach that incorporates the efforts of various health care providers. Studies show that this approach can improve patient care and decrease overall costs to the healthcare system. Despite the evidence for the benefits of interdisciplinary care, there are no well-defined models for training students during their didactic years to become members of an interdisciplinary team. This study utilized an investigator-developed questionnaire to determine the attitudes of administrators of professional schools in the USA toward interdisciplinary education, identified the perceived barriers to interdisciplinary education, examined the extent to which interdisciplinary education is occurring at academic health center campuses, and identified the courses that might best be taught in an interdisciplinary format. Administrators from medicine, nursing, and pharmacy hold positive attitudes toward interdisciplinary instruction. Respondents from nursing and pharmacy hold more favorable attitudes than their counterparts from medicine. Positive attitudes are seen more frequently among females than males, and among respondents from public single and multi-campuses than from private campuses. This study demonstrated that administrators espouse very positive attitudes toward interdisciplinary education, although they perceive the barriers to interdisciplinary education and the courses most suited for anointer disciplinary approach differently. More discussions among administrators of various disciplines may allow barriers to be overcome and allow development of interdisciplinary didactic courses that could test the hypothesis that these courses are more cost effective and more likely to foster interdisciplinary teamwork in the clinical setting. This revised version was published online in June 2006 with corrections to the Cover Date.     

A rural community-based interdisciplinary curriculum: a social work perspective

Although social workers are frequently part of interdisciplinary teams in health care and community settings, interdisciplinary training is often lacking in social work education (Berg-Weger & Schneider, 1998). This article describes a study of the effects of an interdisciplinary community-based experiential course preparing new health care professionals for work as part of interdisciplinary teams. The interdisciplinary curriculum was established for a summer course taught in 2006 by faculty from five disciplines: social work, nutrition, medicine, nursing, and public health. The course, Quality Improvement in Rural Healthcare, which focused on health literacy in people with a diagnosis of diabetes that live in northeast Tennessee, provided a model environment for learning interdisciplinary teamwork. Evaluation of this course found that social work students displayed a statistically significant increase in positive attitude toward interdisciplinary teamwork. Course strengths, weaknesses, obstacles, and opportunities for curriculum improvement are elaborated.     

A Model Rural Health Orientation Course Using Interdisciplinary,Community Oriented,Inquiry Based Strategies

Introduction to Rural Health was developed as the introductory course for the Community Partnerships in Health Education – a new curriculum educating students using interdisciplinary, community oriented, and inquiry based strategies. Medical students, nursing students, and public health students participated in an elective curriculum designed to teach interdisciplinary groups of students to deliver primary health care in under-served communities. The curriculum began with an intensive one-week course designed to introduce students to the community, its people, their health care needs, and the process of working in interdisciplinary groups. The course was taught using a variety of community based activities. Student evaluations indicated that students strongly agreed that the course objectives were met using this nontraditional methodology. Qualitative analysis indicated that students regarded the team-building aspects of the course as the most influential. Community members indicated a high level of satisfaction with their input in the developmental process and with the extent to which community resources and interests were included. This revised version was published online in July 2006 with corrections to the Cover Date.