A Longitudinal Investigation of Medical Student Attitudes Toward the Medically Indigent

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Abstract
Background: Studies have shown that medical student attitudes decline as students progress through school. Controversy persists about the meaning and generalizability of these findings because studies have not been longitudinal and many were conducted prior to an influx of female students. Much of medical education occurs in academic medical center environments where disproportionate numbers of indigent (uninsured and underinsured)patients seekcare. This study examined whether students' attitudes toward providing care to indigent clientele changed over time. Purpose: To track longitudinal changes in attitudes toward providing care for the medically indigent of 1 cohort of medical students and to determine if gender differences existed and persisted over time. Methods: Students entering a Southwest medical school in 1989 participated in this study. Attitudes were compared using the Medical Students' Attitudes Toward the Underserved questionnaire, a self-report, attitudinal scale. Results: Student attitudes declined during the 1st year of school, remained fairly stable during Years 2 and 3, and declined further during Year 4. Analyses comparing 1st- and 4th-year students showed a decline in attitudes for men and women for each scale except Basic Services. Although both women's and men's attitudes declined, women's attitudes remained more favorable across the 4 years. Conclusions: A clearer understanding of how female medical students sustain socially responsible attitudes throughout medical school may help educators develop support mechanisms for men and women that would promote an ethic of social responsibility and encourage students to work with indigent clientele.

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