In order to meet the complex health care needs of the diverse U.S. population, medical schools must strive to 1) instill in students the values and skills that maximize empathic, patient-centered care, 2) encourage more students to choose careers in primary care, and 3) inspire more students to practice medicine in areas and with populations that are underserved. Despite years of interventions designed to reach these goals, medical schools continue to see declines in students' prosocial attitudes and values during medical school. These attitudes predict the provision of patient-centered care, itself a strong determinant of better patient adherence, utilization, and health outcomes. Furthermore, the U.S. faces a projected shortage of 20,400 primary care physicians by the year 2020, and has an immediate need for 8,200 additional primary care physicians in Healthcare Provider Shortage Areas (HPSAs). These problems each contribute to persistent racial and socioeconomic status disparities in health care access, quality, and outcomes. This study will consist of a secondary data analysis of the CHANGES study (Cognitive Habits and Growth Evaluation), a nationally-representative longitudinal study of medical students' experiences during medical school. We will use these data to develop comprehensive models of change in prosocial attitudes and intentions between matriculation and graduation. Specifically, our aims are to 1) assess the independent impact of medical school climate, curriculum, contact, and student experiences on change in a) empathy, b) attitudes about the importance of empathy, and c) attitudes about the importance of patient-centeredness; 2) assess the independent impact of medical school climate, curriculum, contact, and student experiences on intention to specialize in a primary care field of medicine; and 3) assess the independent impact of medical school climate, curriculum, contact, and student experiences on intention to practice medicine in an HPSA or with underserved populations.
Medical students' prosocial attitudes decline during medical school, potentially impacting the quality of care they provide as new physicians. This, along with severe physician shortages in primary care and in underserved communities, contributes to racial and socioeconomic disparities. The aim of this study is to develop comprehensive models of medical school factors that predict change in empathy, attitudes about physician empathy, attitudes about patient- centered care, and intentions to enter primary care or work with an underserved or minority community.
