Michael A. Godkin

Effect of a global longitudinal pathway on medical students' attitudes toward the medically indigent

Background: The increase in people with insufficient health insurance has largely been fueled by a record influx of immigrants, who often live in medically underserved areas of inner cities. An increase in the desire of medical students to practice in underserved areas is needed to counter low physician-to-population ratios in these areas. Purpose: To assess the effect of a Pathway on Serving Multicultural and Underserved Populations, which includes domestic and international experiences with recent immigrant groups, on the attitudes of students toward the indigent. Methods: Students from the classes of 2002 and 2003, including a cohort in the Pathway program, were participants in this study. Changes in attitudes within Pathway and non-Pathway students were studied over their 4 years of medical school. Results: There was no statistically significant difference between the two groups in the rate of change of attitudes over time. The determination of any potential difference was hampered by small sample sizes. Thus, interesting trends, especially related to a more rapid decline in attitudes of non-Pathway students, including their sense of professional responsibility, did not achieve statistical significance. Conclusions: Further research, both quantitative and qualitative, is needed before we can state more definitively that the Pathway curriculum supports positive attitudes toward serving the medically indigent.

A longitudinal study of multicultural curriculum in medical education

Objectives To evaluate impact a multicultural interclerkship had on students’ perception of knowledge, interview skills, and empathy towards serving culturally diverse populations and role student demographics played in learning. Methods Data extracted from students’ self-reported course evaluations and pre/post questionnaires during multiculturalism interclerkship across 11 academic years. Inquired students’ opinion about four areas: effectiveness, small group leaders, usefulness, and overall experience. Subscale and item ratings were compared using trend tests including multivariate analyses. Results During studied years, 883 students completed course evaluation with high overall mean rating of 3.08 (SD=0.45) and subscale mean scores ranging from 3.03 to 3.30. Trends in three of four subscales demonstrated clear uptrend (p<0.0001). Positive correlations between ratings of leaders and “usefulness” were observed (p<0.0001). Pre/post matched dataset (n=967) indicated majority of items (19/23) had statistically significant higher post interclerkship ratings compared to pre scores with nine of 19 having statistically significant magnitudes of change. Questionnaire had high overall reliability (Cronbach alpha=0.8), and item-to-group correlations ranged from 0.40 to 0.68 (p <0.0001). Conclusions By increasing students’ exposure and interaction with diverse patients, their knowledge, attitude, and skills were increased and expanded in positive manner. These findings might inform those who are interested in enhancing this important competence. This is especially true given increasing scrutiny this global topic is receiving within and across healthcare professions around the world.

Global Longitudinal Pathway: Has Medical Education Curriculum Influenced Medical Students’ Skills and Attitudes Toward Culturally Diverse Populations?

Background: The Pathway represents a longitudinal program for medical students, consisting of both domestic and international experiences with poor populations. A previous study reported no significant attitudinal changes toward the medically indigent between Pathway and non-Pathway students. Purpose: The purpose of this study was to investigate and differentiate the skills and attitudes of Pathway and non-Pathway students in working with culturally diverse populations by conducting quantitative and qualitative analyses. Methods: Selected items from a cultural assessment were analyzed using independent t-tests and a proportional analysis using approximation of the binomial distribution. In addition, a qualitative assessment of non-Pathway and Pathway students was conducted. Results: A statistically significant difference was found at the end of Years 2, 3, and 4 regarding student confidence ratings, and qualitative results had similar findings. Conclusions: Clear and distinct differences between the two studied groups were found indicating the root of this increased confidence may have developed due to exposure to the Pathway program.