Medical students attitudes toward and intention to work with the underserved: a systematic review and meta-analysis

Abstract

Background Experts in the field of medical education emphasized the need for curricula that improve students’ attitudes toward the underserved. However, some studies have shown that medical education tends to worsen these attitudes in students. We aimed at systematically reviewing the literature assessing the change in medical students’ attitudes toward the underserved and intention to work with the underserved throughout medical education, the sociodemographic and educational factors associated with favorable medical student attitudes toward and/or intention to work with the underserved and the effectiveness of educational interventions to improve medical student attitudes toward and/or intention to work with the underserved. Method We conducted a systematic review on MEDLINE, Scopus, and Web of Science databases. Three investigators independently conducted the electronic search. We assessed the change in medical students attitudes toward the underserved by computing a weighted mean effect size of studies reporting scores from validated scales. The research team performed a meta-analysis for the sociodemographic and educational factors associated with medical students attitudes toward and/or intention to work with the underserved. Results Fifty-five articles met the inclusion criteria, including a total of 109,647 medical students. The average response rate was 73.2%. Most of the studies were performed in the USA (n = 45). We observed a significant decline of medical students attitudes toward the underserved throughout medical education, in both US and non-US studies. A moderate effect size was observed between the first and fourth years (d = 0.51). Higher favorable medical students attitudes toward or intention to work with the underserved were significantly associated with female gender, being from an underserved community or ethnic minority, exposure to the underserved during medical education and intent to practice in primary care. Regarding educational interventions, the effectiveness of experiential community-based learning and curricula dedicated to social accountability showed the most positive outcome. Conclusions Medical students attitudes toward the underserved decline throughout medical education. Educational interventions dedicated to improving the attitudes or intentions of medical students show encouraging but mixed results. The generalizability of our results is impeded by the high number of studies from the global-North included in the review.

A hybrid educational approach to service learning: impact on student attitudes and readiness in working with medically underserved communities

“…The inclusion of content on social determinants of health has become a critical component of undergraduate medical education in recent years, even more so during a pandemic that has deepened pre-existing health disparities [ 16 ]. Many studies have suggested that medical training negatively impacts medical student attitudes toward the underserved [ 13 , 19 , 26 , 27 ], creating a need for novel approaches to introduce topics of social medicine [ 28 ] and health equity to medical students. As previously reported, our medical school’s community health curriculum adopted an experiential learning model in the form of partnerships with local community organizations to equip students with the knowledge and empathy necessary to intervene on behalf of medically underserved communities.…”

“…A major challenge in undergraduate medical education is the decline in medical student attitudes toward the underserved throughout medical education. A systematic review and meta-analysis of fifty-five studies revealed that experiential community-based learning and curricula dedicated to social accountability were the most protective educational interventions against this decline [ 13 ]. A recent curricular intervention using required longitudinal service learning at the University of Nevada Las Vegas supports this theory.…”

Working intentions of medical students in response to healthcare workplace violence and descending resources reform in China

“…However, medical students are facing a variety of career choices other than practicing medicine, and their career choices depend on the satisfaction (utility) of different demand levels brought by practicing medicine compared with other occupations. If medical students expect that being a healthcare worker means higher safety risks and higher practice costs, their willingness to practice medicine will be weakened [ 47 , 48 ], which will result in medium and long-term insufficient supply of medical services because of shortage of human capital. In the context of ongoing descending resources reform and high incidence of healthcare workplace violence, China’s dominant public hospital system and hospital classification system enable us to observe how medical students will respond to the reform and workplace violence, and help us understand the inter- and intra-market effect of exogenous shock on medical students’ willingness to practice medicine.…”

“…Workplace violence against healthcare workers is a global problem [ 37 , 50 ], and some reports have found that such violence occurs in medical students and impact their working intention to practice medicine [ 48 , 51 ]. This paper focused on the impact of WPV and the anti-violence legal environment on medical students’ working intentions in the context of China’s descending resources reform launched in 2013.…”

Promoting social justice through experiential learning at an interprofessional refugee clinic

“…One of the most effective ways to impact students' commitment to social justice and health equity is through guided experiential learning ( Leaune et al, 2021 ). The premise of Kolb's Experiential Learning Theory (ELT) is that transformative learning is a cyclical, holistic process occurring through experience.…”