Perspective: Medical Students’ Perceptions of the Poor: What Impact Can Medical Education Have?

Abstract

There is currently little knowledge or understanding of medical students' knowledge and attitudes toward the poor. Teaching hospitals bring students face-to-face with poor and uninsured patients on a regular basis. However, an overview of the research available suggests that this contact does not result in students' greater understanding and empathy for the plight of the poor and may, in fact, lead to an erosion of positive attitudes toward the poor. A basic understanding of justice suggests that as the poor are disproportionately the subjects of medical training, this population should enjoy a proportionate benefit for this service. Furthermore, medicine's social contract with the public is often thought to include an ideal of service to the underserved and a duty to help educate the general public regarding the health needs of our nation. In their discussion, the authors situate medical students' attitudes toward the poor within larger cultural perspectives, including attitudes toward the poor and attributions for poverty. They provide three suggestions for improving trainees' knowledge of and attitudes toward the poor-namely, increasing the socioeconomic diversity of students, promoting empathy through curricular efforts, and focusing more directly on role modeling. The authors argue that service learning, especially efforts that include gaining detailed knowledge of a particular person or persons, coupled with critical reflection, presents a very promising direction toward achieving these goals. Finally, they posit an agenda for future educational research that might contribute to the increased efficacy of medical education in this important formative domain.

Influencing Student Beliefs about Poverty and Health through Interprofessional Community-Based Educational Experiences

“…students develop a public health perspective where they are less likely to blame the poor, it is essential to provide positive, interactive experiences with individuals living in poverty along with input from experts in the field [14,19]. Like Wear and Kuczewski, we "hold on to the belief that education matters, that thoughtful, targeted experiences-both in classrooms and clinical settings-have the potential to deepen, enlarge, and even change the perspectives, attitudes, and career goals of trainees" [19, p. 644].…”

Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians

“…For instance, to what extent are the changes in orientation described by the residents impactful in themselves? 14,26 Research suggests that without a structurally informed perspective, even the best-intentioned providers may be more likely to exacerbate or miss opportunities to address health disparities in their delivery of care. 9,[27][28][29][30][31][32][33][34] Thus, such changes in perspective, while not in themselves sufficient to address the structural issues underlying health disparities, may have a meaningful effect on the health care experiences and outcomes of structurally vulnerable patients.…”

Impacting Health Disparities in Urban Communities: Preparing Future Healthcare Providers for “Neighborhood-Engaged Care” Through a Community Engagement Course Intervention

“…2 For Academic Medical Centers (AMCs), this fissure is often larger than for smaller community hospitals due to their larger size, relative immutability and complexity, location within dense, diverse, and disparate urban communities, and having a large component of commuter staff and faculty who do not reside in the surrounding community. 3 An important consequence of this latter characteristic is that providers' and staff members' knowledge of their patients and the communities in which their patients live comes almost exclusively from personal experience in the hospital setting with the most vulnerable and ill. 2,3 The health of patients from these urban communities is subject to many social determinants of health (SDoH), such as lack of resources, limited access to providers, and low health literacy levels resulting in poorer health outcomes. 4 Students and faculty at AMCs are familiar with these patients, who, due to the effect of these SDoH, are often labeled or treated as Bnon-compliant 5 ,^Bsuper-utilizers 6,7 ,^or Bfrequent flyers 8^.…”