The temporal decline of idealism in two cohorts of medical students at one institution

Abstract

BackgroundA number of studies have indicated that students lose idealistic motivations over the course of medical education, with some identifying the initiation of this decline as occurring as early as the second year of the traditional US curricula. This study builds on prior work testing the hypothesis that a decline in medical student idealism is detectable in the first two years of medical school.MethodsThe original study sought to identify differences in survey responses between first-year (MS1) and second-year (MS2) medical students at the beginning and end of academic year 2010, on three proxies for idealism. The current study extends that work by administering the same survey items to the same student cohorts at the end of their third and fourth years (MS3 and MS4), respectively. Survey topics included questions on: (a) motivations for pursuing a medical career; (b) specialty choice; and (c) attitudes toward primary care. Principle component analysis was used to extract linear composite variables (LCVs) from responses to each group of questions. Linear regression was then used to test the effect of the six cohort/time-points on each composite variable, controlling for demographic characteristics.ResultsIdealism in medicine decreased (β = -.113, p < .001) while emphasis on employment and job security increased (β = .146, p < .001) as motivators of pursuing a career in medicine at each medical school stage and time period. Students were more likely to be motivated by student debt over interest in content in specialty choice (β = .077, p = .004) across medical school stages. Negative attitudes towards primary care were most sensitive to MS group and time effects. Both negative/antagonistic views (β = .142, p < .001) and negative/sympathetic views (β = .091, p < .001) of primary care increased over each stage.ConclusionsOur results provide further evidence that declines in medical student idealism may occur as early as the second year of medical education. Additionally, as students make choices in their medical careers, such as specialty choice or consideration of primary care, the influences of job security, student debt and social status increasingly outweigh idealistic motivations.

A preliminary survey of professionalism teaching practices in anatomy education among Indian Medical Colleges

“…As students enter medical college around the age of 17–18 years, the preclinical year is of prime importance as a time for their first exposure to a professional learning environment. While the student entering medical school may not yet possess full‐fledged professional values, studies have shown that it is these very students who are the most idealistic with regards to learning key medical skills and fulfilling obligations to their community, attitudes which wane with years of training (Baingana et al, ; Morley et al, ; Pagnin et al, ; Mader et al, ), and they are less self‐centered than their senior counterparts (Klemenc‐Ketis and Vrecko, ). The first year of medicine would be an ideal foundation to begin the integration of professionalism teaching into medical education in India.…”

Empowering students with the hidden curriculum

“…A recent study suggested that students’ loss of idealism begins early in their training . We now train facilitators to discuss the HC across all years of the programme.…”

“…A recent study suggested that students' loss of idealism begins early in their training. 5 We now train facilitators to discuss the HC across all years of the programme. Helping faculty members to appreciate the impact of their own behaviours on students may improve the informal learning environment for students, and we now run training sessions for faculty members, naming and exploring the HC and discussing its potential impact on student development.…”

“…Often learned implicitly through role models, it is widely held that the HC is influential in shaping the identity and professional development of students. Messages learned through the HC may support or conflict with those communicated in formal sessions, contributing to the erosion of empathy, ethical thinking, and idealism . There have been many calls and proposals for interventions to help learners resolve these conflicts …”

“…Messages learned through the HC may support or confl ict with those communicated in formal sessions, contributing to the erosion of empathy, 3 ethical thinking, 4 and idealism. 5,6 There have been many calls and proposals for interventions to help learners resolve these confl icts. 6,7 This paper describes an educational intervention that aims to support medical students to expose and explore the HC, and reports on a small-scale study that evaluated students' responses to this.…”