The loss of idealism with clinical education

Purpose: Prior studies have suggested student attitudes in general change throughout their clinical education (more cynical, less idealistic). The purpose of this project was to specify what patient types students may become less idealistic towards with each clinical rotation, as well as how their attitudes towards the profession changes. Methods: A 21-item questionnaire was designed and administered to 88 medical students (91% response) in August 1996 prior to their third-year rotations regarding their attitudes towards the medical profession and certain patient-types (the elderly, patients with chronic pain, smokers, drinkers, and the poor). The questionnaire was re-administered to students after completing their 16 week medicine-surgery clerkship, with 1/3 the class surveyed every 16 weeks. Analysis of co-variance approaches compared student responses prior to third-year with their responses after the med-surg clerkship, controlling for baseline student cynicism with a standardized validated cynicism scale. Results: Students became less idealistic for primarily two patient groups: the elderly and people with chronic pain. Examples of item responses: after the clerkship students believed a less percentage of those over 75 could adequately take care of themselves without assistance (65% decreasing to 53%, p=.002) and that a greater percentage of patients over 75 were demented (26% increasing to 35%, p=0.01). After the clerkship, students believed a greater percentage of patients with chronic pain who request narcotics are actually drug seekers (16% increasing to 24%, p=0.006). Regarding the profession, after the clerkship students believed a less percentage of physicians love what they're doing (65 decreasing to 56%, p=. 003). There was no change in attitudes towards the poor, or smokers or drinkers. No specific student characteristics were associated with this loss of idealism (gender, age, GPA, board scores, residency choice) Conclusion: Throughout the third-year of medical school students become less idealistic towards elderly patients, patients with chronic pain, and the profession.